Progressive multifocal leukoencephalopathy (PML) is a disease of the white matter of the brain.

Description

Progressive multifocal leukoencephalopathy (PML) is a disease of the white matter of the brain, caused by lytic infection of oligodendrocytes by the JC polyomavirus (JCV) that targets cells that make myelin – the material that insulates nerve cells (neurons).

This etiological virus was isolated and identified during the brain postmortem of a patient named John Cunningham post his death and thus named as JC virus in his honor. This virus is quite widespread and has been seen to be present in almost 80-85% of normal adult populations. Although these viruses remain inactive in a normal healthy individual but begin showing symptoms of Progressive Multifocal Leukoencephalopathy if the individual has an extremely weak immune system.

Pathophysiology of Progressive Multifocal Leukoencephalopathy

The pathogenesis of PML is not well understood. It is known that the development of PML, while dependent on the presence of the JC virus, is the result of a confluence of specific viral and host risk factors.

JCV infection is chronic; kidney appears to be the primary site of infection and it shed in the urine with the prevalence of shedding dependent on gender and age. JCV is rarely found in blood, and while there have been reports of JCV in the brain, bone marrow, tonsil, and peripheral blood lymphocytes, viral tropism, and lifecycle beyond kidney is not understood. It is therefore unclear how JCV accesses the central nervous system (CNS) and ultimately infects oligodendrocytes in the brain.

There are few research findings suggest that viral mutations in the VP1 capsid protein and/or the noncoding control regions (NCCRs) might result in a change in tropism or replication capacity that is permissive for the pathogenic demyelinating brain infection.

The conversion of JCV from a common benign peripheral infection to a rare pathogenic brain infection is dependent on the convergence of host and viral factors. In addition to viral mutations, significant changes to host immune function are also required. HIV-AIDS is the most common context where PML is observed, but it is also associated with pathological conditions and certain therapeutics that result in significant immune suppression or immune modulation.

Causes

The foremost causative agent of Progressive Multifocal Leukoencephalopathy is a human polyomavirus named as JC virus. People with feeble immune system usually get the infection of JCV that ultimately lead to progressive multifocal leukoencephalopathy. Other reasons to develop progressive multifocal leukoencephalopathy with the weak immune system include:

  • AIDS
  • Immunosuppressive medications like Cyclophosphamide, Cyclosporine, Methotrexate, Prednisone, etc. in treating autoimmune ailments, such as Rheumatoid Arthritis, Multiple Sclerosis and many more.
  • A blood-related cancerous disease like lymphoma or leukemia.
  • If any patients have undergone immune therapy or any type of transplant procedures.

This JC virus is usually present in the brain or bone marrow of healthy people in an inactive state. Many people get infected by the virus but very few actually show symptoms.

Risk factors of Progressive Multifocal Leukoencephalopathy

  • PML is very rare and is likely caused by a combination of factors. Infection with the JC virus (JCV) is required for PML to develop. Other patient-specific factors, including a weakened immune system and possibly genetic factors, may increase the risk of PML.
  • People who have multiple sclerosis, which attacks the central nervous system, or other immune system problems, like rheumatoid arthritis or lupus, may be at risk as well.
  • People who have some types of cancer or take drugs that keep their body from rejecting a transplanted organ also have a higher risk.

Symptoms

Since the brain is the primary organ affected, the symptoms are reflective of brain dysfunction or even damage. Symptoms of progressive multifocal leukoencephalopathy include the following:

Sensory-Motor Changes

  • Visual impairment or loss
  • Tingling sensation or loss of sensation from the limbs
  • Changes in hearing, smell, and taste
  • Non-reaction to a strong or painful sensory stimuli
  • Speech Impairment or even aphasia (loss of speech)
  • Inability to understand speech
  • Unilateral or bilateral weakness
  • Paralysis
  • Face drooping
  • Loss of balance or clumsiness
  • Seizures

Face drooping

Cognitive Changes

  • Disorientation to time, place and people
  • Progressive loss of memory
  • Inability to focus or solve problems
  • Inability to execute activities of daily living
  • Progressive loss of consciousness
  • Drowsiness

Symptoms of the disease occur in a quick and progressive manner.

Complications of Progressive Multifocal Leukoencephalopathy

The possible complications associated with Progressive Multifocal Leukoencephalopathy include:

  • Progressive weakness of the body with complete paralysis
  • Speech defects with eventual aphasia (complete loss of speech)
  • Memory-related signs and symptoms
  • Balance and coordination difficulties

Diagnosis and Test

The diagnosis of Progressive Multifocal Leukoencephalopathy may include a detailed evaluation of medical history and a thorough physical exam. Other diagnostic tests performed to confirm PML may include:

  • MRI scan of the brain, which uses magnetic waves to take pictures of the brain structure and evaluate the extent of damage caused by the JC virus
  • Spinal tap: A small amount of cerebrospinal fluid (CSF) is removed and examined for the presence of JC virus in the brain
  • Brain biopsy: This procedure is very rarely used

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

Treatment and Medications

Till now there are no specific drugs to cure or inhibit viral causing JCV without any toxic effect. Thus, treatment only involves in stopping or slowing of the disease progression or just reversing back the patient’s immune system. AIDS patient with Progressive Multifocal Leukoencephalopathy and undergoing HAART have shown little chance of long-term survival. Therefore, treatment strategies for Progressive Multifocal Leukoencephalopathy include:

Potent Anti-HIV Therapy

To start antiretroviral therapy as soon as the patients are diagnosed with progressive multifocal leukoencephalopathy and are not undergoing therapy

To optimize antiretroviral treatment for viral suppression among patients getting antiretroviral therapy, but are actually HIV-viremic due to antiretroviral resistance. Serious treatment with certain antiretroviral medicines, including Enfuvirtide has been seen to provide probable survival assistance in progressive multifocal leukoencephalopathy patients with unnoticeable plasma HIV.

Cytosine Arabinoside (Ara-C)

Cytosine arabinoside (ara-C, cytarabine, Cytosar-Ur) is currently used as chemotherapy for leukemia and cancer. For treating PML it was commonly given through a shunt into the brain and/or directly into a vein (intravenously). Experienced neurologists may dose ara-C through a shunt (called intrathecally) into the brain at doses of 10mg/m2 for three days, followed by 10mg/m2 twice a week for two weeks, then 20-30mg/m2 each week thereafter. The common dose of ara-C when given into a vein is 2mg/kg in 5-day cycles, every 15 or 30 days.

Side effects include nausea, consistent fevers, and bone marrow toxicity. These effects are dependent on its dose and schedule and vary in severity. Ara-C can harm an unborn child in pregnant women

Treatments under research experiments

Cidofovir: Several studies of the anti-CMV drug, cidofovir, first looked encouraging for treating PML. However, over time these studies failed to show any benefit and so it is no longer recommended for treating PML.

Corticosteroids: There is some debate about adding corticosteroids to potent anti-HIV therapy for treating PML. Those opposed to using them say they may further weaken the immune system, which is critical in successfully treating PML. There are also a few cases where the development of PML has been associated with their use. Those in favor of using corticosteroids note that increased inflammation associated with using anti-HIV therapy may be quieted by using these steroids and thus aid PML recovery. Currently, experts are interested in studying corticosteroids as an added therapy to potent anti-HIV therapy for PML.

Interferon Therapy: Researchers have been interested in using both Interferon-alpha and Interferon-beta to treat PML. In test tube studies, both are active against the JC virus. However, studies in people with PML have been terribly underwhelming. Researchers feel that if there were better ways to target the therapy to the brain lesions and the virus, it may be worth revisiting the research on these therapies.

5HT2a Antagonists: This includes drugs like Remeron (mirtazapine) – a drug usually used to treat depression – and other similar drugs. Some speculate that this class of drugs might be useful in treating PML. Experts have gathered anecdotal information as they ponder further research. Their first reaction to the anecdotes is that they are not terribly impressive. Even still, when added to anti-HIV therapy, this class may provide a new therapy.

Other Possible Interventions: for study include interleukin-2 (IL-2), topoisomerase inhibitors (topotecan, camptothecin, etc.), adoptive cell therapy (enhancing JC virus-specific cellular immunity) and RNAs.

Prevention of Progressive Multifocal Leukoencephalopathy

  • The JC polyomavirus is latently found in most humans; the virus affects a large percentage of the population
  • The viral infection can be prevented by averting immunodeficiency situations, by providing suitable treatment and medical care after major surgeries (organ transplant), or when a body immunity system is weakened by other illnesses
  • The key preventive strategy against Progressive Multifocal Leukoencephalopathy is to keep the immune system healthy

Preeclampsia is defined as the presence of a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP).

Definition

Preeclampsia is defined as the presence of a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg or higher, on two occasions at least 4 hours apart in a previously normotensive patient. If the preeclampsia remains untreated, it can develop into eclampsia, in which the mother can experience convulsions, coma, and can even die. However, complications from preeclampsia are extremely rare if the mother attends her prenatal appointments.

Pathophysiology

The pathophysiology of preeclampsia likely involves both maternal and fetal/placental factors. Abnormalities in the development of placental vasculature early in pregnancy may result in relative placental underperfusion/hypoxia/ischemia, which then leads to release of antiangiogenic factors into the maternal circulation that alter maternal systemic endothelial function and cause hypertension and other manifestations of the disease (hematologic, neurologic, cardiac, pulmonary, renal, and hepatic dysfunction). However, the trigger for abnormal placental development and the subsequent cascade of events remains unknown.

Causes pertaining to Preeclampsia

Potential causes are being explored. These include:

  • Genetic factors
  • History of diabetes, kidney disease, lupus, or rheumatoid arthritis
  • Blood vessel problems
  • Insufficient blood flow to the uterus
  • Genetics plays a role, as well
  • Autoimmune disorders

Risk factors for Preeclampsia

There are also risk factors that can increase your chances of developing preeclampsia. These include:

  • Being pregnant with multiple fetuses
  • Being over the age of 35
  • Being in your early teens
  • Being pregnant for the first time
  • Being obese
  • Nulliparity
  • Multifetal pregnancy
  • Thrombotic disorders (eg, antiphospholipid antibody syndrome)
  • Having a history of high blood pressure
  • Having a history of diabetes
  • Having a history of a kidney disorder
  • History of lupus, or rheumatoid arthritis

Clinical manifestations of Preeclampsia

Signs and symptoms of preeclampsia include:

  • Changes in vision, like blurriness, flashing lights, seeing spots or being sensitive to light
  • A headache that doesn’t go away
  • Nausea (feeling sick to your stomach), vomiting or dizziness
  • Pain in the upper right belly area or in the shoulder
  • Sudden weight gain (2 to 5 pounds in a week)
  • Swelling in the legs, hands or face
  • Trouble breathing
  • Decreased urine output
  • Decreased levels of platelets in your blood (thrombocytopenia)
  • Excess protein in your urine (proteinuria)
  • Impaired liver function

Many of these signs and symptoms are common discomforts of pregnancy.

Complications associated with Preeclampsia

  • Fetal growth restriction or fetal death may result. Diffuse or multifocal vasospasm can result in maternal ischemia, eventually damaging multiple organs, particularly the brain, kidneys, and liver.
  • Factors that may contribute to vasospasm include decreased prostacyclin (an endothelium-derived vasodilator), increased endothelin (an endothelium-derived vasoconstrictor), and increased soluble Flt-1 (a circulating receptor for vascular endothelial growth factor).
  • Women who have preeclampsia are at risk of abruptio placentae in the current and in future pregnancies, possibly because both disorders are related to uteroplacental insufficiency.
  • The coagulation system is activated, possibly secondary to endothelial cell dysfunction, leading to platelet activation.
  • The HELLP syndrome (hemolysis, elevated liver function tests, and low platelet count) develops in 10 to 20% of women with severe preeclampsia

Diagnosis and Test

All women who present with new-onset hypertension should have the following tests:

  • CBC
  • Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels
  • Serum creatinine
  • Uric acid
  • 24-hour urine collection for protein and creatinine (criterion standard) or urine dipstick analysis

Additional studies to perform if HELLP syndrome is suspected are as follows:

  • Peripheral blood smear
  • Serum lactate dehydrogenase (LDH) level
  • Indirect bilirubin

Imaging Techniques

  • Ultrasonography: Transabdominal, to assess the status of the fetus and evaluate for growth restriction; umbilical artery Doppler ultrasonography, to assess blood flow
  • Cardiotocography: The standard fetal nonstress test and the mainstay of fetal monitoring
  • Head CT scanning is used to detect intracranial hemorrhage in selected patients with any of the following:
  1. Sudden severe headaches
  2. Focal neurologic deficits
  3. Seizures with a prolonged postictal state
  4. Atypical presentation for eclampsia

Treatment and Medications for Preeclampsia

  • Preeclampsia has no cure except for delivery of the baby. However, delivery may not always be the best option at the time preeclampsia is diagnosed. The treatment that the patient receives depends on the severity (mild versus severe) of the associated symptoms and the stage of the pregnancy.
  • Close monitoring of the woman and her fetus will be needed. Tests for the mother might include blood and urine tests to see if the preeclampsia is progressing, such as tests to assess platelet counts, liver enzymes, kidney function, and urinary protein levels. Tests for the fetus might include ultrasound, heart rate monitoring, assessment of fetal growth, and amniotic fluid assessment.
  • Anticonvulsive medication, such as magnesium sulfate, might be used to prevent a seizure.
  • Some of the medications used for stroke include labetalol, nifedipine or methyldopa.

Natural or Home Remedies

Lemon

If you are used to its juice, you have already found a wonderful way to hydrate your body, in addition to water. Get fresh lemon juice and combine it with warm water. Drink the mixture 2-3 times on a daily basis.

Ginger

One surprising fact about ginger root is that it prevents inflammation and swelling very effectively. Ginger has stimulating effects on blood circulation, which means that your baby will get more blood and oxygen as well.

  • Prepare several fresh ginger slices.
  • Mix them into warm water and boil them in several minutes.
  • Continue to steep them in the next 15 minutes.
  • Get it strained.
  • The warm tea can be consumed 2-3 times daily.

Garlic

Garlic is one of some natural foods with the greatest effects on high blood pressure. Our body has the higher level of hydrogen sulfide and nitric oxide. These substances possess relaxing effects on our blood vessels, which means that preeclampsia pain is under control.

  • Get several fresh garlic cloves grinded.
  • Then, combine garlic powder (about 3 teaspoons) with a cup of water.
  • Boil them for a few minutes before steeping in the next 20 minutes.
  • Strain the mixture

Beet

Being an excellent source of calcium, beet plays an important role in maintaining the balance of potassium and sodium in our blood. You should consume fresh beet juice by blending it every day to benefit the most from this natural ingredient.

Vitamin C

Vitamin C plays an essential role in human health, not to mention pregnant women. It is the key to a strong immunity, which ensures a lower risk of different infections. You can go for tomatoes, cabbage, potatoes, strawberries, bananas or citrus fruits.

Potassium

Among various nutrients, potassium is one of many irreplaceable. The appearance of potassium-rich foods in meals is a great suggestion for those who want to prevent preeclampsia. Some outstanding examples of these foods are bananas, avocados, chicken or beans.

Vitamin E

Another type of vitamin that is required in the treatment and prevention for preeclampsia is vitamin E. It is effective to improve blood circulation and reduce the risk of swelling. According to the National Institute of Health, pregnant women should take in about 15 mg on a daily basis. Vitamins E can be found in a variety of foods, for example, almonds, corn or fish.

Acupuncture

Acupuncture has great influence on the blood circulation inside our body, which reduces the risks of high blood pressure significantly. Of course, it should be applied only with the help of professionals. And you had better not abuse this method to cope with preeclampsia pain. Every time you intend to do this, please talk to your doctor for the best advice.

Prevention of Preeclampsia

  • Maintain a Healthy Weight
  • Get Regular Exercise: The benefits of exercise during pregnancy include reduced inflammation, help to reach and to maintain a healthy weight, and even defense against the effects of stress
  • Eat a Healing Diet to Reduce Blood Pressure Levels
  • Prevent Dehydration and Fatigue
  • Sleep is good for oh-so-many reasons, but it’s especially important for mama to get some rest.
  • Get some sunshine! Low vitamin D is associated with preeclamptic women in a study in Ireland. (You can also eat vitamin D-rich foods such as sardines, egg yolks, grass-fed butter, or cod liver oil.)

Hyperhidrosis is a medical condition where an excessive amount of sweat is produced by the sweat glands.

Definition

Hyperhidrosis is a medical condition where an excessive amount of sweat is produced by the sweat glands. The amount of sweat produced is out of proportion to the amount required to cool the body. This does not mean that sweating a lot after running on a hot summer’s day that you have hyperhidrosis. However, producing a deluge of sweat whilst at rest in a cool environment is more indicative of hyperhidrosis.

Hyperhidrosis in hand

Epidemiology

United States

In the United States and the United Kingdom, 1-1.6% of people have records reflecting hyperhidrosis. About 60% in both databases were women.

In adolescents and young adults, an incidence rate of 0.6-1% is reported for hyperhidrosis.

International

Palmoplantar hyperhidrosis occurs 20 times more frequently in the Japanese than in any other ethnic group.

Types of Hyperhidrosis

There are two forms of hyperhidrosis – primary and secondary.

Primary hyperhidrosis affects mainly the feet, palms, underarms and face. It is caused by the sympathetic nervous system sending signals to the nerves of the sweat glands, prompting them to increase sweat production unnecessarily.

Secondary hyperhidrosis affects the whole body and is primarily caused by certain medications, hormonal imbalances such as those caused by menopause, infections, metabolic conditions or neurological issues.

Risk factors

Risks for developing excessive sweating are related to the existing medical and underlying conditions of secondary hyperhidrosis.

Genetics

A genetic predisposition is believed to cause primary hyperhidrosis. If you have any family members who suffer from excessive sweating, the chances of you developing the condition are high.

Puberty

Excessive sweating generally develops during puberty where adolescents are consistently exposed to anxiety and stress which can lead to excessive sweating.

Menopause

Women going through menopause experience a variety of emotional and physical changes that can contribute to excessive sweating.

Abnormal Functions of the Brain and Nerves

If the brain has an impaired sensory response it can cause the sweat glands to mistakenly react to the body’s temperature. This causes the body to sweat abnormally.

Obesity

Although excessive sweating can affect any body type, people who are overweight are more susceptible to the condition. This is due to the fact the sweat glands have to operate twice as hard to cleanse the body of toxins as well as regulate the body’s temperature.

Hot Weather

Sweat helps to regulate our body’s temperature. When we are exposed to extreme heat or humidity the body needs to cool down and thus produces high levels of sweat to compensate for the heat. If you are visiting a hot place but normally live in colder conditions, you will sweat more than those who are used to the warmer climate. Other risk factors for developing excessive sweating include neurological disorders such as Parkinson’s disease, certain types of cancers such as Hodgkin’s disease, and variety of infections including HIV, and tuberculosis.

Causes of Hyperhidrosis

In many cases, hyperhidrosis has no obvious cause and is thought to be the result of a problem with the part of the nervous system that controls sweating. This is known as primary hyperhidrosis.

Hyperhidrosis that does have an identifiable cause is known as secondary hyperhidrosis. This can have many different triggers, including:

  • Pregnancy or the menopause
  • Anxiety
  • Certain medications
  • Low blood sugar (hypoglycemia)
  • An overactive thyroid gland (hyperthyroidism)

Symptoms

  • Signs of visible perspiration abundant: the sweat that bead on the face, which soaks the clothes even while remaining inactive or flowing on the worktop
  • Interference in daily activities: even the simplest gestures like operating a door wrist become difficult because of sweaty hands;
  • The skin always looks moist and softened. It whitens in some places and sometimes peels;
  • Frequent skin conditions on parts of the body that sweat excessively. Athlete’s foot, eczema, and itching in the groin are the most common.
  • Excessive perspiration during sleep or when nervous
  • Need to change clothes several times a day.

Complications of Hyperhidrosis

Complications of hyperhidrosis include:

Infections: People who sweat profusely are more prone to skin infections.

Social and emotional effects: Having clammy or dripping hands and perspiration-soaked clothes can be embarrassing. Your condition may affect your pursuit of work and educational goals.

Diagnosis and test

To make the diagnosis, your doctor will perform a physical examination to determine the presence of sweat, and will usually do medical tests to rule out any underlying conditions that might be causing generalized hyperhidrosis. Hyperhidrosis can also be diagnosed based on your history of experiencing excessive sweating.

Simple tests to confirm the condition may also be used. Two common tests include:

Starch-iodine test: A doctor applies iodine solution to the sweaty area and then sprinkles starch to look for a dark blue or purple color. This color indicates the area of excess sweat.

Paper test: A doctor places a special paper on the area where sweating is observed. Sweat absorbs into the paper and then the paper is weighed. The weight of the paper after the test indicates how much sweat was absorbed.

Treatment and Prevention

There are several treatments that can be effective for treating hyperhidrosis, including:

Aluminium chloride antiperspirants

Anti-perspirants containing 20-25% aluminium chloride (so-called “clinical strength” antiperspirant) are often the first line of defense for excessive sweating. Clinical strength anti-perspirant is available without the prescription at most pharmacies and even in the personal hygiene aisle of your neighborhood supermarket. Stronger prescription antiperspirants may contain up to 30% aluminium chloride, which is sometimes effective but can cause skin irritation.

Tap water iontophoresis

Iontophoresis, a treatment used for sweaty hands and feet, electrically charges a basin of tap water into which hands or feet are submerged. One study of the treatment reported that it is effective for palmoplantar (hands and feet) hyperhidrosis, and reported that 24/27 patients found the treatment dramatically improved their condition.

Iontophoresis for sweaty hands

Drionic Underarm Iontophoresis Device

Neuromodulators for hyperhidrosis

Neuromodulator injections are an effective treatment for hyperhidrosis. It is injected near the sweat glands in a quick and relatively painless treatment. Clinical studies on the treatment of hyperhidrosis with Neuromodulators has demonstrated that up to 81% of patients had a 50% reduction in sweating that lasted on average up to 6.7 months.

Underarms – are the most common and easiest place to treat. Botox is injected with tiny needles just under the skin.  It takes only minutes to complete.

Hands – also respond well to Neuromodulator injections.

Forehead – sweating occurs near the hairline and drips down the face.  A few small injections easily treat this.

Feet – like the hands, often require some anesthetic before treatment. It is not uncommon to find improvement of the feet after just the hands are treated.

Amenorrhea is the disappearance of menses in women who are at the reproductive stage.

Description

Amenorrhea is the disappearance of menses in women who are at the reproductive stage. But it is common in prepubertal, postmenopausal, and pregnant woman. It also ceases in the women when they are breastfeeding. Around the age of 50, mensuration stops permanently. However, it is a health problem rather than the disease.

Types of amenorrhoea

There are two types: Primary and Secondary amenorrhea.

Primary amenorrhea

Mensuration that does not occur at the puberty stage is referred as primary amenorrhea. Primary amenorrhea can be diagnosed if a patient has normal secondary sexual characteristics, but no menarche by 16 years of age. If a patient has no secondary sexual characteristics and no menarche, primary amenorrhea can be diagnosed as early as 14 years of age.

Secondary amenorrhea

The cessation of menses for 3 months at any time after the menarche has occurred is referred to as secondary amenorrhea. This is normal during pregnancy, lactation, and menopausal age. Sometimes secondary amenorrhea may also occur for 6 months in women who already have normal periods. Secondary amenorrhea is the more common than the primary amenorrhea. Amenorrhea that occurs more than 9 months is called as oligomenorrhea.

Pathophysiology of amenorrhea

In general, the hypothalamus produces a series of a regulating hormone called gonadotropin-releasing hormone (GnRH). It stimulates the pituitary gland to release gonadotropins (follicle-stimulating hormone [FSH] and luteinizing hormone into the bloodstream. Under the stimulation of gonadotropins, ovaries produce androgens, estrogens, and progesterone and these perform different functions in the reproductive system as follows.

  • FSH: It stimulates the tissues of the reproductive organ which are particularly around the developing oocytes.
  • Oestrogen induces the endometrial lining and causes proliferation.
  • Leutinising hormone releases during the menstrual cycle to promote the maturation and release of the oocytes. Then to form the corpus luteum, which produces the hormone progesterone.
  • It changes the lining of the endometrium into a secretory structure and strengthens it for the implantation of the egg.
  • If the pregnancy does not take place, then the production of estrogen and progesterone decreases and thus the endometrium disrupted and shed during menses.

Epidemiology

  • No evidence indicates that the prevalence of amenorrhea varies according to national origin or ethnic group. However, local environmental factors related to nutrition and the prevalence of chronic disease undoubtedly have an effect.
  • For instance, the age of the first menses varies by geographic location, as demonstrated by a World Health Organization study comparing 11 countries, which reported a median age of menarche of 13-16 years across centers.

Causes of amenorrhea

  • Natural causes: It can occur during pregnancy, lactation, and menopause stage of women.
  • Chromosomal or genetic abnormalities affect the function of ovaries and menstrual cycle. is Example: Turner syndrome
  • Problems with the hypothalamus or pituitary gland: It is an organ that regulates the releasing of gonadotropin-releasing hormone (GnRH), the hormone that starts the menstrual cycle. Pituitary tumors can also be a cause of amenorrhea.
  • Physical problems: Lack of reproductive organs and blockage of passages in the reproductive organs.
  • Gynecological conditions: Polycystic ovary syndrome (PCOS) and Fragile X-associated primary ovarian insufficiency (FXPOI),
  • Thyroid problems: Problem in the regulation of hormones by the thyroid gland. Hyperthyroidism and hypothyroidism cause irregularities in the menstrual cycle.
  • A family history of amenorrhea or early menopause
  • Some birth controls, such as pills, injections, or intrauterine devices. These can affect your menstrual cycle during and after use.
  • Medications: Antipsychotics, cancer chemotherapy, antidepressants, blood pressure drugs allergy medications.

Risk factors

  • Athletic training
  • Family history
  • Eating disorders
  • Women undertake high-volume/high-intensity exercise programs
  • Low fat, low carbohydrate diets
  • Use of anabolic steroids by female athletes is often responsible for a range of menstrual irregularities

Symptoms

The symptom of amenorrhea is the absence of menstrual cycle. You might experience symptoms other than the absence of menstrual cycle such as follows:

  • Milky discharge from breast who is not the pregnant (Galactorrhea) and changes in breast size
  • Reduced peripheral vision
  • Weight gain or weight loss may happen
  • Women may have psychological abnormalities with excessive anxiety
  • Vaginal dryness and pelvic pain
  • Increased hair growth in male pattern due to the androgen production
  • Acne and facial hair growth
  • Hair loss

Complications of amenorrhea

Some of the complications may arise such as:

  • Infertility ( ovulation doesn’t take place so you will not get pregnant)
  • Reduction in bone density cause weakness of bones (osteopenia or osteoporosis)

Diagnosis and test

First, your doctor may do the physical examination by examining the breast and genital area to see the normal changes in puberty.

Some of the following tests are carried out to determine the cause amenorrhea

  • Ultrasonography can be performed in pelvis area to determine the abnormalities in the genital tract or to check for polycystic ovary
  • MRI or CT scan of the head can be performed, to find out the pituitary and hypothalamic causes of amenorrhea
  • To determine the level of hormones secreted by the pituitary gland (FSH, LH, TSH, and prolactin) and the ovaries

The above tests are not  indecisive to determine amenorrhea, the additional tests can be carried out such as:

  • Determination of prolactin level
  • Thyroid function tests
  • Uterus examination can be carried out by doing X-ray for hysterosalpingogram and saline infusion sonography

Treatment and medications

The treatment depends on the cause of the amenorrhea as well as the health status of the person. The primary amenorrhea is the late puberty so it doesn’t manage or treated. This condition will go off later. Some of the causes can be managed by drug therapies such as follows:

  • Dopamine agonist such as bromocriptine (Parlodel) or pergolide (Permax) is effective for treating hyperprolactinemia. It restores the normal endocrine function and ovulation
  • Metformin (Glucophage) to induce ovulation in women’s with polycystic ovary syndrome
  • In some cases, oral contraceptives may be prescribed to restore the menstrual cycle and to provide estrogen replacement to women with amenorrhea who do not wish to become pregnant. Before administering oral contraceptives, withdrawal bleeding is induced with an injection of progesterone or oral administration of 5-10 mg of medroxyprogesterone (Provera) for 10 days
  • Hormone replacement therapy can be used for the women who have low level of estrogen and progesterone

Some of the surgery options are preferred by the physician when in extreme cases such as

  • Surgery may require for some pituitary and hypothalamic tumor in some cases by radiotherapy
  • Women with intrauterine adhesions require dissolution of the scar tissue.
  • Surgical procedures required for other genital tract abnormalities depend on the specific clinical situation.

Prevention of amenorrhea

A woman can prevent the amenorrhea by following programs

  • Sensible exercise programs
  • Maintaining body weight
  • Proper diet maintenance

The conditions when amenorrhea occurs due to genetic or during inborn cannot be prevented.

Malaria is one of the major public health problems of the country.

Definition

Malaria is one of the major public health problems of the country. Around 1.5 million confirmed cases are reported annually by the National Vector Borne Disease Control Programme (NVBDCP), of which 40–50% is due to Plasmodium falciparum. It is curable if effective treatment is started early. Delay in treatment may lead to serious consequences including death. Prompt and effective treatment is also important for controlling the transmission of malaria.

Epidemiology

  • 2 billion people live in areas at risk of malaria transmission in 106 countries and territories.
  • The World Health Organization estimates that in 2016 malaria caused 216 million clinical episodes and 445,000 deaths.

Types of malaria

Parasites of the genus Plasmodium cause malaria. Although there are many species of Plasmodium, only five infect humans and cause malaria.

P. falciparumFound in tropical and subtropical areas; major contributor to deaths from severe malaria

P. vivax: Found in Asia and Latin America; has a dormant stage that can cause relapses

P. ovale: Found in Africa and the Pacific islands

P. malariae: Worldwide; can cause a chronic infection

P. knowlesi: Found throughout Southeast Asia; can rapidly progress from an uncomplicated case to a severe malaria infection

Parasite life cycle

The life cycle of the falciparum malaria parasite is complex. When an infectious mosquito feeds on a human being, parasites (called sporozoites) are injected into the bloodstream. From here they travel directly to the liver where they mature for about 6 days. At this stage, there are no symptoms of disease in the person who has been infected.

The life cycle of the malarial parasite

Infections begin when the following stages occur:

  1. Sporozoites, the infective stages, are injected by a mosquito and are carried around the body until they invade liver hepatocytes.
  2. Then it undergoes a phase of asexual multiplication (exoerythrocytic schizogony) resulting in the production of many uninucleate merozoites. These merozoites flood out into the blood and invade red blood cells.
  3. They initiate the second phase of asexual multiplication (erythrocytic schizogony) resulting in the production of about 8-16 merozoites which invade new red blood cells.
  4. The infection progresses, some young merozoites develop into male and female gametocytes that circulate in the peripheral blood until they are taken up by a female anopheline mosquito when it feeds.
  5. Within the mosquito the gametocytes mature into male and female gametes, fertilization occurs and a motile zygote (ookinete) is formed within the lumen of the mosquito gut, the beginning of a process known as sporogony. The ookinete penetrates the gut wall and becomes conspicuous oocyst within which another phase of multiplication occurs resulting in the formation of sporozoites that migrate to the salivary glands of a mosquito and are injected when the mosquito feeds on a new host.

Risk factors of malaria

  • Rain and increased water bodies are appropriate for mosquito breeding and disease transmission.
  • Young children and infants.
  • Pregnant women.
  • People with weak immunity are more susceptible to the risk of malaria.
  • People traveling to malaria-infected areas.
  • Poverty and lack of health awareness and education contribute to spreading the disease and increasing mortality rate around the world.

Causes

Malaria can occur if a mosquito infected with the Plasmodium parasite bites you. There are four kinds of malaria parasites that can infect humans: Plasmodium vivaxP. ovaleP. malariae, and P. falciparumP. falciparum causes a more severe form of the disease and those who contract this form of malaria have a higher risk of death. An infected mother can also pass the disease to her baby at birth. This is known as congenital malaria. It is transmitted by blood, so it can also be transmitted through:

  • An organ transplant
  • A transfusion
  • Use of shared needles or syringes

Symptoms

A malaria infection is generally characterized by recurrent attacks with the following signs and symptoms:

  • Headache
  • Fever
  • Shivering
  • Joint pain
  • Vomiting
  • Hemolytic anemia
  • Jaundice
  • Hemoglobin in the urine
  • Retinal damage
  • Convulsions
  • Coma
  • Bloody stools
  • Abdominal pain
  • Shaking chills that can range from moderate to severe
  • High fever
  • Profuse sweating

Complications of malaria

  • Malaria is a serious illness that can be fatal if not diagnosed and treated quickly. Pregnant women, babies, young children and the elderly are, particularly at risk.
  • The Plasmodium falciparum parasite causes the most severe malaria symptoms and most deaths.
  • As complications of severe malaria can occur within hours or days of the first symptoms, it’s important to seek urgent medical help as soon as possible.

Other complications that can arise as a result of severe malaria include:

  • liver failure and jaundice – yellowing of the skin and whites of the eyes
  • shock – a sudden drop in blood pressure
  • pulmonary edema – a build-up of fluid in the lungs
  • acute respiratory distress syndrome (ARDS)
  • abnormally low blood sugar – hypoglycemia
  • kidney failure
  • swelling and rupturing of the spleen
  • dehydration

Diagnosis and test for malaria

Blood tests can show the presence of the parasite and help tailor treatment by determining:

  • Whether you have malaria
  • Which type of malaria parasite is causing your symptoms
  • If your infection is caused by a parasite resistant to certain drugs
  • Whether the disease is affecting any of your vital organs

Some blood tests can take several days to complete, while others can produce results in less than 15 minutes.

Blood test

Treatment and medications

Besides supportive care, the medical team needs to decide on the appropriate antibiotics to treat malaria. The choice will depend on several factors, including

  • The specific species of parasite identified,
  • The severity of symptoms, and
  • Determination of drug resistance based on the geographic area where the patient traveled.

Physicians will administer the medication in pill form or as an intravenous antibiotic depending on above factors.

The most commonly used medications are

  • Chloroquine (Aralen),
  • Doxycycline (Vibramycin, Oracea, Adoxa, Atridox),
  • Quinine (Qualaquin),
  • Mefloquine (Lariam),
  • Atovaquone/proguanil (Malarone),
  • Artemether/lumefantrine (Coartem), and
  • Primaquine phosphate (Primaquine).

Here are some home remedies for malaria

1. Grapefruit

Grapefruit contains a substance called quinine which is said to neutralize malaria inducing parasites. It aides in destroying the parasites and strengthens the immune system. A malaria patient should consume grapefruit and grapefruit juice to combat the disease.

2. Cinnamon

Cinnamon has great medicinal values and it contains cinnamaldehyde which provides aid against inflammation. This spice is full of anti-parasitic qualities. Its consumption provides immediate relief to body ache that is usually attached to malaria. It can be boiled with water and the concoction can be taken with honey. It also reverses the loss of appetite, cramps, nausea etc. Consuming this concoction can be a very useful home remedy to fight malaria.

3. Holy basil

Often the major symptoms of malaria include body and joint pains. Holy basil is a popular herb which eases inflammation and joint pains. It can be an amazing home remedy to treat the symptoms of malaria. It is also included in many ayurvedic medicines and is said to cure many diseases including malaria. Basil can be infused with tea or can be boiled with water and consumed with honey by the person suffering from malaria.

4. Fever nuts

These are nuts which contain seeds with immense medicinal properties. It breaks the malaria fever and boosts the immune system. This herb effectively treats the symptom of malaria and helps in curing the person suffering from malaria fever by reducing the soaring body temperatures. Fever nuts are one of the best home remedies that can be used against malaria symptoms. This is one of the best home remedy one can do to prevent malaria.

5. Ginger

Possible qualities of ginger help in relieving nausea, fever, body ache and in improving the appetite. Ginger is one food item which is available in every Indian household and can be used as a home remedy to fight malaria and is symptoms. It can be boiled with water and can be consumed to speed up the recovery process. It has natural antibiotic properties which can be enhanced if it is taken with raisins. This is one of the best home remedy one can do to prevent malaria.

Prevention

  • Use mosquito repellents regularly – apply it to your skin, especially to all exposed areas, and clothing. For your skin, opt for a repellent that contains at least a 10 percent concentration of DEET.
  • Use camphor as a repellent- you can light camphor in the room with all the doors and windows closed. Leave it for about 15-20 minutes to keep the mosquitoes away. You can also use the lemon and clove technique- just stick some cloves in a half-sliced lemon and keep it near your bed while you sleep.
  • Use a mosquito bed net while sleeping.
  • Wear long-sleeved shirts, pants, and socks.
  • Wear covered shoes when outside.
  • Avoid exercising outdoors as mosquitoes get attracted to sweat.
  • Empty and clean all containers that hold water such as flower pots, flower vases, and animal dishes – at least once a week – to prevent mosquitoes from breeding at your house.
  • Keep your surroundings clean, ensuring that there is no stagnant water, which is a breeding ground for the mosquitoes?
  • Try to stay in air-conditioned or well-screened housing.

A migraine is a neurological condition that causes a severe or a moderate headache on one side of the head.

Description

A migraine is a neurological condition that causes a severe or a moderate headache on one side of the head with throbbing pain. This headache may radiate towards the forehead or temple, eyes and makes a person to develop nausea, vomiting, vision problems, and sensitivity to normal light or mild exertion.

People describe migraine pain as:

  • Pulsating
  • Throbbing
  • Perforating
  • Pounding
  • Debilitating

“Classic” migraines begin with an aura such as seeing visual field changes (dots, wavy lines, blurriness) about an hour or less before the pain begins.

Pathophysiology

A migraine is a brain disorder that involves an altered regulation and control of afferents, with a particular focus on the cranium. The once-popular vascular theory of a migraine, which suggested that a migraine headache was caused by the dilatation of blood vessels, while the aura of migraine resulted from vasoconstriction, is no longer considered viable. Vasodilatation, if it occurs at all during spontaneous migraine attacks, is probably an epiphenomenon resulting from instability in the central neurovascular control mechanism.

Types of a migraine

  • A migraine with aura – where there are specific warning signs just before a migraine begins, such as seeing flashing lights.
  • A migraine without aura – It is the most common type, where a migraine occurs without the specific warning signs.
  • Migraine aura without a headache, also known as a silent migraine – where an aura or other migraine symptoms are experienced, but a headache doesn’t develop.

Causes

The exact causes of a migraine are still unknown.

  • Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway.
  • Imbalances in brain chemicals such as serotonin regulate pain in the nervous system. But still, research is going on to study the actual role of serotonin during migraines.
  • Generally, serotonin levels drop during migraine attacks. This may cause your trigeminal nerve to release substances called neuropeptides, which travel to your brain’s outer covering (meninges). The result is migraine pain. Other neurotransmitters play a role in the pain of a migraine, including calcitonin gene-related peptide (CGRP).

Risk factors

  • Changes in the weather
  • Changes in your daily schedule
  • Skipping a meal
  • Change in your sleeping pattern
  • Strong light
  • Smells which stimulate
  • Strong noises
  • Menstruation
  • Ovulation
  • Pill-free days if you take the pill.

Risk factors of a migraine from food

  • Wine
  • Chianti
  • Derivatives of red wine
  • Champagne
  • Sherry
  • Beer and white wine

Symptoms

  • Eye pain
  • Sensitivity to light or sound
  • Nausea
  • Vomiting
  • Severe pain
  • Food cravings
  • Depression
  • Fatigue or low energy
  • Frequent yawning
  • Hyperactivity
  • Irritability
  • Neck stiffness

Complications

  • Extensive deterioration in the quality of life.
  • Significant disability, affecting home life, work, and social activities.

Diagnosis and Test

Doctors diagnose migraines by listening to your symptoms, taking a thorough medical and family history, and performing a physical exam to rule out other potential causes. Imaging scans, such as a CT scan or MRI, can rule out other causes, including:

  • Tumors
  • Abnormal brain structures
  • Stroke

Treatment and medication

Migraines can’t be cured, but your doctor can help you manage them. Your treatment plan depends on your age, frequency of a migraine, type, and symptoms. The treatment pattern includes the combination of the following steps:

  • Self-care migraine remedies
  • Lifestyle adjustments, including stress management and avoiding migraine triggers.
  • OTC pain or migraine medications, such as NSAIDs or acetaminophen (Tylenol)
  • Painkillers – including over-the-counter medications such as paracetamol and ibuprofen
  • Triptans – medications that can help reverse the changes in the brain that may cause migraines
  • Anti-emetics – medications often used to reduce nausea and vomiting
  • Counseling
  • Alternative care, which may include biofeedback, meditation, acupressure, or acupuncture

Prevention

  • Sleep Smart: Sleep is a critical trigger. Too long or too little sleep can bring on a migraine. Therefore it is much important to have your sleep time constant.
  • Do not skip your meals. When your blood sugar level drops brain is the first organ that feels it. Hunger is the common cause of headaches.
  • Be conscious of your caffeine level.
  • Sometimes drastic exercise activity can spark a migraine. Following moderate activity will give your overall health a boost and help you stay headache-free.
  • Even dehydration can cause a migraine and so it is a must to drink too much water when you are roaming under the sunlight.
  • Hours in front of a computer or TV can strain your eyes. Eyestrain leads to head pain. Take breaks often. Stretch, close your eyes, and get up to get your blood flowing.
  • Sometimes tooth pain can also trigger a migraine thus it is advised to take care of your teeth health.

The cervix is placed at the closure of the uterus, arriving at into the vagina.

Definition

The cervix is placed at the closure of the uterus, arriving at into the vagina. The point when the exterior tissues of the cervix get inflamed, more often than not through infection, this is called cervicitis. About 50% of all ladies will experience one session or a greater amount of cervicitis in their lifetimes. Cervicitis has several causes.

Cervicitis is an irritation of the cervix the easier part of the uterus expanding about an inch into the vaginal waterway. Most ordinarily, cervicitis is the infection, despite the fact that it can additionally be initiated by harm or irritation (a response to the chemicals in douches and contraceptives, for instance, or a disregarded tampon).

The foremost symptom of cervicitis is prone to be a vaginal discharge that comes to be more declared quickly emulating your menstrual period. Different signs include bleeding, itching, or irritation of the external genitals; pain throughout intercourse; a burning sensation throughout urination; and lower back pain. In its mildest form, you may not perceive any side effects whatsoever, yet a more intense instance of cervicitis can make a bountiful, practically discharge like, and discharge with an upsetting smell, joined by compelling vaginal irritation or stomach pain. Provided that the spoiling gets into your framework, you might additionally have fever and nausea.

Types

Cervicitis is classified according to the following types:

Acute Cervicitis

Manifestations of the acute form of the disease are expressed significantly. The patient is concerned with purulent or abundant mucosal leucorrhoea, vaginal itching and burning, which are intensified by urination. Also may be painful in cervicitis. Usually, it is a dull or aching pain in the lower abdomen, a painful intercourse. Other symptoms of the disease are due to concomitant pathology. If the inflammatory process of the cervix has arisen against the background of cystitis, worries about frequent and painful urination. With adnexitis and inflammatory process in the cervix, there is an increase in temperature from subfebrile (above 37) to febrile digits (38 and above). With the combination of pseudo-erosion and cervicitis, spotting after coition may appear. A distinctive feature of the disease is the aggravation of all clinical symptoms after menstruation.

Chronic Cervicitis

The disease, which was not adequately treated on time in an acute stage, is chronic. Symptoms of chronic cervicitis are less or less pronounced. The discharge acquires a turbid-mucous character, the flat epithelium of the vaginal part of the cervix is replaced by a cylindrical cervical channel, and pseudo-erosion of the cervix is formed. Inflammatory phenomena (redness and swelling) are poorly expressed. When the inflammation spreads to the surrounding tissues and into the interior, the cervix becomes denser, it is possible again to replace the cylindrical epithelium with the ectopia, which is accompanied by the formation of the set cysts and infiltrates.

Risk factors

You may be at higher risk for cervicitis if you:

  • Had recent sexual intercourse without a condom
  • Recently had multiple sexual partners
  • Have had cervicitis before

Studies show that cervicitis will recur in 8% to 25% of women who get it.

Causes of Cervicitis

  • There are quite a few reasons for the emergence of cervicitis. The most common are a variety of infections of the genitals, which include both venereal diseases (gonorrhea, chlamydia, etc.), and genital herpes, candidiasis or human papillomavirus.
  • The next cause of cervicitis is trauma cervix as a result of frequent sexual acts or the use of tampons during menstruation. Because of minor damage, the cervix becomes exposed to infectious processes.
  • Often cervicitis is diagnosed in women who started sexually early or often change partners. Thus, these factors can also be called the causes of the appearance of the disease.
  • The last cause of cervicitis is mechanical damages of the cervix, which may result from an abortion, a diagnostic curettage, or the installation of a contraceptive spiral.

Symptoms

Some cases of cervicitis in women can be symptomless. However, in most cases, symptoms are present, and they include:

  • Persistence of gray or white vaginal discharge that may or may not smell
  • Vaginal bleeding under certain conditions e.g. in between periods or after sex
  • Pain during intercourse
  • Backache
  • Difficulty or pain during urination
  • In rare cases, fever or pain in the abdomen

Complications of Cervicitis

Untreated cervicitis can give rise to a host of other problems, particularly if the underlying cause is an infection. Some potential complications are listed below:

  • Having cervicitis is associated with a higher risk of contracting HIV infection.
  • If the patient is already HIV positive, having cervicitis can increase the probability of transmitting the virus to their partners.
  • This is the inflammation of the endometrium or inner lining of the uterus.
  • Inflammation of the fallopian tubes. This is known as salpingitis.
  • Pelvic Inflammatory Disease (PID), a severe condition that could leave the reproductive system permanently damaged.
  • Infertility.
  • Neonatal infections and other problems due to exposure of the fetus to infection while passing through the birth canal.
  • Cervicitis may also be implicated in giving rise to cervical cancer.

Diagnosis and test

There are multiple ways cervicitis can be diagnosed.

Pelvic Exam

For this test, your doctor will insert a gloved finger into your vagina while also applying pressure to the abdomen. This way, he or she can detect abnormalities of the pelvic organs, which include the cervix.

Pap Test

For this test, also called a Pap smear, your doctor will take a swab of cells from your vagina and cervix. These cells will then be tested for abnormalities.

Cervical Biopsy

This test is often performed only if your Pap smear detected abnormalities. For this test, also called a colposcopy, your doctor will insert a speculum into your vagina. He or she will then take a cotton swab and gently clean the vagina and cervix of mucus residue. Then, the doctor will direct a light and colposcope (a type of microscope) at your vagina to examine the area. He or she will then take tissue samples from any areas that look abnormal.

The culture of Cervical Discharge for Microscopic Examination

Your doctor may also decide to take a sample of the discharge from your cervix. He or she will then place the sample under a microscope. This test can determine if you have a yeast infection (candidiasis), bacterial vaginosis, or trichomoniasis, among other conditions.

Tests for sexually transmitted infections (STIs) may also be performed. If a specific infection is contributing to your cervicitis, the infection will be treated. This should heal the cervical inflammation.

Treatment and medications

Depending on the cause of inflammation, treatment of chronic cervicitis consists of:

Symptomatic treatment of the symptoms of the chronic cervicitis if it is caused by non-infectious agents is done where the patient is prescribed medicines to reduce inflammation.

Antibiotics are prescribed if the bacterial infection is the cause of Chronic Cervicitis.

Antiviral medications are prescribed if the viral infection is the cause of Chronic Cervicitis.

Procedures such as cryotherapy and laser therapy can also be done to treat Chronic Cervicitis.

Avoiding sexual intercourse is important until the completion of treatment and until the chronic cervicitis is completely resolved. It is also important to treat the patient’s partner if the cause of chronic cervicitis is a sexually transmitted infection.

Prevention of Cervicitis

Things you can do to reduce your risk of developing cervicitis include:

  • Avoid irritants such as douches and deodorant tampons.
  • Make sure that any foreign objects you insert into your vagina (such as tampons) are properly placed. Be sure to follow instructions on how long to leave it inside, how often to change it, or how often to clean it.
  • Make sure your partner is free of any STI. You and your partner should not have sex with any other people.
  • Use a condom every time you have sex to lower your risk of getting an STI. Condoms are available for both men and women but are most commonly worn by the man. A condom must be used properly every time.

Neuropathic pain is defined as pain caused by a lesion or dysfunction in the nervous system.

Definition             

Neuropathic pain is defined as pain caused by a lesion or dysfunction in the nervous system. There is no noxious (pain causing) stimulus that is causing the pain. Rather, the pain results from inappropriate signals in the nervous system. Unlike physiologic pain, which serves to warn and protect individuals from possible or actual injury, neuropathic pain serves no useful purpose.

Some examples of peripheral neuropathic pain include:

  • Postherpetic neuralgia (pain occurring after shingles);
  • Diabetic neuropathy;
  • Pain following limb amputation.

Types of Neuropathic Pain

Painful diabetic neuropathy

Having diabetes and high blood sugar levels can damage your nerves, especially those in the legs and feet. This condition – diabetic neuropathy – can cause pain as well as numbness and tingling.

Trigeminal neuralgia

Trigeminal neuralgia is a disorder of the trigeminal nerve – the nerve that supplies sensation to the face and controls some of the muscles involved in chewing. People with trigeminal neuralgia have episodes of severe facial pain that last from a couple of seconds to several minutes.

Post-herpetic neuralgia

About one in every 5 people with shingles (a painful rash is also known as herpes zoster) develops post-herpetic neuralgia – ongoing pain in the area that was affected by the rash. It occurs when the shingles virus damages the underlying nerves, and the resulting pain can last for months or years.

Phantom limb pain

This condition affects people who have had an arm or leg amputated, causing pain or discomfort in the area of the now-missing limb. The exact cause of phantom limb pain is not known, but it is thought to be due to changes in both the nerves of the affected limb and the central nervous system (brain and spinal cord) following amputation.

Mechanisms/pathophysiology

Neuropathic pain results from damage to an afferent pathway that can be the result of a disease, trauma, or dysfunction.

Ectopic nerve activity/Peripheral Sensitization This mechanism is responsible for pain sensed in the absence of external stimuli. Spontaneous nerve activity has been shown in both the injured nerve as well as uninjured neighboring nerves. This spontaneous activity is thought to be related to an increase in voltage-gated sodium channel expression. This increased expression allows for decreased activation thresholds and increased membrane excitability. Additional expressional changes of other channels (i.e. K+) are also likely to occur but are less studied at this point.

Protein regulation is also altered with nerve damage. For example, a protein TRPV1 (transient receptor protein V1) that is activated at noxious stimuli around 40 Celsius is downregulated at injured fibers but upregulated at nearby uninjured fibers. This may decrease the activation temperature (i.e. to 38 Celsius, near body temperature) and result in the sensation of noxious heat/burning stimuli near the site.

Central Sensitization Regular discharge from peripheral nerves causes a release of excitatory neuropeptides and amino acids in the dorsal horn. This leads to phosphorylation of NMDA and AMPA receptors and expression of voltage-gated sodium channels (similar to ectopic nerve activity). This results in neuronal hyperexcitability that can lead to allodynia and hyperalgesia via activation of mechanosensitive A-beta and A-delta afferent fibers connecting with second-order nociceptive neurons.

Inflammatory reaction Inflammation results in activation of microglia in the nerve as well as the dorsal root ganglion. A proinflammatory milieu is created including cytokines, chemokines, substance P, TNF alpha, etc. These factors facilitate neuropathic pain by further enhancing neuron excitability.

What causes neuropathic pain?

Neuropathic pain often seems to have no obvious cause. But some common causes of neuropathic pain include:

  • Alcoholism
  • Amputation
  • Chemotherapy
  • Diabetes
  • Facial nerve problems
  • HIV infection or AIDS
  • Multiple myelomas
  • Multiple sclerosis
  • Nerve or spinal cord compression from herniated discs or from arthritis in the spine
  • Shingles
  • Spine surgery
  • Syphilis
  • Thyroid problems

What are the risk factors for Neuropathic Pain?

Anything that leads to loss of function within the sensory nervous system can cause neuropathic pain.

  • As such, nerve problems from carpal tunnel syndrome or similar conditions can trigger neuropathic pain.
  • Trauma, causing nerve injury, can lead to neuropathic pain.
  • Other conditions which can predispose patients to develop neuropathic pain include diabetes, vitamin deficiencies, cancer, HIV, stroke, multiple sclerosis, shingles, and cancer treatments.

What are the Symptoms of Neuropathic Pain Exactly?

Each person’s symptoms of neuropathic pain may be different, but these symptoms are common:

  • Shooting, burning or stabbing pain
  • Tingling and numbness, or a “pins and needles” feeling
  • Spontaneous pain, or pain that occurs without a trigger
  • Evoked pain, or pain that’s caused by events that are typically not painful, such as rubbing against something, being in cold temperatures, or brushing your hair
  • A chronic sensation of feeling unpleasant or abnormal
  • Difficulty sleeping or resting
  • Emotional problems as a result of chronic pain, loss of sleep, and difficulty expressing how you’re feeling

Complications of Neuropathic Pain

  • Patients with chronic nerve pain may suffer from sleep deprivation or mood disorders, including depression and anxiety.
  • Because of the underlying neuropathy and lack of sensory feedback, patients are at risk of developing injury or infection or unknowingly causing an escalation of an existing injury.

Diagnosis and Screening

If your doctor suspects you may have neuropathic pain, he or she will ask about your pain and any other sensations you experience, such as pins and needles or numbness. Your doctor will also want to know about any events or illnesses that may have caused it.

Your doctor will perform a physical examination, testing the nerves in the affected area. They may touch the skin in the affected area with cotton wool, toothpicks or warm or cool objects as part of the examination.

If your symptoms and physical examination suggest you have neuropathic pain your doctor can prescribe specific treatment for this type of pain.

To make a definite diagnosis of neuropathic pain, the underlying cause of the pain needs to be found. Your doctor may recommend tests including:

  • Blood tests
  • Nerve conduction studies (to measure how quickly your nerves can carry electrical signals)
  • An MRI scan

Biopsy

Sometimes a biopsy (tissue sample) can help with diagnosis. A skin biopsy (looking for a reduced density of nerve fibres in the skin) or a nerve biopsy (looking for abnormalities in the nerve fibres) may be recommended.

Treatment and medications that cure Neuropathic Pain

Treatment of neuropathic pain first entails addressing the underlying problem. For example, if a person has neuropathic pain from diabetes, optimizing blood sugar (glucose) control is an essential next step. Bear in mind, though, enhanced glucose control cannot generally reverse the neuropathy, although it can prevent it from getting worse and ease current symptoms.

As another example, if a medication is causing debilitating nerve pain, removal or a decrease in the dose of the offending drug may be all that is needed.

First-Line Medications

Besides treating the underlying problem, medication is often needed to manage neuropathic pain.

For the vast majority of patients, treatment of neuropathic pain involves taking one of the following:

  • An antidepressant like Cymbalta (duloxetine) or Elavil (amitriptyline)
  • An anti-seizure medication like Neurontin (gabapentin) or Lyrica (pregabalin)

In terms of side effects, nausea is the most common side effect of Cymbalta. Elavil generally poses more of a problem, mostly because of its risk for heart toxicity, as well as other bothersome side effects, including:

  • Dry mouth
  • Constipation
  • Urinary retention
  • Lightheadedness or dizziness when standing up

Neurontin may cause dizziness, tiredness, confusion, and swelling in the lower legs. Lyrica may cause dizziness, tiredness, dry mouth, swelling, and blurry vision.

Second-Line Medications

Opioids like Vicodin (hydrocodone/paracetamol) and Percocet (oxycodone/acetaminophen) are not as effective for treating neuropathic pain and, thus, are considered second-line treatments. In addition to their questionable benefit, opioids are associated with several side effects.

The potential side effects of opioids may severely affect a person’s quality of life and include:

  • Nausea and vomiting
  • Constipation
  • Itching
  • Dry mouth
  • Urinary retention
  • Drowsiness
  • Memory and thinking problems
  • Slowed breathing

In addition to these side effects, there is a nationwide concern for opioid addiction and abuse, which must be considered.

Unique Therapies

There are some types of neuropathic pain that may require a unique treatment plan.

  • For instance, if a person’s neuropathic pain is localized, as is often the case in postherpetic neuralgia, a topical (on the skin) therapy, like a lidocaine patch may be used.
  • In other instances, surgery may be necessary—for example, to release a compressed nerve, as in carpal tunnel syndrome. In the case of a herniated disc, in which an inflamed spinal nerve is a culprit behind the pain, an epidural steroid injection into the spine is sometimes performed.
  • Lastly, sometimes certain medications are used to treat specific neuropathic pain conditions. A classic example is a trigeminal neuralgia, which is characterized by severe, stabbing neck and facial pain. This disorder is treated with the anti-seizure medication, Tegretol (carbamazepine) or Trileptal (oxcarbazepine).

Complementary Therapies

There are a variety of complementary therapies that can help relieve neuropathic pain. These therapies are commonly used in combination with medications and include:

  • Physical or occupational therapy
  • Relaxation therapy
  • Massage therapy
  • Acupuncture

How to prevent Neuropathic Pain?

The best way to prevent neuropathic pain is to avoid the development of neuropathy.

  • Monitoring and modifying lifestyle choices, including limiting the use of tobacco and alcohol
  • Maintaining a healthy weight to decrease the risk of diabetes, degenerative joint disease, or stroke
  • Using the good ergonomic form at work or when practicing hobbies to decrease the risk of repetitive stress injury are ways to decrease the risk of developing neuropathy and possible neuropathic pain.

Evil: Missing mother of two, found butchered and buried at the backyard of the suspect.

According to a report made available to oneworld, it was learnt that the mother of two, Mercy Henry, has come to an end.

The 35-year-old woman was found, butchered dead and was buried in different sacks behind a building belonging to the prime suspect, Mr. Mayowa Timothy Bamidele.

R.I.P Mercy Henry.

It will be recalled that Bamidele had repeatedly, vehemently denied seeing Mercy. In fact, he maintained that he last saw her four years ago.

The deceased’s grieving father, Pa Henry Ekienabor, 70, choking on emotion, said: “It’s rather unfortunate that my daughter was killed, mutilated and buried at the back of Mayowa’s house. She was killed on the same December 16th, 2021 that she left home.

Police called my son on January 14th, 2022, to tell us the development. I was hoping and praying that maybe they had been able to track and locate where her captors kept her.

The Police told us that she was murdered in cold blood, mutilated and then buried. After mutilating her corpse, she was then packed into five sacks and buried at the back of Mayowa’s house.

Police have gone to the scene to exhume her remains.

Pa Ekienabor further stated, that the breakthrough in the case was said to have started after the Police arrested four people alongside Mayowa.

During interrogation, the detectives appealed to the four suspects that anyone who gives them useful information wouldn’t be punished.

One of the four men raised his hand and then volunteered information to the police. Police went there, searched the house and zeroed in on the spot where Mercy was buried.

Police recovered her handbag, Automated Teller Machine (ATM) card and her phone. These items were hidden in one of the uncompleted houses inside the blocks there. Till tomorrow, Mayowa is still denying knowing anything about the matter, but when the police brought him out of the cell after interrogating the other four suspects; he saw them and almost collapsed. Yes, he knows them.

They are working together, so he couldn’t deny it.

Pa Ekienabor, who opined that Mayowa probably killed Mercy for money ritual purposes, added, All the men of God, women of God, pastors, Bishops, I went to, all assured me Mercy was being kept somewhere, that we should pray, that she would come out, we didn’t know that she had been killed and buried for long.

Yes, she was killed three minutes after her friend, Ayo, transferred N30, 000 into Mayowa’s First Bank Account.” Mercy on December, 16, told her family that she was heading to Ijegun, a suburb of the Ikotun area of Lagos State; she however, never mentioned the name of the person she was going to visit. Ekienabor said: “On December 16th I got a call from my son that Mercy didn’t return home to sleep.

She had told everyone she was going to Ijegun, but she didn’t mention the name of the person she was going to see. That same night, her siblings started calling all her friends, asking if they had heard or seen Mercy.

One of her friends residing at Port Harcourt, named Ayo, said that she spoke with Mercy at noon time. She said that Mercy called, asking for a loan of N30, 000, that she needed it for treatment at a trado-medical home, that she was short of blood and getting leaner.

Ayo told us that she paid the money into a First Bank account bearing the name, ‘Mayowa Timothy Bamidele,’ given to her by Mercy. The money landed in the account at 1:59pm and at 2:02pm, Mercy’s phone number stopped going. Since then, we’ve not been able to reach her.

The following day, the anxious family members dashed to Gowon Police Station to make a formal complaint, declaring Mercy missing. Using the information supplied by Ayo, the police went to First Bank and with the assistance of the Bank, Mayowa; the account holder that received the N30, 000, was arrested.

He, however, denied seeing Mercy. Pa Ekienabor said: “He claimed to have seen Mercy four years ago when she came to his traditional birth centre to deliver a baby girl.

But his phone history and chats showed that he and Mercy spoke on December 15th about 9pm. Now, if you call her phone it would be switched off, but at night it would ring twice or thrice, then it would be switched off. It shows that someone used to charge it.

The children of Mercy, following her disappearance, had been asking for her, but relatives told them their mom would soon be home, unaware she had been killed and buried.

The Lagos State Police Public Relations Officer (PPRO), Mr. Adekunle Ajisebutu, who confirmed the disappearance of Mercy and arrest of Mayowa last week, while speaking with our reporter on the latest development, said: It’s true some suspects have been arrested and exhibits recovered.

We will make a comprehensive press statement soon.

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