What You Need To Know About Intestinal Biopsies

Failure to obtain biopsies during endoscopy misses important treatable intestinal conditions

Thousands of people are undergoing endoscopic exams daily without having tissue samples obtained. Sadly, though their exams may visually appear normal, under the microscope there are often microscopic findings that explain the symptoms that will respond to directed therapy. The gut is lined with superficial cells that contain a few immune cells that release chemical mediators that attract other cells to the area and fight off foreign invaders.

Several cells only seen microscopically play a role in digestive symptoms



Lymphocytes, eosinophils and mast cells are the immune cells that are normally present in small numbers in the surface cells of the gastrointestinal tract. A few lymphocytes are present in the tips of the surface cells that are a type of epithelial cell. These lymphocytes act as the body’s scouts. They survey the barrier of the gut to the inside of the body, looking for signs of potential invading infectious agents. Once an attack is perceived, they signal reinforcements to join them on the front lines.

Lymphocytes are immune cells detected early in celiac disease and cause bowel symptoms

When persistent increased numbers of lymphocytes are present in the surface cells, a chronic inflammatory condition of the gut exists. In the duodenum, autoimmune reaction to gluten in genetically susceptible individuals is a common but frequently missed cause of chronic inflammation known more commonly as celiac disease or Sprue.

Eosinophils and mast cells are allergy cells that cause bowel inflammation often due to food

Eosinophils and mast cells are types of immune cells involved in allergy reactions in the body. They are less commonly present in the gastrointestinal lining except when there are parasites, food allergies, or chronic inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis. Eosinophilic gastrointestinal disorders are less common and a newly recognized condition, mastocytic enterocolitis, is diagnosed when excess mast cells are present in the small bowel and colon. However, mast cells may be difficult to see on biopsies without a special stain for tryptase, an enzyme present in mast cells that are immunologically activated.

Allergic esophagus condition may mimic reflux but is due to food and eosinophils

The esophagus normally contains no eosinophils. The two exceptions gastroesophageal acid reflux in which small numbers, up to 6-7 usually and no more than 10-12 per high power field (40X magnification) are found in the lower esophagus only not in the mid or upper esophagus. Allergic eosinophilic esophagitis is diagnosed when 15 or more eosinophils per high power field are found in more than two fields or more than 20 to 24 per high power field in one field are seen or lesser numbers are present in the upper esophagus. Mast cells that are activated have also been found associated with allergic eosinophilic esophagitis and their presence supports allergic esophagitis over reflux as the cause of the increase eosinophils though it is believed some people have both conditions coexisting.

Allergy and immune cells in the stomach and intestines found microscopically cause symptoms

In the stomach and small intestine more than 10 eosinophils per high power field defines eosinophilic gastroenteritis. In the small intestine and colon more than 20 mast cells per high power field found in association with otherwise unexplained diarrhea is now termed mastocytic enterocolitis. This newly recognized and described entity is previously unrecognized cause of diarrhea in some patients diagnosed with irritable bowel syndrome who may have been told they have a normal colon exam though no biopsies were done. Similarly, more than 20 lymphocytes per 100 epithelial cells in the colon are found in lymphocytic colitis, another form of microscopic inflammation of the intestine resulting in diarrhea that may be inappropriately diagnosed as IBS.

Gluten grains wheat, barley and rye cause increased lymphocytes with normal blood tests

In many of these patients, gluten sensitivity is to blame and the lymphocytic colitis is felt to represent a colonic form of celiac disease. In celiac disease, 30 or more lymphocytes in the tips of the villi per 100 epithelial cells is the earliest sign of gluten injury occurring before the villi become flattened or blunted. This finding may noted before the specific blood tests, anti-endomysial (EMA) and anti-tissue transglutaminase (tTG) antibodies appear in the blood even though the intestine is damaged enough to result in nutrient malabsorption and diarrhea. Anti-gliadin antibodies are often present however when significant intra-epithelial lymphocytosis is present along with symptoms that respond to gluten free diet. Lesser degrees of intra-epithelial lymphocytosis have been proposed as highly suggestive of early celiac disease and or gluten sensitivity, in the range of 20-25 per 100 epithelial cells.

Colon can be affected early with microscopic signs only

In the colon, the presence of eosinophils is considered one of the earliest findings of chronic inflammatory bowel disease. In the right colon more than 20 eosinophils per high power field and in the left colon greater than 20 per high power field is considered abnormal and suggests eosinophilic colitis, chronic inflammatory bowel disease or a parasitic infection.

Allergy cells release chemicals causing pain, diarrhea, and sometimes constipation

Eosinophils and mast cells release chemicals that irritate the bowel, increase permeability (cause leaky gut), increase contractions of the gut, increase intestinal secretions and heighten pain. Both cells are related to allergies including food allergies. It is therefore not difficult to conceive of a link to adverse food reactions in the development of intestinal irritation.

Most digestive symptoms should be evaluated by scope examination and blood tests

The important point to be aware of if you have gastrointestinal symptoms and are undergoing or have undergone an endoscopic examination is that a normal appearing intestinal lining does not exclude the presence of damage or irritation sufficient to cause symptoms of pain, bloating, gas, and diarrhea nor exclude impaired digestion and absorption. Blood tests exist that can help screen for celiac disease, Crohn’s disease and ulcerative colitis but biopsies of intestinal lining is usually required for definitive diagnosis.

Normal appearing gut lining may not be normal, make sure you get biopsies

Only through obtaining tissue samples that are examined under the microscope can abnormal types and number of inflammatory cells be identified. It is through biopsies of normal appearing intestinal lining that the correct diagnosis of various microscopic forms of gastrointestinal inflammatory diseases is confirmed. So, if you are preparing to undergo an endoscopic exam, I encourage you to insist that your doctor perform biopsies even they believe your exam looks normal. Based on the information I have reviewed above, a normal exam should be tip off that one of these microscopic conditions might be to blame for your symptoms.

References:

Al-Haddad S, and Ridell RH. “The role of eosinophils in inflammatory bowel disease.” Gut 2005; 54:1674-1675.

Guilarte M et al. “Diarrhoea-predominant IBS patients show mast cell activation and hyperplasia in the jejunum.” Gut 2007; 56:203-209.

Jakarte S et al. “Mastocytic enterocolitis. “Increased mucosal mast cells in chronic intractable diarrhea.” Arch Pathol Lab Med. 2006; 130:362-367.

Kirsch R et al. “Activated mucosal mast cells differentiate eosinophilic (allergic) esophagitis from gastroesophageal reflux disease.” Journal of Pediatric Gastroenterology and Nutrition 2007; 44: 20-26.

Liacouras CA. “Eosinophilic gastrointestinal disorders.” Practical Gastroenterology March 2007. 53-67.

Rubio CA et al. “Lymphocytic esophagitis: a histologic subset of chronic esophagitis.” Am J Clin Pathol. 2006; 125(3): 432-437.

Yousef MM et al. “Duodenal intraepithelial lymphocytes in disorders of the esophagus and stomach.” Clinical Gastroenterology and Hepatology 2006; 4:631-634.

How Does Weight Loss Affect a Menstrual Cycle?

Weight loss just as gaining weight usually causes a great change in the body. You become a lot healthier and your general performance improves. For an obese person loss of weight would mean a new found self confidence. The diseases that posed a threat to the body are past tense. The heart for instance becomes healthier pumping blood without a lot of strain, the sugar level in the blood is greatly reduced, food digestion is also improved and the liver gets to perform efficiently with a healthy system.

The female reproductive system is also affected by weight loss. You may find that some one who has lost weight has stopped having their menstruation for sometime. This happens because the reproductive system is reacting to the loss of fats in the boy. The abdominal region of the body has lost fats therefore your reproductive system knows that this are not the conditions that could sustain a pregnancy of it occurred, so ovulation will stop until your reproductive system know that it will be safe in case you have a baby.

Another effect of weight loss on menstruation is the absence of fatty tissues in the body means low production of the female hormones responsible for menstruation. Losing a lot of weight means loss of the fats or a great reduction of fats in your body. The estrogen hormone partly depends on the fats in your body to be released therefore fat reduction affects the hormone responsible for menstruation. However, you will realize that after you stop losing weight, your menses will return to normal. On the other hand you can develop a slow weight loss program that will give your body time to recover and adjust to the loss of weight without much interruptions of the menstrual cycle.

Losing weight affects your dietary routine which in turn affects the menstrual cycle. When you lose weight, fats and certain elements of great nutritional value like zinc, irons and other minerals are also reduced in the body. Inadequate of these minerals in the body is a reason for irregular menstrual cycle.

When you lose weight, your body usually goes through a lot of stress with intense exercise routines diet that you may not have been psychologically prepared for. As much as exercise for weight loss helps the process of ovulation and increase the chances of fertilization, too much of it will affect your ovulation. Anything that affects ovulation, the process of releasing an egg in the female reproductive system monthly, will affect menstruation.

The hormones estrogen and progesterone play a very important role in this process. The stress in the body brought a bout by weight loss produces the stress hormone in large amounts so as to cope and in turn suppress the female hormones responsible for menstruation. When this happens you experience irregular periods until the stress is reduced. It is therefore advisable to due moderate exercise so as to give your body enough time to adapt to the stress.

The Turbinates – What You Must Know

Most people know about the septum and sinuses when it comes to breathing, but not many people (even most doctors) know about the nasal turbinates. Turbinates are like wings along the sidewalls of your nasal cavity, opposite your midline nasal septum. There are three paired structures: the inferior, middle and superior turbinates. Your sinus passageways drain from underneath the middle turbinates. Swollen turbinates are probably responsible for most cases of nasal congestion.

The turbinates are bony on the inside and surrounded by a mucous membrane covering, with a very rich vascular tissue in between. The vascular tissue can engorge significantly, like what occurs with the penis. Any degree of inflammation, irritation or infection can aggravate turbinate swelling. Allergies are a common cause. Even weather changes such as temperature, pressure or humidity fluctuations can aggravate turbinate swelling. In many instances patients are told by their medical doctors that they have nasal polyps, when in fact, it’s a very enlarged turbinate that’s seen.

Sometimes it’s difficult to tell whether a swollen structure is a turbinate or a polyp. A polyp is a protuberance of mucous membrane that grows beyond the normal tissue boundaries. Most nasal polyps originate from underneath the middle turbinates where the sinuses drain, but polyps can also occur anywhere in the nose, including on the turbinates.

Turbinate Trivia

One important feature of the turbinates that not too many people know about is what’s called the nasal cycle. The turbinates alternate in size from side to side every few hours. One side shrinks and the other side swells. Normally you won’t notice this, unless both your turbinates are somewhat congested. If you have a deviated septum, then you’ll notice this more.

Gravity also affects the size of your nasal turbinates. When you lay down, blood pools in the vessels, leading to slight engorgement. However, your involuntary nervous system detects this relative change and automatically constricts your blood vessels to improve breathing. The same process occurs when you exercise-due to activation of the sympathetic nervous system, the turbinates shrink, opening up your breathing passageways.

Sometimes, the balance between the two halves of the involuntary nervous system(the sympathetic and parasympathetic parts) is out of alignment, and this automatic mechanism doesn’t work properly. So when you lay down or exercise, the vessels don’t constrict fully. Other times, the turbinates become extra sensitive to allergies, weather changes, chemicals, scents or odors. Once it’s irritated, an inflammatory reaction occurs which leads to engorgement and production of mucous. This is called vasomotor or nonallergic rhinitis. Throat acid reflux has been shown to be associated with this condition.

Ultimately, how well you breathe through your nose is determined by a combination of the size of your turbinates, your septal geometry, and the how flimsy your nostrils are. (See the other sections on the septum and flimsy nostrils.) Your nose is not just a passive tube that acts a channel for air to pass into the lungs-it’s a very dynamic structure, able to change minute by minute.

What You Must Know About Turbinate Surgery

If you’ve tried all the conservative options for treating your allergies or nasal congestion, and surgery is the only option left, there are a few very important facts that you must know before undergoing any type of turbinate surgery. Decades ago, surgeons use to remove significant amounts or completely the lower nasal turbinates. Initially, patients would breathe much better, but years later would complain of either a dry nose or a constantly runny nose and even a return of nasal congestion. Paradoxically, when you look into these patient’s noses, the nasal cavity would be wide open. The is called the empty nose syndrome (ENS).

We now know that turbinates are a vital part of your nasal anatomy and functioning, and you need a certain amount of nasal resistance to perceive and benefit from proper breathing.

There are a variety of options for shrinking nasal turbinates, from more conservative to more aggressive. The simplest procedure that can be performed in the office is an intramural cautery procedure. This is where a needle or a probe is placed underneath the mucous membranes and the blood vessels are either cauterized or vaporized. With time, the scar tissue that’s created shrinks and tightens the turbinate soft tissues. You’ll see various names such as radio-frequency or Somnoplasty. One recent variation called Coblation uses radiofrequency energy to vaporize tissues at relatively low temperatures. All these procedures have the advantage that they can be performed in the office, and no cutting or excising of the mucous membrane is involved.

The remaining procedures are usually performed in the operating room, under local or general anesthesia. There are many ways that surgeons modify, shrink, de-bulk, or excise parts of the turbinate. The previously mentioned in-office procedures can be performed along with any other procedures, such as a septoplasty or sinus surgery. The simplest way is to physically cut the front-lower portion of the turbinate off using scissors or electrocautery. Sometimes the deep bony parts are removed as well. Complete inferior turbinate resections are rarely performed anymore due to the possible risk of the “empty nose syndrome.”

Another popular method is called a sub-mucous resection (meaning the any deep bone, cartilage or tissue is removed, leaving behind the overlying mucous membrane). For the turbinates, an incision is made lengthwise along the lower portion of the inferior turbinate, and the bone is exposed and a portion removed.

The mucous membrane layers are replaced and pressed down onto the raw bony bed with soft nasal packing. A more recent way of doing this without making an incision is to use what’s called a suction microdebrider. This device has been used for years in sinus surgery. The tip of a long thin rod with an open end has a rotating blade which oscillates back and forth, while simultaneously applying a vacuum to suction out whatever tissues is removed (either soft tissue or bone).

What To Expect After Surgery

Most surgeons still use nasal packing, especially with the more aggressive procedures, to keep the mucous membrane layer pressed against the raw surfaces. Since turbinate procedures are usually performed alongside septal procedures, nasal packing with or without splints are more common than not. Depending on surgeon preference, packing may or may not be used for some of the minimally invasive procedures.

Turbinate procedures by themselves are not considered painful. Most patients don’t take any pain medications, unless other procedures are performed simultaneously.

It may take anywhere from days to weeks before your breathing improves significantly, since there will be swelling, blood and mucous immediately after the procedure. Many surgeons clean out this debris a few days to a week after the procedure in the office during follow-up.

Nasal saline can be applied every few hours just after the surgery to loosen the secretions. Blowing your nose is discouraged until you get the go ahead from your surgeon during the first post-op visit.

Turbinate surgery is a very useful procedure that can be done alone or in combination with other procedures. Bleeding and infection, although rare, can occur, just like any other surgical procedure. There can be anesthesia risks as well. In the rare chance that the procedure fails, reasons for failure include too conservative of a procedure, persistent nasal septal deviation, or nasal valve collapse.

Large Ovarian Cyst Symptoms – What Are the Symptoms of Ovarian Cysts?

What does the size of a large ovarian cyst look like? The only way that you can truly know the real size of an cyst is by going to your family doctor to get an ultrasound done. If your doctor finds that you have a large ovarian cyst, it is time for you to start thinking about what your treatment options are, Because cyst that are real large can rupture and are extremely painful. Cyst pain can be very stressful and annoying.

Large Ovarian Cyst Symptoms Here are some of the symptoms associated with having a large ovarian cyst: breast tenderness, weight gain, pain during sex, vomiting, rapid breathing, dull ache in the lower back, abnormal bleeding, swelling in the abdomen, pelvic pain, and pain during your period. You should seek immediate medical attention if you have the following symptoms: rapid breathing, faintness, dizziness, weakness, sudden, severe abdominal pain, and pain with fever and vomiting.

Follicular cysts are not that painful, but they can grow over two inches. Endometrioid cysts can get up to 9 inches are really painful during menstruation. A Dermoid cyst can be severe, things things can grow up to six inches in size and can cause you serious pain.

Even though all the cysts i mentioned can be very painful, it is not all bad news, they are not permanent fixtures on your body. There is no good reason for you to have to suffer from these large cyst all of your life. Most large cyst will eventually go away on its own without any type of treatment. This is why it is real important to learn how you can prevent large ovarian cyst so you don’t have to deal with the pain of having one again and again.

I don’t want you to think that surgery or medication is necessary. Surgery does not prevent future large ovarian cyst from developing, it will only remove the cyst that you now have. The hormonal treatments that are prescribed by some doctors are known to have damaging side effects as much as the cysts themselves, so you need to be careful when deciding what you are going to do about your large cyst.

When I had my own problems with my cysts, I was desperate to find a natural cure and get rid of the terrible pain. You can free yourself from the pain and get a natural cure to help you feel better right now.

Remedies for Thrush in Adults – 3 Simple Tips to Erase Adult Thrush Naturally

Thrush is a yeast infection, also called Candida or Candidiasis. But although thrush should actually only pertain to oral yeast infection, it is used a lot nowadays to describe a vaginal yeast infection too. So I’ve used it in that context here. And, although oral thrush can also appear in young babies, I’ve limited myself to thrush in adults only.

Let’s quickly go over the cause of thrush (yeast infection) in adults. It’s mostly caused, or at least the symptoms are caused, by a yeast-like fungi called Candida Albicans which you can find in all of our bodies quite naturally. Thrush appears when the fungi overgrow and spread.

The underlying conditions that allow this overgrowth are things such as; a lowered immune system, poor diet, too many antibiotics, stress, hormonal imbalance, and some drug usage. When one or more of these conditions are in existence then the fungi can overgrow, causing thrush symptoms.

Your normal treatment is through prescription or over-the-counter medications such as creams, lotions, foams, sprays, oral suspensions, etc., depending on the location of the thrush infection. These can take some time to work, but they can eliminate the symptoms.

But, many adults cannot use them because of some nasty side effects. And, they tend just to address the local thrush symptoms not the root cause(s) as described above. The outcome can be nasty recurring thrush infections.

So more and more adults with thrush are discovering the benefits of using natural home remedies. Here are 3 home remedies for thrush in adults that you can try:

(a) Raw Apple Cider Vinegar

This must be un-distilled, raw apple cider vinegar, with no additives and has the sediment still in the bottom. This type works by adjusting body pH which can help to prevent further fungal growth.

Add 3 teaspoons to a large glass of water and stir well. Drink a glass 3 times a day. You can douche by mixing 2 tablespoons in 2 quarts of warm water. Alternatively you can add 2 cups of apple cider vinegar into a low, warm bath and bathe for about 20 minutes or so.

(b) Fresh Garlic

Fresh garlic has fantastic antifungal benefits. Eat garlic every day. Good garlic capsules if you don’t like the odour on your breath. Pulp it into a smooth paste and coat the affected area. For inside the vagina wrap muslin around a peeled clove and leave in overnight.

(c) Natural Yogurt

Natural yogurt with no added sugar, no fruit and no other additives contains Lactobacillus acidophilus which are live beneficial bacteria that can attack the Candida fungi. So eat every day. You can also coat it over the localized area. And for inside the vagina, just coat a regular tampon and leave in overnight.

Now, whilst these 3 natural remedies for thrush in adults can be effective, they probably aren’t enough to actually cure your thrush on their own. Remember the underlying conditions above? These have to be addressed if you are to be confident that it’s not just the symptoms of thrush that have gone, but that the root cause has also been taken care of as well.

In this way you can be better assured that your thrush won’t keep returning (recurring thrush) and causing you serious health problems down the road.

Hepatitis – Learn About the Disease

Hepatitis C

Hepatitis C is a hepatic disease caused by virus called hepatitis C virus (HCV). This disease was initially named non-A, non-B (NANB) hepatitis after ruling out hepatitis A, hepatitis B and a variety of other viral and bacterial infection. despite of intensive efforts and untiring investigations, the virologists could not determine the etiological agent of this disease. Various type of virus particles were found present in the serum, urine, hepatocytes and KUPPER CELLS but virologists failed to establish etological relationship with NANB hepatitis.

A few workers persistently observed the association of a virus with majority of the cases of NANB hepatitis. This virus eventually attracted the attention of virologist who cloned it in three different laboratories by recombinant DNA techniques. the clones were thoroughly studied and found similar in all respect. the virus was then named hepatitis C virus and the disease hepatitis C.In 1989, a serological test was developed to detect antibodies specific to HCV.

The test proved highly useful in the serological diagnosis of acute and chronic hepatitis c.the repeated application of this test yielded results that confirmed the involvement of HCV in cases of NANB hepatitis.

VIRAL STRUCTURE

HCV is a spherical, enveloped, single-stranded RNA virus included in the family Flaviviridae. The diameter of the virus is approximately 50nm.The structure of the envelop is covered with the protein spikes. The RNA is a linear structure comprising of 9379 nucleotides. It acts as genome of the virus. The 5'terminal of the genome encodes the structural capsid and envelop proteins. The 3'terminal on the other hand, is the functional region and thus encodes viral proteases, RNA polymerase, and regulatory proteins. The RNA genome is a positive strand which encodes for a polyprotein of 3010 to 3030 amino acids. This protein undergoes proteolytic post-translational cleavage. The capsid is composed of phosphorylated protein. The diameter of the virus is approximately 50nm.The structure of the envelop is covered with the protein spikes. The RNA is a linear structure comprising of 9379 nucleotides.

HOW VIRUS REPLICATE?

HCV replicated in the cytoplasm of hepatocytes. Following penetration, the positive RNA strand is first translated to synthesize various structural proteins including RNA_dependent RNA polymerase. The RNA polymerase prepares a complementary copy, or the negative strand, using the positive strand as a template. The negative strand act as a replicative intermediate. The RNA_dependent RNA polymerase uses this structure as template and synthesize positive strands. The virus is then assembled that is released by a process of budding.

GENETIC VARIATION IN HCV

HCV has a tendency to undergo genetic variation during the process of replication. This tendency has been related to the lack of proofreading mechanism for the newly synthesized RNA. Thus, HCV populations are extremely heterogeneous. This persistent diversity over the centuries has led to the development of several distinct groups of the virus and now classified as six major HCV subtypes. It is yet to be confirmed what role these genotypes or their subtypes play in the severity of the disease. The ability of HCV to change its genotype character over time also occurs within the infected person and creates a family of closely related viruses with minor differences, called quasispecies.These minor changes do favor the virus by providing it an ability to escape the host's immune surveillance .It is because the antibody produced against one quasispecies often fails to defend against another quasispecies

PATHOGENESIS

Hepatitis C is a worldwide disease involving all segments of population. HCV is present in the blood of the patients and carriers. It is established that about to infectious doses may be present in one microliter of the blood .Till a couple of years back, the transmission was believed to occur through transfusion of blood with sharing of needles and promiscuous sexual activities as other risk factors. The transmission patterns have, however, changed in recent years. Although direct percutaneous exposure through transfusion of blood products remains an efficient means of transmission, currently most HCV infections are acquired outside the transfusion settings. Modern blood bank practices, including the blood screening tests for viral diseases have nearly eliminated the risk of HCV infection for the blood recipient in most part of the planet. As a consequence, injection-drug use has emerged the most common cause of HCV infection. According to one medical survey, more than 75% of all new injection-drug users become seropositive for HCV within one year after beginning drug use. In Pakistan, the situation, however remains the same, as the transfusion practices are not safe as in many other countries. Hence, the blood transfusion remains the main cause of HCV transmission. Today, the most commonly identified risk factors are injection-drug use, hemodialysis, sexual or household exposure to an infected contact, multiple sexual contacts or perinatal exposure and health care employment. Low socioeconomic status also remains an important risk factor for HCV infection .Transmission of HCV to the host is the beginning of the infection .The virus is transported to the liver via blood circulation where it initiates the process of replication in hepatocytes.

CLINICAL MANIFESTATIONS

The clinical manifestation of Hepatitis are similar to Hepatitis B. The mean incubation period of the disease is 7 weeks, with a range of 3 to 20 weeks. The disease is usually insidious in onset. It begins with anorexia, malaise, nausea, vomiting, myalgia and hepatomegaly. The disease is characterized by prolonged viremia and development of a persistent carrier state. The disease is milder than hepatitis B. The acute illness typically lasts from 2 to 20 weeks. In up to 15% of cases, the disease is self limiting; symptom resolve, HCV RNA become undetectable, and ALT levels return to normal. Medical reports indicate that more than 85% of patients with acute disease become chronically infected (HCV RNA +) and 65% to 85% develop chronic hepatitis (elevated ALT). Among chronically infected patients, approximately 30% show a persistent normal ALT levels whereas other have an occasional ALT elevation. The chronic hepatitis C is a progressive liver disease, characterized by some mild, intermittent, and non specific symptoms.They include fatigue, abnormal pain, fever and arthralgia.The disease progression usually evolves over decades and, in many patients may be slow that it does not result in increased morbidity or mortality. Some patients develop cirrhosis mostly during first 20 years of the disease. The symptoms exhibited by a cirrhotic patient include severe fatigue, marked muscle soreness and neuralgia, fluid retention, jaundice, darkening of urine, upper intestinal hemorrhage, and itching.In most of the cases, hepatitis C accompanied by cirrhosis may lead to hepatic failure and death. There are a few serious extrahepatic manifestations of hepatitis C. These include essential mixed cryoglobinemia (EMC), arthritis, membranoproliferative glomerulonephritis, keratoconjunctivitis and porphyria cutanea tarda .The EMC is characterized by the presence of cryoglobins in serum, hypocomplementemia, and symptoms such as fatigue , muscular and joint pain, arthritis, dermatitis, and neuropathy.

LABORATORY DIAGNOSIS

  • ELISE-2: Hepatitis C is diagnosed in the laboratories by serological methods. The most important method for detecting antibodies specific to HCV is the second generation enzyme-linked immunoassay (ELISA-2) .The test is gaining popularity nowadays as it is simple, automated, easily reproducible, and extremely high, more than 90% and only one positive test is reliably sufficient for diagnosis. Attempts are being made to develop a third-generation assay with the sensitivity and specificity higher than 95%.
  • RECOMBINANT IMMUNOBLOT ASSAY (RIBA) This test is based on the use of recombinant viral antigen, named C100-3, in a capture Assay for circulating HCV antibodies.Anti-C100-3antibodies appear to be developed against nonstructural viral epitopes weeks or months after acute infection. The presence of anti-C100-3 antibodies is also indicative of chronic persistent viremia.
  • HCV RNA ASSAY A recent approach in the diagnosis of hepatitis C is based on the demonstration of HCV RNA in the blood of the patient. This method is called HCV RNA ASSAY is considered very useful in the detection of HCV genome and measurement of the level of circulating virus in the infected person. The test is also useful in the monitoring the effectiveness of antiviral therapy.

THERAPY

Currently, interferons are the only agents with proven efficacy in the treatment of hepatitis C.Three types of interferons are now available in the market: Interferon alpha-2b (marketed in 1991), Interferon alpha-2a (marketed in 1996) and a synthetic consensus interferon alpha con-1 (marketed in 1997) .Other interferons under investigation, a lymphoblastoid interferon and interferon beta

PREVENTION

Measures as recommended by WHO to prevent hepatitis C are same as those for Hepatitis B. There is, however, no vaccine available so far .The main problem in developing an effective vaccine for HCV infection is genetic variation the virus persistently exhibits in its genome. It is however, recommended that all patients with hepatitis C should be vaccinated against hepatitis A and hepatitis B as these infections may cause significant morbidity and mortality when superimposed on pre-existing disease.

Liver Failure – Ayurvedic Herbal Treatment

Liver failure occurs when a major part of the liver has been damaged and it is no longer able to function. This condition may be either acute or chronic. Acute liver failure is usually caused by Hepatitis A, B and C, drug toxicity and food poisoning. Chronic liver failure is caused by Hepatitis B and C, alcoholism, cirrhosis, malnutrition and metabolic disorders. Early symptoms include nausea, loss of appetite, fatigue, and diarrhea. Late symptoms include jaundice, easy bleeding, abdominal swelling, mental disorientation, sleepiness and coma. Treatment is usually supportive. Prevention and removal of the known cause are very important.

The Ayurvedic treatment of liver failure consists of treating the known cause of the disease and correcting liver damage. Hepatitis can be treated using medicines like Arogya-Vardhini, Sutshekhar-Ras, Suvarna-Sutshekhar-Ras, Bhunimbadi-Qadha, Punarnavadi-Qadha, Guduchyadi-Qadha, Kutki (Picrorrhiza kurroa), Kalmegh (Andrographis paniculata), Sharpunkha (Tephrosea purpura), Punarnava (Boerhaavia diffusa), Haritaki (Terminalia chebula), Deodar (Cedrus deodara), Haridra (Curcuma longa), Daru-Haridra (Berberis aristata), Chirayta (Swertia chirata), Guduchi (Tinospora cordifolia) and Patol (Tricosanthe dioica). Hepatitis viruses A, B and C can be deactivated using medicines like Bhumiamalaki (Phyllanthus niruri), Amalaki (Emblica officinalis), Yashtimadhuk (Glycyrrhiza glabra), Haridra, Tulsi (Ocimum sanctum), Kutki and Chitrak (Plumbago zeylanica).

Alcoholism can be treated using medicines like Arogya-Vardhini, Punarnavadi-Qadha, Saraswatarishta, Nardiya-Laxmi-Vilas-Ras, Shrung-Bhasma, Kutki, Brahmi (Bacopa monnieri), Mandukparni (Centella asiatica), Shankhpushpi (Convolvulus pluricaulis), Jatamansi (Nardostachys jatamansi) and Vacha (Acorus calamus). Drug toxicity and food poisoning can be treated using medicines like Punarnavadi-Guggulu, Gokshuradi-Guggulu, Punarnavadi-Qadha, Saarivasav, Arogya-Vardhini, Shankh-Vati, Chitrakadi-Vati, Lashunadi-Vati, Laghu-Sutshekhar-Ras, Kutaj-Ghan-Vati, Praval-Panchamrut-Ras, Kutaj-Parpati and Panchamrut-Parpati. Metabolic disorders which are responsible for liver failure can be treated using medicines like Amalaki, Yashtimadhuk, Haridra and Daru-Haridra.

In addition, medicines are also given to reduce or undo the damage to the liver cells so that the liver can function properly. Medicines used for this purpose include Suvarna-Sutshekhar-Ras, Suvarna-Parpati, Punarnava-Mandur, Rasayan-Churna, Suvarna-Bhasma, Abhrak-Bhasma, Tamra-Bhasma, Amalaki, Kutki and Guduchi. Abdominal swelling can be treated using medicines like Punarnava-Mandur, Punarnavadi-Qadha, Jaypal-Ras, high doses of Arogya-Vardhini, and Ichha-Bhedi-Ras. In this condition, a predominantly milk diet is advised while water intake is restricted or prohibited.

Thus, both acute and chronic liver failure can be successfully treated by using a judicious combination of Ayurvedic medicines. Timely use of these medicines can help to prevent irreversible liver damage and complete liver failure. These medicines can therefore control liver failure and improve the chances for survival and recovery in patients affected with this condition.

Source Code – Movie Review

Source Code is a fast paced sci-fi thrilling affair. It appears to test brains but it serves better if they are allowed to rest. It brings a big idea and the idea is interesting enough to keep all glued to screens for an hour and a half. It tries in vain at length to explain the idea through calculus and electromagnetics- is it really important? Avatar, Inception ……. no one cared to think.

The Idea: Consciousness remains in body even after death and by using it we can access and even live last eight minutes of someone's life.

Colter Stevens (Jake Gyllenhaal) wakes up in train sitting next to a beautiful woman named Christina (Michelle Monaghan). He has no idea what he is doing on the train. Christina knows him as Sean but he does not know her. His last memories are of a soldier fighting in Afghanistan. The big thing: When he looks into a mirror he sees a different face. Eight minutes after he wakes up the trains blows up with a deadly bomb and everyone gets killed. Except, Colter, who finds himself in a strange capsule and a woman is talking to him.

She is an air force officer named Coleen Goodwin (Vera Farmiga). She orders him to go back again in that train and locate the bomb and the person who planted that bomb. That train had already been blown but they fear that more such attacks are ahead. He had to accomplish this through a time program, Source Code, which enables to virtually take over some dead person's body and live last eight minute of that person's life. Colter takes over Sean's body (a school teacher that travelled in the train that had blown up). He goes back to that train through Source Code and comes back unsuccessful. Coleen and her boss (Jeffry Wright) keep sending him back and tell to find the planter of the bomb so that future incidents may be avoided. He also learns that in fact he is also dead: died two months prior to this train incident.

He eventually does the job and saves future bombings. Source Code is a success. So what is next with him? Can he also save the passengers that had already died? Can he survive?

Crazy? A little too much? But still it works and because the proceedings are fast and the direction (Dunken Jones) is smart and crafty. Gyllenhaal plays a role which every decent actor should play well. Christina does what she had to: She looks sweet and innocently charming. Jeffry Wright looks the bossy scientist he needs to look. Vera Farmiga does wonderfully well first as a soldier than as a person with a heart.

Source Code is a smart sci-fi thriller with two spoilers: the odd logics given and the end. Just before the end, there was a frozen shot where everyone was happy and the shot was really moving. It could have been a much better ending. But the makers decided to take a step forward and which is not truly appealing.

Canine Parvo Virus

In the recent months I have seen an increase in the Canine Parvo Virus here in Granada Hills, Ca. Granada Hills is a suburb of Los Angeles in the San Fernando Valley.

Parvo is a virus that attacks the gastrointestinal system in canines. There is not a Parvo vaccine that protects dogs 100% against the virus. It is common in dogs under three years of age to contract this virus whether they are vaccinated or not.

The virus is passed through feces of the animal. It does not matter if the infected feces is dry or wet. The feces can be several weeks old and still carry the virus. A microscopic amount of the feces can be carried on hands, shoes or any object and infect any un-suspecting canine.

Symptoms of Parvo virus include vomiting, listlessness and bloody diarrhea. Parvo is a very deadly disease. With treatment 80% of dogs that contract Parvo will live. Without treatment 70% of dogs that contract the disease will die. There is a strain of Parvo that attacks the brain and the heart muscle. If a canine contracts that strain of Parvo they will die no matter what the treatment. There are a few different tests on the market for Parvo but none test to see which strain of Parvo they have.

Most dogs that contract the Parvo Virus do not die of the Virus but die of dehydration. The Virus causes so much vomiting and diarrhea the animal dehydrates and dies.

Treatment for Parvo averages three to five days. Treatment includes intravenous fluids, Antibiotics, Anti-vomiting medication, Anti-diarrhea medication, Potassium Chloride supplements and Vitamin supplements. Many dogs will get worse before they get better during the treatment.

Every time the dog vomits, the dog dehydrates a little more. So you do not want to do any thing to aggravate the stomach and worsen the pet’s condition. During the treatment all medication will be give by injection. The dog is to get no medication, food or water by mouth. Anything given by mouth could upset the stomach and encourage vomiting.

After the vomiting and diarrhea has stopped the veterinarian will try the patient on a small amount of water and see if he vomits. If he does not they will increase the amount. If he still does not vomit they will try the patient on a small amount of a bland food. If the patient does not vomit the food they will increase the amount. Once the patient is eating and drinking without vomiting or diarrhea and the energy level is normal the hospital will typically send the patient home.

In the few cases where the canine has contracted the strain of Parvo that attacks the brain and heart muscle. It is not uncommon for the canine to appear to be recovering and then die unexpectedly. The canine strain of Parvo is only contagious to dogs; it is not contagious to humans or other species. There is a human strain of Parvo but it is un-related to the canine strain.

Bleach kills the Parvo virus. If you suspect that your home, clothing or any other item has been in contact with the Parvo virus you should wash it thoroughly with bleach.

Prevention is the best defense against Parvo. Make sure your canines get all of their vaccinations. Parvo vaccinations are given at six weeks of age, nine weeks of age, 12 weeks of age, 15 weeks of age, and then once a year for the rest of their life. With dogs less than three years of age avoid dogs you are not familiar with.

I hope you found this information helpful.

Food Storage Tips

Seventy to eighty million people a year in the United States get food poisoning resulting in over 100,000 hospitalizations and numerous deaths. Only 20% are attributed to restaurants and food workers. Many cases are somewhat self-inflicted by poor handling and storage of food in the home. Whether it is summer picnics, cookouts or holiday dinner season, proper food handling and storage is critical to keeping your family safe and enjoying your celebrations with food.

Handling your food properly as soon as purchased means prompt and proper storage until it is ready for consumption. Raw meat products are a common source where it is important to avoid cross contamination with other products. Separate clean packaging in plastic until it can be promptly refrigerated or frozen is important in avoiding the spread and proliferation of harmful bacteria. Effective refrigerator temperature is 40 degrees Fahrenheit and freezers at 0 degrees to ensure safe storage. Carefully store meats in clean leak-proof bag, double wrapped tightly with suitable freezer wrap or plastic. Storing on the bottom shelf of the refrigerator will avoid possible dripping on other foods. Fresh meats or fish should be consumed within 1-3 days. Five days can still be satisfactory for some whole products such as a roast or chops. On average, frozen meat products should be consumed within six months, sooner for products like ground beef. Some whole roasts can be safely frozen for up to 10-12 months. Even if safe, this pushes the limits of food product integrity. Monitor the temperatures in your refrigerator and freezer to ensure no temperature fluctuations are occurring due to mechanical malfunctions or weather conditions.

Check use-by or sell-by dates on food packages. Remember, these dates do not apply once the package is open even if restored properly. Best-if-used-by dates provide the most reliable information. They take into account normal handling and use of the product. Any package new or leftover can get lost in the refrigerator. You cannot safely judge a food product by the appearance, smell or taste. If in doubt, please throw it out! It is not worth the risk of consuming tainted food. Condiments often remain open in the refrigerator for long periods and are easily forgotten. Storage of condiments on the door is a suitable location in the refrigerator by design. Even the few acidic condiments that may be safe for longer will lose integrity of quality and taste; they still should be replaced after two months. Fresh eggs should always be stored in a protective carton in a more consistently cool area. Do not store on the door where they are subject to temperature fluctuations and breakage. Fresh produce should be stored in perforated bags that allow air circulation and evaporation of moisture. Do not wash them before storage.

The moisture will speed decay and decrease shelf life dramatically. Except for selected items like a hard aged salami or cheese that contain natural mold that can be trimmed or even safely consumed, moldy or questionably appearing products should be discarded. Cleaning the refrigerator/freezer more regularly is important to avoid excess build up of bacteria. Clean spills as soon as they occur with a weak cleaning solution that will sanitize. Bananas, potatoes and onions should be stored in a cool dry place, not refrigerated. Store leftovers of any kind, in a clean airtight container. Food you prepare should be refrigerated within 2 hours after cooking to avoid spoilage and development of excess bacteria.

Enjoy cooking and family celebrations but stay safe. Remember when in doubt throw it out!

Recommended Diets For Peptic Ulcer Patients

Peptic ulcer affects the stomach and the duodenum, giving symptoms like burning and pain in the upper abdomen frequently after one or two hours after eating was done. This discomfort is relieved after taking antacid drugs and food.

Keeping a diet is very important in treating ulcer. A few years ago it was thought that food can cause ulcer but now it has been proven that certain aliments can only aggravate the symptoms of ulcer and delay healing.

Some tips you must follow in order to prevent or heal faster the ulcer are:

1. Try to avoid the following aliments because they only injure your stomach line: pepper,

chilly, peppermint, citrus fruits, cocoa, chocolate, cola, and fried fatty foods. This list can be adjusted according to your tolerances but the doctors should be consulted about it too.

2. When eating try to eat slowly, chewing well the aliments in a non-stressful atmosphere.

3. Try to take your meals two hours before bedtime.

4. If you smoke, you should quit because smoking only delays ulcer healing.

5. Pay attention to the foods that cause you pain and burnings and try not to eat them any more.

6. If you caught a cold do not use aspirin because the substances it contains are harmful to your stomach and will delay ulcer healing.

7. Do not skip taking the drugs the doctor recommended: antacids, antibiotics.

Here is a scheme of a diet you can follow, approved by the National Research Council’s Recommended Dietary Allowances (RDA):

At breakfast, eat one toast with margarine and jelly; drink half a cup of apple juice, skim milk-one cup; you are allowed one teaspoon of sugar and a quarter of a teaspoon of salt.

At lunch, you can have a cream of potato soup with broiled chicken patty and tossed salad, one teaspoon of mustard, and a quarter of salt. If you want you can have peaches after.

At dinner: baked fish with mashed potatoes and one slice of bread; half a cup of apricot nectar and vanilla pudding. Margarine is admitted in one teaspoon.

This type of diet can also be followed by those who suffer of non-ulcer dyspepsia. This affection is similar to the peptic ulcer but the differences are that non-ulcer dyspepsia does not give an ulcer, a lesion on the stomach or duodenum; it only gives the same symptoms as peptic ulcer.

Ayurveda Remedy PMS

There is a huge chunk of the female population that suffers from mild to severe form of premenstrual symptoms or PMS. Because every woman has their menstruation every month, the female sex is at a vulnerable situation. But PMS can be easily remedied by Ayurveda treatments.

PMS almost often induces the symptoms of insomnia, swelling in one’s lower extremities, back aches, headaches and breast sensitivities. All of these are triggered by hormonal changes that one undergoes in a menstrual cycle and the anxiety coupled with that.

There are different classifications of PMS which is often determined by which dosha is aggravated.

Vata PMS

When your Vata gets aggravated, this causes pelvic cavity abnormalities that in turn cause lower abdominal pains. Because of this, the following symptoms are felt: headaches, lower backaches, calf muscle pains, constipation, insomnia, and crankiness.

To help alleviate the symptoms, you can have body massages using warm sesame oil. You can also fix up a bath for you that is prepared with a third cup of baking soda and ginger. Warm castor oil can also help you with your cramps and abdominal pains. You may also drink garlic tea which is made of a chopped clove of garlic in hot water, half teaspoon of cumin and half teaspoon of cinnamon.

Pitta PMS

A pitta induced PMS is triggered by smoking and intake of alcohol as well as constant exposure to heat like being under direct heat of the sun most of the time. The symptoms of Pitta PMS include breasts sensitivity, hyperacidity, headaches, hives, vaginal discharges and irritability.

Remedy for Pitta PMS include massages that use sunflower and sandalwood oils. You should also take only lukewarm baths to relieve the pain. You can also try coconut oil on the soles of your feet. You should also try drinking blue hibiscus tea for your PMS.

Kapha PMS

A kapha PMS is often characterized by symptoms like watery eyes, sinus congestion, lethargy, weight gain and excess urination.

However, Vata remedies often work for Kapha PMS as well like sesame oil massages and ginger and baking soda baths.

Ayurveda Remedy PMS

There is a huge chunk of the female population that suffers from mild to severe form of premenstrual symptoms or PMS. Because every woman has their menstruation every month, the female sex is at a vulnerable situation. But PMS can be easily remedied by Ayurveda treatments.

PMS almost often induces the symptoms of insomnia, swelling in one’s lower extremities, back aches, headaches and breast sensitivities. All of these are triggered by hormonal changes that one undergoes in a menstrual cycle and the anxiety coupled with that.

There are different classifications of PMS which is often determined by which dosha is aggravated.

Vata PMS

When your Vata gets aggravated, this causes pelvic cavity abnormalities that in turn cause lower abdominal pains. Because of this, the following symptoms are felt: headaches, lower backaches, calf muscle pains, constipation, insomnia, and crankiness.

To help alleviate the symptoms, you can have body massages using warm sesame oil. You can also fix up a bath for you that is prepared with a third cup of baking soda and ginger. Warm castor oil can also help you with your cramps and abdominal pains. You may also drink garlic tea which is made of a chopped clove of garlic in hot water, half teaspoon of cumin and half teaspoon of cinnamon.

Pitta PMS

A pitta induced PMS is triggered by smoking and intake of alcohol as well as constant exposure to heat like being under direct heat of the sun most of the time. The symptoms of Pitta PMS include breasts sensitivity, hyperacidity, headaches, hives, vaginal discharges and irritability.

Remedy for Pitta PMS include massages that use sunflower and sandalwood oils. You should also take only lukewarm baths to relieve the pain. You can also try coconut oil on the soles of your feet. You should also try drinking blue hibiscus tea for your PMS.

Kapha PMS

A kapha PMS is often characterized by symptoms like watery eyes, sinus congestion, lethargy, weight gain and excess urination.

However, Vata remedies often work for Kapha PMS as well like sesame oil massages and ginger and baking soda baths.

Method of Immersion Baths – Cold, Hot and Neutral Immersion Bath

Immersion bath makes the body healthy and is done in bath tub which is connected with hot and cold water connections. This bath is taken hot, cold, neutral and graduated at different temperature. It is also called full bath. Below you will learn the methods of cold, hot and neutral immersion bath.

Cold Immersion Bath

Cold immersion bath is given about 20 minutes at a temperature of 10º C to 23.8º C. Before this bath, patient’s body is applied including the head. Cold pack with moist cloth or towel is applied. At the time of bath his body is rubbed very well. After this bath he must be dried soon and wrapped in the woolen blanket. This is not to be given to very young and old persons. It is not to be done in enteritis, gastritis, inflammation of uterus and also ovaries.

Hot Immersion Bath

Hot immersion bath is given at a temperature of 37º C and gradually raised to 40º C by adding hot water. Before taking this bath the patient must drink cold water and make his body cold especially head, neck and shoulders with cold water. A cold compress is done during the entire treatment.

Hot immersion bath is useful in dropsy-accumulation of fluids in the body. It relieves in children, bronchitis and bronchopneumonia and also congestion of lungs. The bath is stopped when the skin becomes red. In chronic bronchitis hot bath is taken for about 5-10 minutes along with friction and rubbing after bath. If necessary, oil application is made to the skin of the patient. It is beneficial in chronic Rheumatism, gall bladder stones and urinary stones. It is not given in diseases of the brain and spinal cord, cardiac hypertrophy and weakness of heart.

Neutral Immersion Bath

Neutral immersion bath is given at a temperature of 26º C to 28º C, the normal body temperature for about one hour. It activates the skin and kidney diseases as it works as a sedative. It is useful in diseases of brain, spinal cord, meningitis, arthritis and rheumatism.

This is useful in dropsy of cardiac, renal and general, alcoholism, chronic multiple neuritis, chronic, diarrhea, peritonitis and chronic diseases of abdomen. It is not to be done in skin diseases as eczema and heart diseases.

Disclaimer: This article is not meant to provide health advice and is for general information only. Always seek the insights of a qualified health professional before embarking on any health program.

Copyright © Nick Mutt, All Rights Reserved. If you want to use this article on your website or in your ezine, make all the urls (links) active.

Body Pillows For Pregnant Women

If you are at the end of your pregnancy you are probably starting to have difficult nights. You try to turn in bed but no matter how much you move around you just can’t get comfortable. But there is help to find. Body pillows for pregnant women is the answer and will help you get a good night of sleep.

If you have reached the late part of your second trimester or your third trimester then there seems to be no end to the discomforts you feel due to your growing belly. Not only do you get pain in your hips and back, but there will also be leg cramps, reflux and heartache to bother your sleep. Some women also experience edema and this can get even worse when you are lying down.

Body pillows for pregnant women can help alleviate all of these problems and can help you get some good rest during the nights before your baby’s arrival. It is important to rest as much as you need in the end of the pregnancy as there will be enough to keep you awake at night once the baby has arrived.

The best body pillows for pregnant women provide support and comfort. You need extra support for your back and a pillow under the belly also helps you feel more comfortable. If you suffer from pain in the back, then it can help a lot if you put a pillow between your knees. This will take off the pressure of the lower back. If you have edema it will also help to sleep with your feet slightly lifted.

Some of the best body pillows for pregnant women have a u-shaped form. This means that they provide support for back and belly at the same time when you put the pillow between your knees. You can also hug the pillow with your arms which provides support for the chest that is already heavier at this time of pregnancy. The great thing about these body pillows for pregnant women is that they can also be used as nursing pillows once the baby is born. This way you get 2 in 1 and you don’t need to go out and buy a nursing pillow as well.