Myopathy is defined as a disorder that affects the muscle itself. The muscle is made of fibres that contract in a rhythmic fashion resulting in contraction of the muscle and movement of that part.

Here the muscle fibres that make up the muscle mass are affected and cause lies within the muscle itself. In many other conditions, the cause of the muscle weakness is neurological in origin where the nerve supply is affected leading to muscular problems. Weakness, muscle cramps and stiffness of the affected muscle are some of the common manifestations of myopathy.

Causes and Symptoms of Myopathies

There are many known causes of myopathies and they all affect the skeletal muscles of the body. These causes include genetic, inflammatory, metabolic and hormonal disorders. We shall discuss the list of muscular system diseases and their causes along with symptomatology.

(1) Genetic Myopathy:

The cells within the muscles are responsible for producing proteins of many types and this production is under the control of genes. When there is a genetic defect, the particular protein production is affected. It is either deficit or made in excess leading to myopathy. Examples of genetic muscle disorders are:

• Central core disease
• Myotubular myopathy
• Periodic paralysis
• Mitochondrial muscular myopathy

Most of the genetic disorders have an autosomal dominant inheritance where one defective gene is sufficient for the transmission of the disease. One of the parent has a defective gene and so he manifests the active disease. Each of his children have a 50% chance of getting the disease. This probability remains the same in male and female children.

In case of myopathies, two defective genes need to be inherited one from each parent to get the disease. This is also called as autosomal recessive pattern of inheritance.

Symptoms:

• Weakness of the voluntary muscles leading to difficulty in walking and climbing stairs. In children it can lead to delayed motor skills and milestones like sitting up, crawling and walking. When the child grows up, he is unable to jump, run and climb stairs like other children due to muscle weakness fatigue.
• Among other causes of pain in legs and thighs, myopathy is one of them.
• Another condition that may be associated with myopathy is myotonia where the muscle contracts normally but it fails to relax leading to stiffness and fatigue. This happens mostly after exposure to cold and long periods of rest like a night’s sleep. Jerking and repeated movement helps the muscle to get back to normal.
• The muscles may have periodic moments of weakness and paralysis. This paralysis is a result of the potassium levels fluctuating in the blood as in hypokalemia or hyperkalemia.
• In mitochondrial myopathy, the symptoms are slightly different. The muscles of the eye are affected called as ocular myopathy. There is weakness of the arms and legs and there can be multisystem problems involving the brain.

(2) Inflammatory Myopathy:

There are some disorders which lead to an inflammatory reaction within the muscles and cause myopathy. They are associated with the typical signs of inflammation like heat of the part, redness, inflammation, swelling and pain. Examples of this type of muscle diseases are:

• Dermatomyositis is a disorder of the connective tissue involving the muscles. The exact cause is not known but it holds some relation with rheumatological diseases and cancer.
• Polymyositis is an inflammatory disorder involving more than one muscle groups. It is associated with pain, deformity, swelling and sleep problems.
• Myositis ossificans is a rare genetic condition where the muscle tissue gets replaced by bone tissue. It begins in childhood and is a cause of muscle disorders in children.

(3) Endocrinal Myopathy:

The myopathy symptoms arise as a result of some endocrine causes where the production of hormones is abnormal. In hyperthyroidism, the levels of thyroxine are very high and so there is muscle weakness, wasting of muscles associated with tremors and weight loss. In hypothyroid myopathy, there is deficiency of the hormone leading to muscle weakness, cramps and stiffness.

(4) Muscular Dystrophy:

Muscular dystrophy is a disease that affects the muscle groups leading to progressive loss of muscle mass and loss of strength to carry out day to day activities. There is a lot of muscle pain and weakness. The main reason is the lack of protein called dystrophin within the muscle. This disturbance in protein synthesis is genetic in origin. The condition is more common in males and it is seen in young age and adolescence.

Diagnosis

Each case of myopathy needs to be investigated in detail. It begins with history taking. Appearance of symptoms and their severity and intensity are recorded. To confirm the diagnosis, laboratory investigations are used.

(a) History: The following points are noted while taking the history of the patient

• Presence of family history of periodic paralysis or muscular dystrophy
• History of pre-existing autoimmune disease, thyroid problems or renal insufficiency
• History of severe weakness-weak legs or painful legs experienced after exposure to cold or post a heavy meal
• History of electrolyte imbalances
• Use of medications like steroids, lipid lowering drugs or alcohol consumption
• Travel history to rule out the consumption of barium chloride accidentally.

(b) Investigations:

• Creatine kinase is present within the muscles and gets elevated if there is a muscle injury.
• Serum myoglobin levels
• Serum blood urea nitrogen and Serum creatinine
• Complete blood count
• ESR-erythrocyte sedimentation rate
• Thyroid function tests
• Calcium, magnesium and potassium levels.
• Urine analysis shows myoglobinuria and red blood cells on microscopic study

Other investigations include imaging techniques and special tests:

• Genetic testing
• Electromyography
• Magnetic resonance imaging (MRI)
• Muscle biopsy
• Antinuclear antibody levels
• ECG – Electrocardiography

Management of Myopathy

The treatment of the myopathy mainly depends on the causative factor. Supportive therapy may be required for cases that present with acute symptoms like maintaining the breathing, airway, circulation and hydration of the patient. The treatment will change as per the existing cause.

1. Periodic paralysis caused by fluctuations in the potassium levels can be treated by diet and medication
2. For myopathy resulting out of endocrinal imbalances like hypo or hyperthyroidism, hormonal replacement or medications need to be given to stabilize the levels of thyroxine in the blood.
3. Myopathy that is part of central core disease or nemaline myopathy have no known treatment methods.
4. Myositis ossificans where the bone tissue replaces the muscles is untreatable and the patient can only be given symptomatic relief.
5. Muscular dystrophy is another progressive debilitating disorder. Gene therapy is being tried to control the symptoms of the disease.
6. Physical therapy aims at helping the person carry out his daily activities without help. They work by strengthening the muscles and increasing muscle strength.
7. Occupational therapy is usually needed by those individuals who have muscle weakness or a particular part and it is hindering their work. They will be taught the use of braces and alternate methods to function inspite of the minor disability.
8. For speech and language disorders, a speech pathologist needs to be consulted. The various methods and techniques used by them to strengthen the muscles of the tongue and mouth help the patient to a great extent.

The post Myopathy appeared first on All Health Site - Health Articles and News.

1. Vitamin D Supplements: This is the only one supplement that the child needs in addition to breast milk. This is because the amounts passed on from the mother in the milk are very scanty. The other source of Vitamin D is exposure to the sun. So it is advisable to let the baby take a sun bath for at least 15 minutes a day. This is not possible at all times and places and the exposure to very harsh sun rays can damage the baby’s delicate skin. The American Academy of Pediatrics recommends that babies should be given 400 IU of vitamin D supplement per day. This dose is essential in those babies who take less than 32 ounces of breast milk or formula in one day. Dosage: The baby should be given 400 IU (international units) of Vitamin D drops within the first few hours after birth. The supplement should be continued till at least one year of age till the child begins to drink one liter of regular cow’s milk or 32 ounces of baby formula. There are many brands available in the market which sell vitamin d drops for infants.
2. Iron Supplements: All pregnant mothers take iron supplements and so the baby gets iron from the mothers blood. If the baby is exclusively breast fed then the amount of iron received in human milk is scanty. So around four months of age, babies are at a risk of developing iron deficiency anemia. Dosage: AAP recommends giving 1 mg/kg/per day of liquid iron supplement to babies till around six months. The iron supplement should be continued till the baby begins taking outside food that is rich in iron. When solids are introduced and the baby is still on mother’s milk, then the dose of the iron supplement will be adjusted by your pediatrician. The same dose is recommended for babies who are partially breast fed.If the little one is on baby formula, then most of these preparations are iron fortified and they contain around 4-12 mg of iron. So in case of babies who have been on formula from their birth, the dose of the iron supplement will be different. If you are wondering what’s the best formula for infants, it is the one that is fortified with iron and DHA both.In case of premature babies, the requirement will be slightly higher as they will have fewer iron stores in their body.
3. Vitamin Supplements: Baby vitamin supplements for breastfed babies is very important. Multivitamin supplements are generally given to most of the babies for the first six months as breast milk at times may not provide all the nutrients, especially if the mother is not careful about her diet or is unwell. Vitamin B12 is very essential for development of the nervous system. After 6 months, when outside baby food is started the need for supplements tends to go down.The best source of B complex is fish, eggs, milk, meat and poultry so if the mother is vegetarian then the baby will benefit by taking a B complex supplement. If the baby is taking infant formula, then he will get adequate vitamins as the formula is fortified. Vitamins for kids between the age of 1 to 2 years is advised occasionally if the child is not eating well.
4. DHA: Omega 3 fatty acid is a very essential component for optimum development of the brain and eye. If the mother has a diet rich in DHA or is taking supplements for the same, then DHA will be found in the breast milk. So vegetarian mothers should take a daily dose of a DHA supplement along with other prenatal vitamins. Babies who take best milk formula, generally get enough omega 3 as the formula is fortified. So DHA supplements are recommended mainly for breast feeding mothers rather than for babies.Thus baby vitamin supplements are essential for babies and there are certain situations where they become almost mandatory. They are:

• Premature babies
• Small for date babies
• Low birth weight babies, vitamin supplement for breastfed babies
• Babies who have trouble latching to the breast and so do not take enough breast milk
• Babies who take less than normal formula feeds
• Babies born with some illness or chronically unwell.

Always remember to give any baby vitamin, supplement or formula under the guidance of your pediatrician only. These medications have doses that need to be adjusted according to the baby’s needs and  body statistics. So you should follow what has been planned for your baby by his doctor.

The post Baby Vitamin And Nutrition Supplements appeared first on All Health Site - Health Articles and News.

Down syndrome, also called Down’s syndrome, is a genetic condition due to which a child’s mental and physical development gets delayed.

What Causes Down Syndrome?

Down syndrome occurs when instead of the normal 46 chromosomes that a child inherits from his parents during conception, he gets an extra copy of chromosome 21, thus having 47 chromosomes that account for the various disabilities.

This syndrome, named after the English physician John Langdon Down, can be classified into 3 types on the basis of the abnormalities of the chromosomes.

Types

• Trisomy 21, where there are three copies of the chromosome 21 rather than the habitual two. Also called Trisomy G, it accounts for about 95% of all Down’s syndromes.
• Mosaicism, where some cells have 46 chromosomes while some have 47, with an extra copy of chromosome 21. Also known as Mosaic Down’s Syndrome, this condition accounts for approximately 2% of Down syndrome cases.
• Translocation, where a part of the chromosome 21 gets attached (translocated) to another chromosome, usually the chromosome 14. This is said to affect 2?3% of cases of Down syndrome patients.

Is Down Syndrome Genetic/Hereditary

All cases are genetic, but Trisomy 21 and mosaicism Down syndrome are not inherited. However, about one-third of children having the translocation variety inherit the condition from their parents.

Risk Factors

• Advanced age of mother: The tendency of chromosomes to divide incorrectly increases with a woman’s age and consequently places them at a higher risk of conceiving a baby with Down syndrome. A 35 years old woman carries a risk of about 1 in 350 whereas a 40 years old woman carries a risk of about 1 in 100 of bearing a child with the disorder.
• Mother has had a child with Down’s syndrome: If a woman already has had a baby with Down syndrome, then she has about a 1 in 100 chance of conceiving another baby with the condition.
• Having a family history of the condition

Signs and Symptoms

Physical Characteristics

• Flattened features of the face
• A poorly formed nasal bone and a flat nasal bridge
• Small head
• Short neck
• A small mouth with a protruding tongue
• Eyes having a tendency to slant upward
• Oddly shaped or small ears
• A reduced muscle tone suggesting hypotonia
• Small and broad hands with relatively small fingers and a palm having a single crease
• Small feet
• The colored portion of the eye, called Iris having tiny, white spots called brushfield spots
• Oral manifestations involving absent primary and permanent teeth, a small mouth with a protruding tongue and reduced salivary flow
• A big space (sandal sap) between the first and second toe
• Short height

Why do People with Down Syndrome Look Alike

Many people with Down syndrome look alike, with similar physical features like short height or almond shaped eyes, as they often have similar genetic structure with an extra copy of chromosome 21. However, all do not look the same and they also share physical characteristics with their own families.

Neurological Symptoms

• Delay in motor development such as sitting up, crawling, walking, reaching or talking
• Delay in speech and attainment of self-care skills like eating, getting dressed or knowing toilet rules
• Limited attention span
• Behavioral problems involving poor judgment, impulsiveness, hyperactivity
• Learning disability
• Seizures
• Extensive flexibility

Complications

• Congenital heart defects
• Pulmonary hypertension that can lead to lung damage
• Hearing disability
• Ocular problems such as near or farsightedness, strabismus (cross-eyed), cataract, nystagmus, keratoconus and glaucoma
• Breathing problems such as sleep apnea and asthma
• Thyroid problems like hypothyroidism
• Digestive problems such as common constipation, diarrhea, indigestion and even the serious ones like small bowel obstruction, coeliac disease, reflux and Hirschsprung disease
• Infections such as pneumonia
• Childhood leukemia
• Unstable upper spine
• Cervical spine abnormalities such as Atlantoaxial instability
• ADHD
• Autism spectrum disorder (ASD)
• Dementia
• Obesity

How is Down Syndrome Diagnosed?

Prenatal screening tests that consider the risk if a baby has the syndrome or not are followed by diagnostic tests that may confirm if he will have the condition after birth.

Screening Tests during Pregnancy

First Trimester Combined Test

This test, done between 11-14 weeks of pregnancy involves:

1. Blood test to measure the levels of pregnancy-associated plasma protein A (PAPP-A) and the pregnancy hormone called beta-HCG (human chorionic gonadotropin) since abnormal levels of both may indicate a problem with the baby.
2. Nuchal translucency ultrasound screening test to check the collection of fluid at the back of the baby’s neck, since a greater amount of fluid than usual indicates the presence of some abnormality.

Triple Screen or Quadruple Screen Test

Also known as the multiple marker test, this is carried out between 15 and 18 weeks of pregnancy and measures the amount of normal substances in the mother’s blood.

Integrated Screening Test

Done in two parts, the first and second trimester quadruple screen uses the combined results to present a probable outcome of the condition.

Cell-Free Fetal DNA Analysis

Usually done after 10 weeks of gestation (in high risk cases), this looks for fetal DNA circulating in the mother’s blood, giving more specific results.

Diagnostic Tests during Pregnancy

Amniocentesis

This, normally done after 15 weeks of pregnancy analyzes the chromosomes of the fetus by using a sample of its amniotic fluid and contains a slight risk of miscarriage.

CVS (Chorionic Villus Sampling)

Carried out between 10 and 12 weeks of pregnancy, it checks the fetal chromosomes by taking cells from the placenta and carries a higher miscarriage risk.

Cordocentesis

Also called percutaneous umbilical blood sampling and generally performed after 18 weeks, this test examines chromosomal defects with the help of fetal blood taken from a vein in the umbilical cord and contains a greater miscarriage risk than both amniocentesis and CVS.

Tests after Birth

After the baby is born, a physical examination is carried out to look for the characteristic symptoms. If results positive, a blood test called karyotype might be done to analyze his chromosomes and confirm the syndrome.

Treatment and Management

Early Intervention Programs

Since children having this syndrome develop slowly as compared to normal kids, special programs by therapists may provide affected children with an early stimulation so that they improve their quality of life.

• A speech and language therapist may help in improving his language skills
• A pediatric physiotherapist may aid him in developing his motor skills
• A pediatric neurologist may provide support in improving his cognitive skills

Educational Strategies

Special educational procedures like integrated classrooms may also aid an affected child in learning life skills.

Feeding Strategies

Due to poor muscle tone and protruding tongue, generally all babies with the condition are messy eaters and most of the ways of food intake such as breastfeeding or bottle feeding usually take a longer time than normal babies. At times, some children face feeding problems like difficulty swallowing, requiring to be fed with the help of a special tube, called a gastronomy tube or a G-tube, inserted through the abdomen to directly deliver the necessary nutrition.

Medication

Several studies put forward the view that administration of amino acids such as Acetyl-L-Carnitine and L-Carnosine in the form of tablets may nourish brain cells, thereby helping in Down’s syndrome. However, more research needs to be done in this area.

Management of the Associated Conditions

Dietary Therapy

According to certain studies, an addition of vitamins and minerals to the diet may help in dealing with certain complications of the disorder. B12 seems to normalize metabolism; vitamin C may provide protection against the occurrence of Alzheimer’s disease, and the mineral zinc may improve subclinical hypothyroidism associated with the condition.

Surgery

Surgical treatment is provided to overcome cardiac and GI anomalies that may emerge with the condition, and generally, careful anesthetic measures are undertaken during the preoperative period since children affected with the condition tend to be hyperactive and hard to manage.

Immunization

Immunization can be given to prevent the occurrence of infections such as hepatitis B.

Can Down Syndrome be Prevented

Although there are no known ways to prevent the syndrome, genetic counseling before conceiving may help in understanding the chances of having a baby with the syndrome.

Prognosis

Prognosis of Down’s syndrome that is based on the nature and severity of the associated complications has improved over the years.

Life Expectancy: How Long do People with Down Syndrome Live

With modern medical assistance, children having the condition usually have a long life expectancy with nearly 80% living up to age 55 and even longer. According to a survey, Joe Sanderson, 80, from Saltburn, Cleveland, is the oldest living person with Down syndrome.

Can People with Down Syndrome Reproduce

Reproduction is a rare phenomenon with people affected with Down syndrome and they need careful and sensitive advice regarding the issue of having children.

Prevalence and Incidence Statistics: How Common is it

Considered to be the most common chromosomal disorder, there are about 6000 diagnoses every year, with around one in every 700 babies being born with Down’s syndrome. According to several studies, the survival rate of African American infants having the syndrome is much lower as compared to white babies. However, more research needs to be done to decipher the reason of this disparity.

Down Syndrome vs. Autism

Various studies have been carried out to compare the prognosis and quality of life for adults living with Down syndrome and those with autism spectrum disorders. Although the conditions may often coexist, it has been suggested by experts that Down syndrome patients have better social and residential independence, with more frequent contact with family and friends, better educational capabilities and less behavioral problems than those with ASD.

Down syndrome ICD 9?CM and ICD?10 CM Codes

The ICD-9-CM code for the syndrome is 758.0, and the ICD-10-CM code is Q90.

References:

1. http://www.mayoclinic.org
2. http://kidshealth.org
3. http://www.ndss.org
4. http://www.nhs.uk
5. http://www.healthline.com
6. http://patient.info

The post Down Syndrome appeared first on All Health Site - Health Articles and News.

Fibromuscular dysplasia, first observed by Leadbetter and Burkland, is a rare vascular condition that mostly affects the arteries supplying blood to the kidneys (renal arteries) and brain (carotid and vertebral arteries).

Location of FMD in other parts of the body are the mesenteric arteries, coronary arteries, arteries to the arms (brachial arteries) and those to the legs (iliac arteries), subclavian and axillary arteries, femoral arteries or hepatic arteries and temporal arteries.

FMD Types: Pathologic Classification

On the basis of an arterial wall involvement, FMD can be classified into three types such as:

1. Medial dysplasia
   • Medial fibroplasias (75–80%)
   • Perimedial fibroplasias (10–15%)
   • Medial hyperplasia (1–2%)

2. Intimal fibroplasias (<10%)
3. Adventitial fibroplasia (<1%)

Causes

Fibromuscular dysplasia occurs when the fibrous tissue and muscle layers in the middle of the medium and large arterial walls of the body have abnormal cellular development. This leads to the subsequent narrowing (stenosis) and enlargement (an aneurysm) and even tears (dissections) of the arteries.

Risk Factors

Though it can affect both adults and children, studies have suggested some possible risk factors:

Gender: About 90% of those affected are women

Age: Premenopausal women are at a greater risk than men, suggesting possible hormonal influences

Genetic pattern: According to certain studies, about 10% of people diagnosed with FMD have a relative suffering from this condition.

Birth defect: abnormal position of the arteries at birth may also lead to the condition.

Smoking: The disease seems to aggravate in persons who smoke.

Signs and Symptoms

The symptoms, mainly depending on the affected artery may not be detectable in some people having the disease.

Symptom of FMD of renal artery (kidney)

• A discomfort felt in the upper abdomen or back and sides.

FMD of the carotid arteries (brain)

• Headache
• Dizziness
• Swooning ringing in ears called pulsatile tinnitus
• Room spinning sensation or vertigo
• Neck pain implying carotidynia
• Hazy vision including drooping eyelids
• Numbness felt in the face

FMD of the mesenteric arteries

• Abdominal pain after eating
• Changes in the color or appearance of skin
• Hands and legs feeling numb, cold and weak
• Sudden weight loss

FMD of the extremities or the brachial arteries and iliac arteries

• Discomfort in the limbs while doing exercise or moving

FMD of coronary artery (heart)

• Chest pain

FMD may also lead to the development of tears in the walls of the coronary arteries called spontaneous coronary artery dissection or SCAD, which may induce symptoms as

• Shortness of breath
• Sweating and nausea

Complications

• Heart attack
• High blood pressure or renovascular hypertension characterized by a potassium deficiency (hypokalemia) and renal murmurs (renal bruit)
• Carotid dissection
• Aneurysms
• Pain or cramps felt in lower legs or intermittent claudication
• Ischemic renal atrophy
• Stroke
• kidney failure (rare)
• Organ dysfunction
• Rupture of the inner wall of the aorta called aortic dissection

Diagnosis

Along with a discussion of family history, a routine examination of abdomen or neck is done to detect a swooshing noise called a bruit that signifies an abnormal blood flow. Once FMD is diagnosed in a particular body area, the other blood vessels are also checked to determine further blockage of arteries.

The radiology studies are:

An X- ray or scan may be done to look for the beaded appearance of the arteries usually referred to as a “string of beads.”

Catheter-based angiography is an accurate imaging test that can be done by inserting a catheter or a long, slender tube into a large artery and slowly extending it to the concerned blood vessel. An accurate radiographic image of the arteries is then obtained.

Computer tomography angiogram (CTA) which makes a combination of X- rays, contrast dyes and computer technology to obtain 3 dimension images of the arteries.

Magnetic resonance angiography (MRA) which employ a combination of radio frequencies and computer to derive detailed pictures of the cluster of cells that narrow the artery.

Duplex ultrasound or Doppler by which images of blood vessels, tissues and organs are obtained through the application of high-frequency sound waves and computer.

If these tests do not give satisfactory results, then therapeutic procedures such as balloon angiography, or an angiogram dye test are done.

Differential diagnosis

• Atherosclerotic stenosis
• Stenosis linked with type 1 neurofibromatosis
• Vascular Ehlers- Danlos syndrome
• William’ syndrome
• Polyarteritisnodosa
• Vasculitis
• Neurofibromatosis

Fibromuscular Dysplasia Treatment

FMD is treated on the basis of the patient’s overall health, the area where the artery has been affected, and any existing conditions such as high blood pressure. The treatment procedures are:

Medications

Angiotensin-converting enzyme inhibitors (ACE) and Angiotensin II receptor blockers

If there is high blood pressure in the renal arteries (renovascular hypertension), these medications may be prescribed to prevent the narrowing of blood vessels or renal artery stenosis. ACE inhibitors include medications as enalapril (Vasotec), benazepril (Lotensin) and lisinopril (Zestril). Angiotensin II receptor blockers include medications such as irbesartan (Avapro), candesartan (Atacand) and valsartan (Diovan).

Diuretics

Blood pressure can also be controlled by using diuretics like hydrochlorothiazide (Microzide).

Beta Blockers and Calcium Channel Blockers (CCB)

Metropol (Toprol- XL, Lopressor) and atenolol (Tenormin) are the beta blockers that may slow the heart rate and block adrenaline. CCBs like nifedipine (Procardia, Adalat) can ease the blood vessels.

Surgery

An invasive surgery, mostly aortorenal bypass is undertaken if the arterial narrowing is severe. It mainly depends on the area affected and the extent of damage. It involves removal of the blocked portion of the artery or forming a bypass around the block. Most patients with brain aneurysms may be treated with an open surgery.

Percutaneous Transluminal Angioplasty (PTA)

PTA is done in patients who suffer from uncontrollable blood pressure or are unresponsive to medication. In patients with renal FMD, PTA leads to controlled blood pressure indicated by a decrease in the activity of the hormone, rennin, while it may prevent strokes in patients having carotid FMD.

Angioplasty for patients with renal Fibromuscular Dysplasia is done without placing a metallic stent whereas; it is needed for patients with carotid or vertebral FMD who have got a tear.

FMD Alternative Treatment

Psychological treatment may be given to tackle stress and anxiety.

Patients having FMD can be given gynecological advice regarding the use of oral contraceptives or estrogen therapy that can influence blood flow in arteries.

Follow-up

Even though FMD can be managed successfully, there are chances of its recurrence. Hence, the follow-up of patients generally consists of regular check-up of blood pressure, surveillance imaging every 6 to 12 months along with carotid and renal ultrasound to keep a record of the progress.

Prevention

Though it is difficult to prevent Fibromuscular Dysplasia, yet having a healthy diet consisting of fresh vegetables, fruits, and salad may help.

Prognosis

The prognosis depends on the severity of the symptoms and the complications that develop.  However, patients with FMD usually have an average life expectancy. But in rare cases, intense FMD can result in nerve damage, bleeding in the brain and even death.

Prevalence

According to several reports, amidst the few thousand cases of FMD, the prevalence of renal artery FMD is about 65% – 75%, cerebrovascular involvement is about 25% – 30%, visceral involvement is nearly 9% and the prevalence of FMD of the arms and legs is 5%.

ICD-9 and ICD- 10 Codes

The ICD- 9 code used for referring to the ailment is 447.8, while the ICD- 10 code is 177.3.

Reference

1. http://my.clevelandclinic.org
2. http://www.mountsinai.org
3. http://en.biomanantial.com
4. http://circ.ahajournals.org
5. http://www.fmdsa.org

The post Fibromuscular Dysplasia appeared first on All Health Site - Health Articles and News.

Vitamin D is a fat soluble vitamin which is very important for a good bone structure as it regulates calcium and phosphorous metabolism in the body. The main source of Vitamin D is sunlight. The body can synthesize vitamin D in the body with the help of sunlight.

Physiology of Vitamin D

The active form of Vitamin D is called calcitriol (1,25-hydroxyvitamin D3). Vitamin D is synthesized when cholesterol on the skin is converted into calciol (vitamin D3). The vitamin D 3 then goes to the liver where it is converted into Calcidiol (25 hydroxyvitamin D3). This calcidiol is converted into the active form of Vitamin D in the kidneys.

Now that we have understood the regulation of Vitamin D, let us also know the sources of Vitamin D. It has been seen that people with darker skin tones and long term use of sunscreen can reduce the absorption of Vitamin D by the skin and lead to deficiency. In such cases vitamin D supplement and taking foods rich in Vitamin D is recommended.

Sources of Vitamin D

The main source of Vitamin D is sunlight. The average daily requirement of Vitamin D in adults is 600-800 IU. In infants and children the requirement is between 400-600 IU. There are dietary rich sources also. Eating these vitamin D foods will help you fulfill the body’s requirement of Vit D. Certain foods with Vitamin D are:

• Egg yolk
• Cod liver oil
• Mushrooms
• Tofu
• Cheese
• Beef liver
• Fortified foods like dairy products, juices, soy milk etc
• Fatty fish like tuna and salmon

Benefits of Vitamin D

Vitamin D is an essential vitamin in our body which helps our body structure (bones) remain strong, healthy and free from bone related diseases. Here are some of the health benefits of this vitamin that we should be aware about:

1. Bones: Vitamin D is very important for the proper absorption of calcium in the intestines. Vitamin D deficiency can lead to rickets in children with softening of bones and curved legs. In adults the deficiency leads to osteoporosis making the individual more prone to fractures as the bony network is not strong enough. Osteoporosis is more commonly seen in post menopausal women.
2. Pregnancy: Low levels of vitamin D during pregnancy are found to be associated with higher risk of preeclampsia and gestational diabetes. Hence all pregnant ladies are advised to take calcium and Vitamin D supplements.
3. Cardiac Diseases: Vitamin D deficiency symptoms, based on researches has been associated with increased risk of cardiac diseases, hypertension and type 2 Diabetes. These conditions, further increase our health risks and also at times prove to be fatal with other complicated health conditions.

Deficiency of Vitamin D

The following diseases are associated with deficiency of Vitamin D. The symptoms of Vitamin D deficiency are as follows:

• Rickets: Low levels of Vitamin D causes a poor absorption of calcium and phosphorous. Rickets is basically a childhood disorder and is seen more commonly in middle east countries and Africa. The reason why it is more common in infants is low levels of Vitamin D in breast milk and lack of exposure to sunlight. It is characterized by bowing of legs and weak and deformed bones.
• Osteomalacia: It is a disease that results from deficiency of Vitamin D in adults. It is characterized by softening of bones, bowing of legs, muscle weakness and weak bones leading to increased risk of fractures.
• Other Conditions: Apart from the above two, vitamin d deficiency can also lead to a weakened immune system, depression, autoimmune diseases, cancer, skin problems like eczema and dementia.

Vitamin D Side Effects

The side effects of Vitamin D are not very common and are likely to occur only when high dose supplementation is done. The normal upper limit of Vitamin D levels in the body is 4000 IU/day.

• Pregnant women and breast feeding mothers need to be very careful about over dosage of Vitamin D as it can lead to hypercalcemia and cause serious harm to the fetus in the form of a syndrome with mental retardation and facial deformities.
• High levels of vitamin D in people with a pre-existing kidney disease, where the kidney is unable to regulate the normal levels of calcium and phosphorous proves harmful. It can lead to renal osteodystrophy.
• Hyperparathyroidism patients can develop vitamin d toxicity by long continued use of supplements.

The post Vitamin D appeared first on All Health Site - Health Articles and News.

Iron is a very important component of blood. The oxygen from the lungs is carried to the various parts of the body by the iron component (heme) of the hemoglobin. This oxygen is required by each and every cell of the body to carry out its function. Insufficient levels of iron in the blood cells affects the oxygen carrying capacity of the blood and results into Iron Deficiency – Anemia. And the only way to avoid anemia is by following a diet with foods high in iron for a better health.

Metabolism of Iron

A well nourished individual has 4 to 5 grams of iron in his body. Of this, around 2.5 grams is used to carry oxygen and the rest is stored in the form of iron-ferritin which makes up the iron reserves in our bone marrow, liver and spleen. In case of iron deficiency, these body stores come to use, especially when the iron demand increases in the body during menstruation, lactation and childbirth.

The iron is absorbed mainly from the upper part of the small intestine. The absorption of iron is accentuated by the presence of Vitamin C. Calcium on the other hand is known to slow down iron absorption. So, foods with iron when taken along with vitamin C rich foods leads to better iron absorption.

Sources of Iron

There are two forms of dietary iron-heme and non-heme for iron source. Heme iron comes from hemoglobin containing animal food sources like red meat, poultry and fish which is very well absorbed. Non heme iron is derived mainly from plant sources like fruits, vegetables, grains and nuts and is absorbed less effectively than animal iron. This is the reason iron deficiency anemia is more commonly seen in vegetarians. Above all, it is important to know what foods have iron in them for maintaining our better health.

Foods High in Iron

Here is a list of iron rich foods which one must incorporate in their daily diet. They are mainly derived from plant and animal sources as discussed above. Read below to know the proper list of foods rich in iron which you should follow carefully.

Iron Foods are of Two Categories:

Animal Derived Sources of Iron

• Chicken liver
• Beef
• Oysters
• Red meat
• Sardines
• Fish
• Turkey

Plant Derived Sources of Iron

• Spinach
• Beetroot
• Jaggery
• Lentils
• Broccoli
• Pumpkin
• Sesame seeds
• Kidney beans
• Chickpeas
• Soya beans
• Tofu
• Raisins
• Apricots

Importance of Iron in Pregnancy

In case you are planning a family, it is very essential to get screened for iron deficiency anemia. Mild anemia will not harm you but in case the anemia is severe, you may need to get treated before you get pregnant.

During pregnancy, the blood volume increases by 50% and so does the iron requirement. Insufficient levels can lead to deficiency in the growing fetus. Adequate iron stores are needed to compensate the blood loss which occurs during pregnancy.

You must be aware of the Common causes of iron deficiency anemia which are as follows:

• Heavy menstrual flow
• Diet that is lacking in iron rich foods
• Recent blood loss due to a surgery or childbirth
• Pathological conditions like Crohn’s disease
• Closely spaced pregnancy (less than 18 months)
• Diet lacking in vitamin C which is needed for iron absorption
• Having excess of dairy products, tea or coffee

Anemia (low levels of hemoglobin) are manifested by symptoms like weakness, lethargy, easy fatigue etc. Good sources of iron or eating foods high in iron can help not being an Anemic. It is a routine to check the hemoglobin levels in all pregnant ladies at regular phases of pregnancy to ensure the healthy growth of the baby.

Diagnosis and Treatment

Iron deficiency anemia is diagnosed by CBC-complete blood count examination which gives the blood values of Hb, RBCs and WBCs. The Hb level is a direct indicator of the status of anemia. The normal levels are 11-13 gm% in females and 12-16 gm% in males.

In patients with severe anemia, second line of tests may be required like-serum ferritin levels, TIBC, Reticulocyte count and peripheral smear which will help to identify the exact cause of anemia.

The treatment is commonly oral iron supplementation along with the intake of high iron foods. The only side effect being constipation and change in the color of the stool.

Prevention of Iron Deficiency Anemia

1. Have plenty of iron enriched foods or a special anemia diet as suggested by your doctor. There are plenty of vegetables and other foods high in iron, especially if you are a vegetarian. Also ensure you have lots of Vitamin C which will help in better absorption of the vegan iron.
2. Avoid excessive tea, coffee, dairy and soy products (calcium rich foods) which are known to slow down iron absorption and instead consume more fruits rich in iron.
3. Identify and treat bleeding from any part of the body eg: bleeding from anus as in fissure, piles, bleeding gums etc.
4. Take an iron supplement on a regular basis.
5. Include more and more iron rich diet.

The post Foods High in Iron appeared first on All Health Site - Health Articles and News.

Atrophic Gastritis, characterized by chronic inflammation and thinning of the stomach mucus membrane, occurs when its gastric glandular cells are damaged, lost or replaced by intestinal or fibrous tissues, either due to an H.pylori bacterium infection or a mistaken attack of the immune system on the stomach cells. Consequently, there is no more formation and release of essential digestive secretions such as hydrochloric acid, pepsin and the glycoprotein intrinsic factor. As a result, the body is rendered incapable of absorbing vital minerals and vitamins. Lack of iron can cause iron deficiency anemia and vitamin B12 deficit can cause megaloblastic anemia. In the long run, it can even lead to cancer.

It is the final stage of chronic gastritis and is seen to affect nearly 20% of people aged from 60 to 69 years, and 40% of people above 80.

Atrophic Gastritis Types

Type A or autoimmune atrophic gastritis develops when the antibodies produced by the body erroneously attack and destroy the stomach cells. When they attack the intrinsic factor, they cause pernicious anemia and profound hypochlorhydria. It is also called autoimmune metaplastic atrophic gastritis or AMAG due to the changes brought about in epithelial cell types. AMAG typically affects the gastric corpus and fundus or the upper part of the stomach.

Type B atrophic gastritis is multifocal and is formed when the H pylori bacterium causes an infection in the antrum and oxyntic mucosa of the gastric body and stomach. Also induced by environmental factors as diet, it is referred to as environmental metaplastic atrophic gastritis or EMAG.

Atrophic gastritis Symptoms & Signs

The symptoms of type A gastritis are different from type B due to their causes. H pylori infected gastritis which is more common includes symptoms of:

• A burning and stabbing abdominal pain that is infrequent but lasts for over a month. This is followed by an unwillingness to have food.
• Regular nausea, bloating, vomiting and moderate to extensive weight loss without any reason

The progression of the disease may manifest in symptoms as belching and indigestion which may simultaneously suggest the development of gastric or peptic or duodenal ulcers.

The symptoms of type A gastritis are mainly caused due to the deficiency of vitamin B12 and involve:

• Nonspecific symptoms such as dyspepsia or anemia symptoms such as weakness, headache, heart palpitations, dizziness and tinnitus or a ringing sensation in the ears.
• Light headedness, shortness of breath and lethargy due to iron deficiency anemia.
• GERD or acid reflux and heartburn (discomfort may be lower in younger people)

The progression of the ailment may be accompanied by neurological symptoms as:

• A tingling skin sensation called parenthesia
• Unsteadiness in walking
• Muscle tightness or jerky movements suggesting spasticity
• Slow reflexes along with abnormal and painful sensations implying damage of the peripheral nerves or peripheral neuropathy
• A trembling sensation along with memory loss, jumbled speech indicating dementia

However, in older people folate synthesizing bacteria may form additional folic acid which can in turn conceal the symptoms of the vitamin insufficiency, thus delaying the diagnosis and leading to fatal results.

Atrophic Gastritis: Causes

Type A chronic gastritis that is more prevalent in women than men is caused due to the diffuse atrophy of parietal cells by immune reaction. To be more specific, the cell’s H/K – ATPase molecule is the target antigen that undergoes CD4+T cell induced immune reaction and leads to the growth of T-cells, cytokines and auto antibodies. However exact causes are still unknown.

Type B atrophic gastritis that results from H.pylori infection is a frequent phenomenon during childhood. It is caused if you eat from contaminated utensils and consume the bacteria present in the food or fluid. If kept untreated, it may worsen with age. Other possible causes involve a direct association with feces, vomit or saliva of an infected person.

Risk factors

Even though rare, you are more likely to develop autoimmune gastritis if you have

• A family history of helicobacter gastritis
• Certain autoimmune disorders like autoimmune thyroiditis or Hashimotor’s disease, type1 diabetes mellitus, lupus and also others as vitiligo, psoriasis and alopecia

People living in developing countries are at a greater risk of H.pylori infection due to:

• Congested living quarters and unhealthy sanitation.
• Greater incidence of Sjogren’s syndrome as it increases the chances of chronic atrophic gastritis.

Complications

Hypochondria caused due to an attack on the intrinsic factor may lead to gastritis cell hyperplasia (abnormal growth in the number of cells). When the hormone gastrin employs a growth effect on the ECL cells, (a type of neuendocrine cells present in the gastric mucosa) it may cause ECL neuendrocrine cell hyperplasia, which may finally lead to carcinoid tumors in AMAG.

EMAG may involve the risk of having gastric carcinoma, achlorhydria and Hashimotor’s thydroitis.

Atrophic gastritis diagnosis and tests

The doctor may begin by asking about your family’s medical history and then look for symptoms like pale skin or rapid pulse rate to detect B12 deficiency. For type B gastritis, the doctor may lightly press certain points around your stomach to check for bloating and tenderness.

Blood tests are then recommended for both. But for type A gastritis, the blood test may detect anemia which can be microcytic (iron deficiency type) or macrotic (vitamin B12 lacking type). The tests may also point out antibodies responsible for stomach cell and intrinsic factor impairment. In case of type B gastritis, serological findings may detect low pepsinogen levels and high gastrin levels or gastrinoma.

Since an acute form of the disease cannot be detected by blood tests, the doctor may also do a biopsy, instilling a long and flexible tube called an endoscope down your throat and deep into your stomach, to collect tissue samples. They are then analyzed to check for the presence of infections, gastric mucosal atrophy, cancerous cells and other traces of inflammation.

The doctor may also conduct upper gastrointestinal barium x-ray radiography to detect gastric carcinoma and fluoroscopy to check for decreased or absent fundal folds.

Differential diagnosis

• Chronic gastritis
• Gastroesophageal reflux disease
• Pernicious anemia with increased frequency of HL-A7 and HLA-3 haplolytes.
• Gastroparesis

Atrophic gastritis treatment

Medical treatment

There are two distinct steps involved in the treatment of AMAG. To reduce anemia, you may be given iron tablets or vitamin B12 injection. In case of early detection of carcinoid and carcinoma in stomach, there is endoscopic surveillance of the gastric mucosa and finally evaluation and eradication of carcinoid nodules.

EMAG is generally treated by eradicating the H.pylori infection by means of antibiotics such as proton pump inhibitors (PPIs) and rantidine bismuth citrate. Proton pump inhibitors such as omeprazole or nexium reduce the acid and the bismuth helps in killing the bacteria.

Atrophic gastritis: recovery

The symptoms of most people suffering from AG lessens after treatment

To determine whether you are responding to the treatment or not, you may be advised for a close follow up with tests to check vitamin B12 levels. Although it may get better with proper treatment, there are no reports to indicate that the condition is reversible.

Natural treatment

The doctor’s prognosis may entail to avoid certain foods that are spicy, fried or fatty or contains gluten. Alcohol consumption is also not recommended as it tends to increase inflammation. Presence of ginger, mint, and cumin seeds in diet can lessen nausea and help the digestive process. You should also look for means to manage stress as it is detrimental to the symptoms of atrophic gastritis. This may involve exercise or meditation.

Certain homeopathic medications claim to resist the symptoms but there is no evidence to prove that they actually work.

Atrophic gastritis ICD – 9 and ICD -10

The ICD -9 –CM code used for this disease is 535.1 while the ICD -10 –CM code used is K29.4.

References:

1. http://emedicine.medscape.com
2. http://www.healthline.com
3. http://www.merckmanuals.com
4. http://www.giejournal.org

The post Atrophic Gastritis appeared first on All Health Site - Health Articles and News.