The heart valve disease is the damage in one of the heart valves such as the mitral valve, aortic, tricuspid and pulmonary.


The heart valve disease is the damage in one of the heart valves such as the mitral valve, aortic, tricuspid and pulmonary. It can disrupt the blood flow to the heart by tissue flopping. The heart valves work by ensuring that blood flows in a forward direction and doesn’t back up or cause leakage.

If you have a heart valve disorder, the valve isn’t able to do this job properly. This can be caused by a leakage of blood, which is called regurgitation, a narrowing of the valve opening, which is called stenosis, or a combination of regurgitation and stenosis. Your heart valve disease treatment depends on the heart valve affected and the type and severity of the valve disease. Sometimes heart valve disease requires surgery to repair or replace the heart valve.


Valvular heart disease (VHD) is a common condition in clinical practices that are strongly connected to heart dysfunction and death. This explains the important changes in the presentation of valvular disease, which now mainly affects predominantly older people. However, rheumatic heart disease remains the main etiology in developing countries.

The overall VHD prevalence in the USA is 2.5% with a wide age-related variation from 0.7–13.3%6. The prevalence increased significantly with age, from less than 2% before 65 years, to 8.5% between 65 years and 75 years, and 13.2% after 75 years. Similar age tendencies were also demonstrated in the Euro Heart Survey7.


There are two main types of heart valve disease

Valvular insufficiency: It is also called regurgitation, incompetence or “leaky valve”. It occurs when the valves are not tight. So the blood may leak across the valve and it may worsen by working harder the valve and the rest blood may flow to the rest of the body. Based on the wall affected it is called as tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation or aortic regurgitation.

Valvular stenosis: It occurs when the valve is smaller than normal due to fused leaflets or stiff. The narrowed valve makes the heart to pump very hard to make blood flow to the body. This leads to heart failure. All the valves can be stenotic and it is called tricuspid stenosis, pulmonic stenosis, mitral stenosis or aortic stenosis.

Risk factors

Some of the risk factors are as follows:

  • As older the age your heart valve becomes thicker and stiffer
  • Infection of pericardium and lining of heart valves. It is called as Infective Endocarditis
  • Congenital heart disorders.
  • Myocardial infarction, coronary artery disease, and heart attack
  • People who with rheumatic fever, heart failure and previous heart valve diseases are higher risks of heart valve disease
  • High blood pressure, smoking, high blood cholesterol, overweight or obesity, insulin resistance and intravenous drug use
  • Some babies born with aortic valve had two valves instead of three valves

Causes of heart valve disease

  • Heart valve disease can develop before birth or sometimes after the birth can be acquired due to infection and other heart conditions. The main cause of the heart valve disease is unknown.
  • Your heart has four valves that make the blood to flow incorrect directions. These valves include the pulmonary valve, aortic valve, tricuspid valve and mitral valve. Each has flaps that close and open when flows in each heartbeat.
  • Sometimes infection may also cause heart valve disease. The microbes may enter the bloodstream and thus it infects the surface of the heart muscles and valves. This rare but serious infection is called infective endocarditis. The germs can enter the bloodstream through needles, syringes and other medical devices or through skin wounds or gums.
  • Rheumatic fever, untreated strep throat or other infections that progress to rheumatic fever can also cause heart valve disease.

Heart valve diseases include:

Stenosis is the condition when the heart valves become stiff and fused. This may result in narrowing valve opening and decreased blood flow.

Atresia is the condition in the valve is not formed, in which solid sheet of tissue blocks the blood flow between the chambers.

Regurgitation is the condition in which the valves don’t close properly and thus it causes blood to flow backward in your heart. It commonly occurs due to the valve bulging back and the condition is called prolapse.

Heart failure means your heart is working less efficiently and cannot pump a normal amount of blood.

Atrial fibrillation is an abnormal heart rhythm that starts in the atria (upper chambers of the heart). It can cause a rapid, disorganized heartbeat.

Mitral valve prolapse is a common cause of a heart murmur caused by a “leaky” heart valve.

Symptoms associated with heart valve diseases

  • Shortness of breath or difficulty catching your breath
  • Heart palpitations may come as irregular heartbeats, rapid heart rhythm, skipped beats or a flip-flop feeling in the chest.
  • Edema: swelling of ankle, abdomen, feet, and even belly, which can cause you to feel bloated.
  • Weakness or dizziness: Feeling very much weak and sick. Sometimes dizziness and fainting can occur.
  • Weight can be increased about one or two pounds a day.
  • Feels discomfort like pressure or a weight on the chest while doing activities.
  • Panic, anxiety, and fatigue.
  • Numbness or tingling in the hands and feet.
  • Wet cough.
  • Blood clots.

Diagnosis and Test

If any people admitted with valvular disease, a doctor will look for patient’s medical history and their physical examination. Some of the diagnostic techniques are also used as follows.

Electrocardiogram (EKG or ECG): It is a diagnosing technique to read about the heart electrical activity, heart rate, rhythm and the size of the heart chambers. It is a painless and non-invasive procedure using electrodes that are attached to various parts of the chest and the trunk region.

Cardiac catheterization: It is fully an invasive procedure, in which a catheter is inserted into an artery present in the leg or arm and slowly propelling into the heart. After that, along with the catheter, a dye is also injected to visualize the damaged heart valves through an X-ray imaging.

Echocardiogram: Sound waves are used to frame a moving image of the heart. The echocardiogram is much more definite than the images obtained by X-ray imaging and also it doesn’t use any radiation. The image obtained from this imaging technique is probably used to find out the deformity of the muscles, valves of the heart. It is also supposed to identify any fluid that is surrounding the heart.

Chest x-ray: it is a technique used electromagnetic radiations to take a picture of the bones. But it is employed to find the changes in the size of the heart. Enlargement of the heart can be easily identified through an X-ray image.

Stress test: Variety of exercise test is performed to identify the amount of stress tolerance and at the same time to monitor the response of the heart to physical exercises. In some cases, patients aren’t able to perform physical exercise, during such conditions medications are used to mimic the effect of exercise on the heart.

Treatment and medication

Heart valve repair

If any of the heart valves is repaired you will probably have any of the following procedures according to the fault in your heart.

  • Commissurotomy: it is a procedure to remove the severely narrowed valves because of scar tissue in the flaps of valves, and calcium deposits on the valve. It is usually employed in people shouldn’t have balloon valvotomy.
  • Decalcification: Calcium deposits are excised to allow the valve leaflets more flexible and to close free flow.
  • Leaflet reshaping: floppy leaflets are excised out, after that the flap will be tailored back together. This allows the valves to close tightly. This procedure is also called as quadrangular resection.
  • Chordal transfer: If the anterior leaflet of your mitral valve is floppy (your doctor may say it has prolapse), the tendons that connect your valves — called the chordae — are moved from your posterior leaflet to your anterior leaflet. Then, the posterior leaflet is fixed by the reshape leaflets procedure.
  • Annulus support or annuloplasty: The tissue that supports valves called valve annulus. If this valve annulus is too wide then a doctor will tailor a ring-like structure around the valve. The ring may be made of synthetic material or a biological tissue, which maintains the original shape of the valve.
  • Patched leaflets: Your surgeon may use tissue grafts to repair any leaflets that have tears or holes.

Heart valve replacement

If the heart valve repair surgery is failed or cannot be repaired, your doctor will go for valve replacement surgery. During this surgery damaged valve is removed and a new synthetic valve is sewn with the tissues of the old valve.

The new valve can be of two varieties as follows:

  • Mechanical valve: It is fully made up of mechanical parts, which operates on the external source or automatically. Usually, these valves are covered by a polyester knit fabric.
  • Biological or bioprosthetic valve: it is usually made up of animal or human tissue and even it can be generated using natural materials like collagen, chitosan, and other biomaterials through tissue engineering techniques.


  • ACE inhibitors & Vasodilator: As the name suggests it opens the blood vessels fully and can help to reduce high blood pressure and slow heart failure.
  • Anti-arrhythmic medications: They help to restore a usual pumping rhythm to the heart.
  • Antibiotics: It can help to prevent the occurrence of infections in the heart.
  • Anticoagulants (blood thinners): Reduces the risk of developing blood clots due to poor circulation of blood through the faulty heart valves. Blood clots are highly dangerous because they can lead to stroke.
  • Beta-blockers: They can reduce the stress by aiding the heart to beat slowly. In some instances, it may help to get rid of the heart palpitations.
  • Diuretics (water pill): They assist to reduce the amount of fluid in the tissues and bloodstream which can minimize the stress on the heart.

Lifestyle changes to prevent the onset of heart valve diseases

Healthy lifestyle improves the overall health of the heart and can help to slow the progression of heart diseases. Some healthy choices include:

  • Healthy Diet: Take low fat, low salt, low cholesterol diet and also avoid excessive intake of caffeine and alcohol.
  • Don’t Smoke: If you do smoke, get help from a doctor to quit. You will immediately escape from the risk of heart disease as soon as you quit
  • Reduce mental stress through exercise: Daily physical activity is a great way to get rid of stress, disturbed sleep, excess weight, and also improves your overall sense of wellbeing. Always consult with a doctor before beginning any new physical activity.

Dry mouth, or xerostomia, refers to a condition in which the salivary glands in your mouth don’t make enough saliva to keep your mouth wet.


Dry mouth, or xerostomia, refers to a condition in which the salivary glands in your mouth don’t make enough saliva to keep your mouth wet. It is often due to the side effect of certain medications or aging issues or as a result of radiation therapy for cancer. Less often, dry mouth may be caused by a condition that directly affects the salivary glands.

Saliva helps prevent tooth decay by neutralizing acids produced by bacteria, limiting bacterial growth and washing away food particles. Saliva also enhances your ability to taste and makes it easier to chew and swallow. In addition, enzymes in saliva aid in digestion. Decreased saliva and dry mouth can range from being merely a nuisance to something that has a major impact on your general health and the health of your teeth and gums, as well as your appetite and enjoyment of food.


Stimulation of the oral mucosa signals the salivatory nuclei in the medulla, triggering an efferent response. The efferent nerve impulses release acetylcholine at salivary gland nerve terminals, activating muscarinic receptors (M3), which increase saliva production and flow. Medullary signals responsible for salivation may also be modulated by cortical inputs from other stimuli (eg, taste, smell, anxiety).

Causes that develops Xerostomia

Possible causes include:

Medications: Many prescription and OTC medications cause dry mouth, including antihistamines, decongestants, hypertensive medications (for high blood pressure), antidiarrheals, muscle relaxants, urinary continence drugs, some Parkinson’s disease medications, as well as a number of antidepressants.

Age: Even though the dry mouth is not a natural part of aging, older adults tend to take more medications than the rest of the population. Many of the medications taken by seniors cause dry mouth.

Cancer treatment: Radiotherapy (radiation therapy) to the head and neck can damage the salivary glands, resulting in less saliva being produced. Chemotherapy can alter the nature of the saliva, as well as how much of it the body produces.

Injury or surgery: This can result in nerve damage to the head and neck area can result in dry mouth.

Tobacco: Either chewing or smoking tobacco increases the risk of dry mouth symptoms.

Dehydration: This is caused by lack of sufficient fluids.

Exercising or playing in the heat: The salivary glands may become dry as bodily fluids are concentrated elsewhere in the body. Dry mouth symptoms are more likely if the exercise or playing continues for a long time.

Some health conditions, illnesses, and habits can cause dry mouth, such as:

  • Anxiety disorders
  • Depression
  • Parkinson’s disease
  • Poorly controlled diabetes
  • Sjögren’s syndrome
  • Sleeping with the mouth open
  • Snoring
  • Stroke and Alzheimer’s disease, although these are more likely to cause a perception of dry mouth even when the salivary glands are functioning appropriately

Risk Factors for Xerostomia

Frequently a consequence of:

  • Stress
  • Radiation therapy of the head and neck
  • Glandular fibrosis or destruction
  • Mouth breathing
  • C Pap use
  • Circadian rhythms
  • Gender

A side effect of certain diseases and infections include Sjögren’s syndromeSarcoidosis, HIV/AIDS, Alzheimer’s disease, Diabetes, Anemia, Cystic fibrosis, Crohn’s disease, Systemic Lupus, Erythematosus, Rheumatoid arthritis, Hypertension, Parkinson’s disease, Stroke, Mumps, Scleroderma, and Hepatitis.

A side effect of using recreational drugs include MethamphetaminesCocaine, and Ecstasy

Symptoms and associated complications

A lack of moisture in the oral cavity can cause several different clinical signs and symptoms that hamper the quality of life of patients that suffer from xerostomia. If you’re not producing enough saliva, you may notice these signs and symptoms all or most of the time:

  • Dryness or a feeling of stickiness in your mouth
  • Saliva that seems thick and stringy
  • Bad breath
  • Difficulty chewing, speaking and swallowing
  • Dry or a sore throat and hoarseness
  • Dry or grooved tongue
  • A changed sense of taste
  • Problems wearing dentures
  • In addition, dry mouth may result in lipstick sticking to the teeth.

The most common complications are related to:

  • Chewing
  • Swallowing
  • Phonation
  • An alteration of taste perception (dysgeusia),
  • Pasty morning mouth
  • Burning mouth sensation

A decrease in saliva makes the soft tissues more susceptible to dryness, redness, irritation and cracking, facilitating the attack of opportunistic microorganisms. This, in turn, promotes inflammation of the mucosa (mucositis), inflammation of the gums (gingivitis), the presence of painful ulcerations and local fungal infections such as candidiasis, lip fissures, halitosis. It is often related to pharyngitis, laryngitis, dyspepsia or constipation.

The main effects of reduced salivary flow on dental tissues include an increase in carious lesions and tooth sensitivity.

In patients with xerostomia who wear dental prostheses, rubbing causes erosion on oral mucosa.

Diagnosis and Test for Xerostomia

History – Specifics of the complaint of dry mouth are obtained: duration, frequency, and severity. The history of dryness at other sites (eyes, nose, throat, skin, and vagina) is documented. A complete medical and prescription drug history is obtained.

Examination – Major salivary glands are palpated for the presence of tenderness, firmness, or enlargement. The amount and quality of saliva coming from the ducts inside the mouth is assessed. The presence of dry or reddish oral mucosa is noted. The extent and pattern of dental decay are evaluated.

Salivary flow rate – In this test, the amount of saliva produced during a specified amount of time may be measured. The test is non-invasive and painless.

Scintigraphy – Performed in the hospital, this test measures the rate at which a small amount of injected radioactive material is taken up from the blood by the salivary glands and secreted into the mouth. It is another method to measure salivary flow rate.

Biopsy of minor salivary glands – A small, shallow incision is made inside the lower lip to remove at least four of minor salivary glands. A pathologist then examines them for changes characteristic of the salivary component of Sjögren’s syndrome.

Treatment and Medications

You can do some things to relieve dry mouth temporarily. But for the best long-term dry mouth remedy, you need to address its cause.

To relieve your dry mouth:

  • Chew sugar-free gum or suck on sugar-free hard candies to stimulate the flow of saliva. For some people, xylitol, which is often found in sugar-free gum or sugar-free candies, may cause diarrhea or cramps if consumed in large amounts.
  • Limit your caffeine intake because caffeine can make your mouth drier.
  • Don’t use mouthwashes that contain alcohol because they can be drying.
  • Stop all tobacco use if you smoke or chew tobacco.
  • Sip water regularly.
  • Try over-the-counter saliva substitutes – look for products containing xylitol, such as Mouth Kote or Oasis Moisturizing Mouth Spray, or ones containing carboxymethylcellulose or hydroxyethyl cellulose, such as Biotene Oral Balance.
  • Try a mouthwash designed for dry mouth — especially one that contains xylitol, such as Biotene Dry Mouth Oral Rinse or ACT Total Care Dry Mouth Mouthwash, which also offers protection against tooth decay.
  • Avoid using over-the-counter antihistamines and decongestants because they can make your symptoms worse.
  • Breathe through your nose, not your mouth.
  • Add moisture to the air at night with a room humidifier

Saliva is important to maintain the health of your teeth and mouth. If you frequently have a dry mouth, taking these steps to protect your oral health may also help your condition:

  • Avoid sugary or acidic foods and drinks because they increase your risk of tooth decay.
  • Brush with a fluoride toothpaste — ask your dentist if you might benefit from prescription fluoride toothpaste.
  • Use a fluoride rinse or brush-on fluoride gel before bedtime. Occasionally a custom-fit fluoride applicator (made by your dentist) can make this more effective.
  • Visit your dentist at least twice yearly to detect and treat tooth decay or other dental problems.

If these steps don’t improve your dry mouth, talk to your doctor or dentist. The cause could be a medication or another condition.

Prevention of Xerostomia

There are a number of steps you can take to help minimize dry mouth, including:

  • Sipping water or sugarless drinks often and during meals
  • Avoiding drinks with caffeine, such as coffee, tea, and some sodas
  • Professional recommendation for oral care products that will assist in moisturizing the mouth
  • Chew sugarless gum or suck on sugarless hard candy to stimulate saliva flow citrus, cinnamon or mint-flavored candies are good choices
  • Avoid tobacco or alcohol, which dry out the mouth
  • Minimize spicy or salty foods, which may cause pain in a dry mouth
  • Avoid sugar and acidic foods
  • Using a humidifier at night

Overactive bladder Syndrome is a health condition that causes a variety of symptoms, many of which can cause feelings of embarrassment.


Overactive bladder Syndrome is a health condition that causes a variety of symptoms, many of which can cause feelings of embarrassment. Dealing with these symptoms can sometimes cause you to want to isolate yourself or limit your social and work life activities to avoid feeling uncomfortable. The most common symptoms include:

  • The sudden urge to urinate
  • Inability to control urination (urge incontinence)
  • Frequent urination

An overactive bladder also causes nocturia, when you’re woken up by the urge to urinate. A frequent urge to urinate not only leaves you running for the bathroom, but it can also be a true disruption to your everyday life.


Earlier reports estimated that about one in six adults in the United States and Europe had OAB. The prevalence of OAB increases with age, thus it is expected that OAB will become more common in the future as the average age of people living in the developed world is increasing.

However, a recent Finnish population-based survey suggested that the prevalence had been largely overestimated due to methodological shortcomings regarding age distribution and low participation (in earlier reports). It is suspected, then, that OAB affects approximately half the number of individuals as earlier reported.

The American Urological Association reports studies showing rates as low as 7% to as high as 27% in men and rates as low as 9% to 43% in women. Urge incontinence was reported as higher in women. Older people are more likely to be affected, and the prevalence of symptoms increases with age.

Risk factors of Overactive Bladder Syndrome

  • Older age
  • Increased BMI/metabolic syndrome
  • Diabetes
  • Depression
  • Neurological disorders
  • Pregnancy
  • Vaginal delivery
  • Post-menopause
  • Cystitis and chronic bladder


There are several factors that may cause Overactive Bladder Syndrome or may make it worse.

  • Urinary tract infections may inflame and irritate the lining of the bladder, which can make it more sensitive and prone to being overactive.
  • Caffeinated and carbonated drinks and some citrus and spicy foods may cause irritation of the bladder.
  • Certain neurological conditions including Multiple Sclerosis may disrupt normal bladder function.
  • Sometimes the bladder may fail to empty completely. If there is an obstruction or if there is a prolapse blocking the flow of urine, this can lead to an overactive bladder as there is not enough storage space available.
  • Certain medications may disrupt bladder activity.
  • Bladder abnormalities such as tumors or bladder stones.
  • Sometimes there is no known cause for Overactive Bladder Syndrome.

Symptoms of Overactive Bladder Syndrome

The symptoms include:

The frequency of urination: A person will urinate more than eight times a day.

Nocturia: A person cannot sleep through the night without waking up to urinate, usually one to two times.

Urinary urgency: A person will experience a sudden and uncontrollable urge to urinate.

Urge incontinence: A person will leak urine when they experience the urge to urinate.

A person with an overactive bladder may often feel like they can’t completely empty their bladder. They may use the restroom and then feel like they need to go again a very short time after.


Any type of incontinence can affect your overall quality of life. If your overactive bladder symptoms cause a major disruption to your life, you might also have:

  • Emotional distress or depression
  • Anxiety
  • Sleep disturbances and interrupted sleep cycles
  • Issues with sexuality

Diagnosis and test

Medical History

Your health care provider will ask you a number of questions to understand your medical history. This should include information about the symptoms you are having, how long you have had them, and how they are changing your life.

Physical Exam

Your health care provider will examine you to look for something that may be causing your symptoms. In women, the physical exam will likely include your abdomen, the organs in your pelvis, and your rectum. In men, a physical exam will include your abdomen, prostate, and rectum.

Bladder Diary

You may be asked to keep a bladder diary, where you will note how often you go to the bathroom and any time you leak urine. This will help your health care provider learn more about your day-to-day symptoms.

Other Tests

Urine culture: Your health care provider may ask you to leave a sample of your urine to test for infection or blood.

Bladder scan: This type of ultrasound shows how much urine is still in the bladder after you go to the bathroom.

Cystoscopy:  During this test, the doctor inserts a narrow tube with a tiny lens into the bladder. This can be used to rule out other causes of your symptoms.

Urodynamic testing: These tests check to see how well your lower urinary tract stores and releases urine.

Symptom Questionnaire: Many doctors use a written quiz to ask questions about your bladder problems and what causes you the most bother.

Treatment  of Overactive Bladder Syndrome

Kegel or pelvic floor retraining exercises: These exercises teach you how to strengthen the muscles of the pelvic floor. By contracting the muscles that support the bladder, you strengthen and tighten the bladder outlet. These exercises need to be done on a regular basis and as discussed with your health professional in order for them to be successful.

Bladder training or bladder drill: By gradually increasing the time between each visit to the bathroom you may be able to train your bladder so that the urge to urinate does not occur as often. Your doctor will provide education on this technique and how to schedule your bathroom visits. While you are doing this, your doctor may ask you to reduce your fluid intake. Always discuss any change of fluid intake with your doctor.

Surgery: Those who don’t experience relief from OAB with medications or other treatments may benefit from surgery. Surgery may be aimed at reducing the nerve stimulation that causes the involuntary contractions of the bladder, increasing the size of the bladder, or creating a different pathway for urine to be drained.

Medications for OAB include

Antimuscarinic (antispasmodic) medications: These medications reduce the number of involuntary bladder contractions by preventing spasm of the detrusor muscle that causes them, and increase bladder capacity. In general, these medications can reduce leakage of urine caused by OAB by 60% to 75%. Examples of antimuscarinic medications include:

  • Darifenacin
  • Oxybutynin
  • Solifenacin
  • Tolterodine
  • Trospium

The most common side effects of antimuscarinic medications are dry mouth, dry eyes, increased pressure inside the eye, and constipation. Be sure to tell your doctor about all of the medications you are taking and all of your medical conditions, as there are some people who should not take antimuscarinic medications. These side effects can be minimized by starting with a low dose of medication and gradually increasing the dose.

Prevention of Overactive Bladder Syndrome

OAB prevention and managing options include:

  • Staying hydrated but not overhydrated
  • losing weight
  • treating chronic constipation through medication or diet
  • pelvic floor muscle exercises, including Kegels
  • treating urinary and bladder infections
  • quitting smoking to reduce coughing
  • regular exercise

Many foods and drinks worsen OAB symptoms. Making a few dietary changes will often reduce symptoms greatly.

Caffeine, alcohol, and salty foods can act as a diuretic, increasing urine output and trips to the bathroom.

Epididymitis is an inflammation of the epididymis.

What is epididymitis?

Epididymitis is an inflammation of the epididymis. The epididymis is a tube located at the back of the testicles that stores and carries sperm. When this tube becomes swollen, it can cause pain and swell in the testicles.

Epididymitis can affect men of all ages, but it’s most common in men between ages 14 and 35. It’s usually caused by a bacterial infection or a sexually transmitted disease (STD). The condition usually improves with antibiotics.

Acute epididymitis lasts six weeks or less. In most cases of acute epididymitis, the testes are also inflamed. This condition is called epididymo-orchitis. It can be difficult to tell whether the testes, epididymis, or both are inflamed. That’s why the term epididymo-orchitis is commonly used. According to the Centers for Disease Control and Prevention (CDC) Trusted Source, gonorrhea and chlamydia are the most common causes in men 35 years old or younger

Chronic epididymitis, on the other hand, lasts six weeks or more. Symptoms include discomfort or pain in the scrotum, epididymis, or the testicles. This may be caused by granulomatous reactions, which can result in cysts or calcifications.

Pathophysiology of epididymitis

The pathophysiology of epididymitis is divided; Chlamydia trachomatis and Neisseria gonorrhoeae are the most common pathogens in patients younger than 35 years, whereas Enterobacteriaceae and gram-positive cocci are frequent pathogens in older patients. In either case, infection results from a retrograde ascent of infected urine from the prostatic urethra into the vas deferens and, finally, into the epididymis.

Causes of epididymitis

The spread of bacterial infection usually causes epididymitis. This infection will often start in the urethra, prostate, or bladder.

Two main types of infection cause epididymitis:

Sexually transmitted infection (STI)

Epididymitis caused by an STI, such as gonorrhea or chlamydia, is most common in young, heterosexual men; particularly those who have sex with multiple partners and do not use a condom.

Cases of epididymitis that are not caused by an STI are less common.

Urinary tract infection (UTI)

Epididymitis caused by a UTI occurs in children, older men, and men who have sex with men. The following factors often cause UTIs in men:

  • Enlarged prostate pressing on the bladder
  • Insertion of a catheter into the penis
  • Surgery on the groin, bladder, or prostate gland


While cases of epididymitis in children are rare, they do occur. Often the bacterial infection will spread from the urethra or bladder.

Inflammation will usually develop due to one of the following:

  • Direct injury to the area
  • Twisting of the epididymis
  • Urine flowing back into the epididymis

Other causes

There are also some more unusual causes of epididymitis:

  • Mumps
  • Tuberculosis
  • High doses of a medication called amiodarone, usually taken for heart rhythm problems
  • Groin injury
  • Structural problems in the urinary tract
  • Behcet’s disease
  • Congenital kidney and bladder problems

Risk factors

Certain sexual behaviors that can lead to STIs put you at risk of sexually transmitted epididymitis, including having:

  • Sex with a partner who has an STI
  • Sex without a condom
  • History of STIs

Risk factors for nonsexually transmitted epididymitis include:

  • History of prostate or urinary tract infections
  • History of medical procedures that affect the urinary tract, such as insertion of a urinary catheter or scope into the penis
  • An uncircumcised penis or an anatomical abnormality of the urinary tract
  • Prostate enlargement, which increases the risk of bladder infections and epididymitis


When a bacterial infection strikes, the epididymis gradually becomes swollen and painful. This usually happens on one testicle, rather than both. It can last up to 6 weeks if untreated.

You might have one or more of these other possible symptoms:

  • Redness, swelling, or tenderness in the scrotum, the sac that contains the testes
  • A more frequent or urgent need to pee
  • A lump on your testicle
  • Painful urination or ejaculation
  • Fever
  • Bloody urine
  • Discomfort in your lower abdomen
  • Enlarged lymph nodes in your groin
  • A lump on your testicle

See your doctor if you have any of these symptoms.

Complications of epididymitis

If left untreated, acute epididymitis can lead to a range of complications, including:

  • Chronic epididymitis – the inflammation can become persistent, even when there is no bacterial infection present
  • Abscess – a ball of pus can accumulate inside the epididymis or nearby structures, requiring surgery to drain the pus
  • Destruction of the epididymis – the inflammation can permanently damage or even destroy the epididymis and testicle, which can lead to infertility
  • Spread of infection – the infection can spread from the scrotum to any other structure or system of the body.

How is Epididymitis diagnosed?

A health care practitioner will take a detailed history (including a sexual history), collect a urine sample, and perform a physical examination, including a prostate exam.

Laboratory Tests

  • Urinalysis and urine culture: These tests aid in the diagnosis of a urinary tract infection (bladder infection).
  • Urethral culture
  • Urine can be tested for sexually transmitted diseases present in the urethra.
  • Sometimes a swab is inserted about a one-half inch into the urethra and sent for testing (although uncomfortable, it only takes a few seconds).
  • The results usually take about a day to come back to the health care practitioner, so follow-up is very important.
  • The health care practitioner often also orders other tests such as a white blood cell count. A white blood cell count may be high if the infection is present. A Gram-stain of urethral exudates, in some cases, can presumptively diagnose the infecting bacteria.
  • There are several rapid tests for some of the bacteria that cause epididymitis (N. gonorrhea, C. trachomatis). They detect the organisms by PCR and immunological methods. However, these tests usually require confirmation by actually culturing the bacteria.

Imaging Tests

  • Ultrasound and nuclear scans help differentiate testicular torsion from epididymitis.
  • CT and MRI scans are used occasionally to help determine and differentiate between many conditions that can cause some symptoms similar to epididymitis (for example, cysts, hydrocele formation (fluid-filled area), hernias, cancerous tissue, or the extent of abscesses or gangrene in swollen testicles).

The correct diagnosis of the cause of epididymitis by health care practitioners is important because an incorrect diagnosis may lead to many problems beyond the symptoms in the individual. The majority of infections involving the epididymis (over 50%) are due to sexually transmitted infectious agents or by bacteria acquired during sexual intercourse. Consequently, sexual partners of many patients should be notified and treated, even if they currently show no symptoms. However, many men (usually older than 39 years of age) and some children can acquire the disease without it being linked to sexual transmission (for example, bladder infection or chemical inflammation). Consequently, health care practitioners need to take a detailed history from the patient, and the patient has the responsibility to answer medical history questions honestly. The situation is even more complex when children have symptoms of epididymitis; most experts suggest that a Child Protective Agency be contacted if sexual abuse is suspected.


Antibiotics are used to treat epididymitis caused by:

  • STDs. A variety of antibiotics work against chlamydia and gonorrhea. These infections are the most common causes of epididymitis related to STDs. To prevent the spread of these diseases, all your sex partners should receive antibiotics as well.
  • Intestinal bacteria. A variety of antibiotics work against this type of infection.

A young boy with epididymitis probably will be referred to a urologist. This doctor specializes in illnesses of the urinary tract and male reproductive organs. The urologist will check for urinary tract problems.

For epididymitis the following measures can help relieve the discomfort and may lead to quicker recovery:

  • Rest in bed for a day or two.
  • Elevate your scrotum with a towel.
  • Apply cold packs to the painful area.
  • Drink plenty of fluids, especially water.
  • Take a nonsteroidal anti-inflammatory drug (NSAID) to relieve pain and inflammation. Ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) are NSAIDs.

People with severe pain in the scrotum may need prescription pain medication.


  • You can reduce your risk of developing epididymitis caused by STDs.
  • Practice safe sex.
  • Have sex with only one, uninfected partner.
  • Use latex or polyurethane condoms during every sexual activity. This includes oral and anal sex.

US government said on Friday January 21 it would suspend 44 Chinese flights.

According to oneworld news cjannel it was gathered that the US government said on Friday January 21 it would suspend 44 China-bound flights from the United States by four Chinese carriers in response to the Chinese government’s decision to suspend some US carrier flights over COVID-19 concerns.

The suspensions will begin on Jan 30 with Xiamen Airlines’ scheduled Los Angeles-to-Xiamen flight and run through Mar 29, the Transportation Department said.

The decision will cut some flights by Xiamen, Air China, China Southern Airlines and China Eastern Airlines.

Since Dec 31, Chinese authorities have suspended 20 United Airlines, 10 American Airlines and 14 Delta Air Lines flights, after some passengers tested positive for COVID-19. As recently as Tuesday, the Transportation Department said the Chinese government had announced new US flight cancellations.

Liu Pengyu, a spokesman for the Chinese Embassy in Washington, said Friday the policy for international passenger flights entering China has “been applied equally to Chinese and foreign airlines in a fair, open and transparent way.

He called the US move very unreasonable and added We urge the US side to stop disrupting and restricting the normal passenger flights by Chinese airlines.

Airlines for America, a trade group representing the three US carriers affected by China’s move along with others, said it supported Washington’s action to ensure the fair treatment of US airlines in the Chinese market.

The Transportation Department said France and Germany have taken similar action against China’s COVID-19 actions.

It said China’s suspension of the 44 flights are adverse to the public interest and warrant proportionate remedial action.

It added that China’s unilateral actions against the named US carriers are inconsistent” with a bilateral agreement.

China has also suspended numerous US flights by Chinese carriers after passengers later tested positive.

The department said it was prepared to revisit its action if China revised its policies to bring about the necessary improved situation for US carriers.” It warned that if China cancels more flights, we reserve the right to take additional action.

China has all but shut its borders to travellers, cutting total international flights to just 200 a week, or 2 per cent of pre-pandemic levels, the Civil Aviation Administration of China (CAAC) said in September.

The number of US flights being scrapped has surged since December, as infections caused by the highly contagious Omicron variant of the coronavirus soared to record highs in the United States.

Beijing and Washington have sparred over air services since the start of the pandemic. In August, the US Transportation Department limited four flights from Chinese carriers to 40 per cent passenger capacity for four weeks after Beijing imposed identical limits on four United Airlines flights.

Before the recent cancellations, three US airlines and four Chinese carriers were operating about 20 flights a week between the countries, well below the figure of more than 100 per week before the pandemic.

Hundreds of Malaysians rally around the Capital demanding resignation of the Anti Graft Chief.

According to Homepage news channel, it was learnt that hundreds of Malaysians rallied in the capital on Saturday (Jan 22), demanding the country’s powerful anti graft chief  resign over a stock trading controversy where he owned millions of shares.

Wearing masks and shouting reject corruption, the mostly black-clad crowd of about two hundred called for immediate action against Azam Baki, the Malaysian Anti Corruption.

Protests in the Southeast Asian nation have been rare since the beginning of the COVID-19 pandemic due to virus curbs and fears of infection.

But public anger over corruption has previously led to mass demonstrations and election upsets, with the multi-billion-dollar 1Malaysia Development Berhad (1MDB) scandal contributing to the longest-governing coalition’s downfall in 2018.

Azam, a key investigator into the former regime’s looting of the 1MDB state fund, has been under scrutiny for weeks over allegations of improper proxy trading after he admitted to letting his brother use his account.

Azam has denied any wrongdoing, while Malaysia’s securities regulator said this week that he had control of his account at the time of the trades, clearing him.

But that has not appeased the public.

We have come because we cannot allow the practice of corruption to continue, Mohamad Zawawi Ishak, 29, told AFP as a crowd massed in front of a city train station at about 11am.

In the fight against corruption, whoever is corrupt, we have to fight.

Sivaranjani Manickam, 41, said the government was encouraging more corruption by not punishing Azam.

Anger is making us come out to the streets today to protest, she said.

Police closed several major roads city-wide as dozens of officers, including some in riot gear, tailed the crowd before rally-goers dispersed peacefully less than two hours later.

A MACC veteran of over 36 years, Azam was appointed head of the anti-graft department in 2020 in the midst of efforts to claw back pilfered funds.

That same year, ex-leader Najib Razak was convicted of corruption and given a 12-year jail term. He is awaiting a final appeal at the country’s top court while facing two other ongoing 1MDB-related trials.

Syphilis is an infection by the Treponema pallidum bacteria that is transmitted by direct contact with a syphilitic sore on the skin.


Syphilis is an infection by the Treponema pallidum bacteria that is transmitted by direct contact with a syphilitic sore on the skin, and in mucous membranes. A sore can occur on the vagina, anus, rectum, lips, and mouth. It is most likely to spread during oral, anal, or vaginal sexual activity. Rarely, it can be passed on through kissing. The first sign is a painless sore on the genitals, rectum, mouth, or skin surface. Some people do not notice the sore because it doesn’t hurt. These sores resolve on their own, but the bacteria remain in the body if not treated. The bacteria can remain dormant in the body, sometimes for decades, before returning to damage organs, including the brain.

History of Syphilis

The history of syphilis has been well studied, but the exact origin of the disease is unknown. There are two primary hypotheses: one proposes that syphilis was carried to Europe from the Americas by the crew of Christopher Columbus as a by-product of the Columbian exchange, while the other proposes that syphilis previously existed in Europe but went unrecognized. These are referred to as the “Columbian” and “pre-Columbian” hypotheses.

The first written records of an outbreak of Treponema pallidum in Europe occurred in 1494/1495 in Naples, Italy, during a French invasion. Because it was spread by returning French troops, the disease was known as “French disease”, and it was not until 1530 that the term “syphilis” was first applied by the Italian physician and poet Girolamo Fracastoro. The causative organism, Treponema pallidum, was first identified by Fritz Schaudinn and Erich Hoffmann in 1905.The first effective treatment (Salvarsan) was developed in 1910 by Sahachirō Hata in the laboratory of Paul Ehrlich which was followed by the introduction of penicillin in 1943. Many famous historical figures including Franz Schubert and Édouard Manet are believed to have had the disease.


International statistics

Internationally, the prevalence of varies by region. It remains prevalent in many developing countries and in some areas of North America, Asia, and Europe, especially Eastern Europe. The highest rates are in South and Southeast Asia, followed closely by sub-Saharan Africa. The third highest rates are in the regions of Latin America and the Caribbean. In some regions of Siberia, as of 1999, prevalence was 1300 cases per 100,000 population.

Age distribution

Syphilis is most common during the years of peak sexual activity. Most new cases occur in men and women aged 20-29 years. In 2013, the rate of primary and secondary syphilis was highest in people aged 25-29 years (27 per 100,000).

The incidence of congenital syphilis has increased to 11.6 cases per 100,000 live births in 2014, the highest congenital syphilis rate reported since 2001. The number of congenital syphilis cases declined in the United States during 2008-2012, from 446 to 334 cases (10.5 to 8.4 cases per 100,000 live births) but is increasing; from 2012-2014, the number of reported congenital syphilis cases in the United States increased from 334 to 458.

Sex distribution

Men are affected more frequently with primary or secondary syphilis than women. This difference has varied over time. Male-to-female ratios of primary and secondary syphilis increased from 1.6:1 in 1965 to nearly 3:1 in 1985. After, the ratio decreased, reaching a nadir in 1994-95. The past decade has seen a sharp rise in syphilis cases among men, driven mostly by the MSM community. Males with primary and secondary syphilis outnumber females 10 to 1. Among women, the reported primary and secondary syphilis rate increased from 0.9 to 1.5 per 100,000 population per year during 2005- 2008 and decreased to 0.9 in 2013.

Risk factors

You face an increased risk of acquiring it if you:

  • Engage in unprotected sex
  • Have sex with multiple partners
  • Are a man who has sex with men
  • Are infected with HIV, the virus that causes AIDS

Causes of Syphilis

  • The cause of syphilis is a bacterium called Treponema pallidum. The most common route of transmission is through contact with an infected person’s sore during sexual activity. The bacteria enter your body through minor cuts or abrasions in your skin or mucous membranes. It is contagious during its primary and secondary stages, and sometimes in the early latent period.
  • Less commonly, it may spread through direct unprotected close contact with an active lesion (such as during kissing) or through an infected mother to her baby during pregnancy or childbirth (congenital syphilis).
  • Syphilis can’t be spread by using the same toilet, bathtub, clothing or eating utensils, or from doorknobs, swimming pools or hot tubs.
  • Once cured, it doesn’t recur on its own. However, you can become re infected if you have contact with someone’s syphilis sore.

Stages of syphilis


Syphilis develops in stages, and symptoms vary with each stage. But the stages may overlap, and symptoms don’t always occur in the same order. You may be infected with Treponema pallidum and not notice any symptoms for years.

Primary syphilis

The first sign of syphilis is a small sore, called a chancre. The sore appears at the spot where the bacteria entered your body. While most people infected with Treponema pallidum develop only one chancre, some people develop several of them. The chancre usually develops about three weeks after exposure. Many people who have syphilis don’t notice the chancre because it’s usually painless, and it may be hidden within the vagina or rectum. The chancre will heal on its own within three to six weeks.

Primary syphilis

Secondary syphilis

Within a few weeks of the original chancre healing, you may experience a rash that begins on your trunk but eventually covers your entire body even the palms of your hands and the soles of your feet. This rash is usually not itchy and may be accompanied by wart-like sores in the mouth or genital area. Some people also experience hair loss, muscle aches, a fever, sore throat and swollen lymph nodes. These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year.

Secondary syphilis

Latent syphilis

If you aren’t treated, the disease moves from the secondary to the latent (hidden) stage, when you have no symptoms. The latent stage can last for years. Signs and symptoms may never return, or the disease may progress to the tertiary (third) stage.

Tertiary (late) syphilis

About 15 to 30 percent of people infected with Treponema pallidum who don’t get treatment will develop complications known as tertiary (late) syphilis. In the late stages, the disease may damage your brain, nerves, eyes, heart, blood vessels, liver, bones and joints. These problems may occur many years after the original, untreated infection.

Tertiary syphilis

Congenital syphilis

Babies born to women who have syphilis can become infected through the placenta or during birth. Most newborns with congenital syphilis have no symptoms, although some experience a rash on the palms of their hands and the soles of their feet. Later symptoms may include deafness, teeth deformities and saddle nose  where the bridge of the nose collapses.

Complications of Syphilis

Without treatment, it can lead to damage throughout your body. Syphilis also increases the risk of HIV infection and, for women, can cause problems during pregnancy. Treatment can help prevent future damage but can’t repair or reverse damage that’s already occurred.

Small bumps or tumors

Called gummas, these bumps can develop on your skin, bones, liver or any other organ in the late stage of syphilis. Gummas usually disappear after treatment with antibiotics.

Neurological problems

It can cause a number of problems with your nervous system, including:

  • Stroke
  • Meningitis
  • Hearing loss
  • Visual problems
  • Dementia
  • Loss of pain and temperature sensations
  • Sexual dysfunction in men (impotence)
  • Bladder incontinence
  • Sudden, lightning-like pains

Cardiovascular problems

These may include bulging (aneurysm) and inflammation of the aorta your body’s major artery and of other blood vessels. It may also damage heart valves.

HIV infection

Adults with sexually transmitted syphilis or other genital ulcers have an estimated two- to five fold increased risk of contracting HIV. A syphilis sore can bleed easily, providing an easy way for HIV to enter your bloodstream during sexual activity.

Pregnancy and childbirth complications

If you’re pregnant, you may pass syphilis to your unborn baby. Congenital syphilis greatly increases the risk of miscarriage, stillbirth or your newborn’s death within a few days after birth.

Diagnosis and test

A doctor will carry out a physical examination and ask about a patient’s sexual history before carrying clinical tests to confirm syphilis.

Tests include:

Blood tests: These can detect a current or past infection, as antibodies to the disease will be present for many years.

Bodily fluid: from a chancre during the primary or secondary stages can be evaluated for the disease.

Cerebrospinal fluid: may be collected through a spinal tap and examined to test for any impact on the nervous system.

If there is a diagnosis of syphilis, any sexual partners must be notified of and tested for the disease.

Local services are available to notify sexual partners of their potential exposure to syphilis, to enable testing and, if necessary, treatment.

Treatment and medications

  • When diagnosed and treated in its early stages, syphilis is easy to cure. The preferred treatment at all stages is penicillin, an antibiotic medication that can kill the organism that causes syphilis. If you’re allergic to penicillin, your doctor will suggest another antibiotic.
  • A single injection of penicillin can stop the disease from progressing if you’ve been infected for less than a year. If you’ve had syphilis for longer than a year, you may need additional doses.
  • Penicillin is the only recommended treatment for pregnant women with syphilis. Women who are allergic to penicillin can undergo a desensitization process that may allow them to take penicillin. Even if you’re treated for syphilis during your pregnancy, your newborn child should also receive antibiotic treatment.
  • The first day you receive treatment you may experience what’s known as the Jarisch-Herxheimer reaction. Signs and symptoms include a fever, chills, nausea, achy pain and headache. This reaction usually doesn’t last more than one day.

Treatment follow-up

After you’re treated, your doctor will ask you to:

  • Have periodic blood tests and exams to make sure you’re responding to the usual dosage of penicillin
  • Avoid sexual contact until the treatment is completed and blood tests indicate the infection has been cured
  • Notify your sex partners so that they can be tested and get treatment if necessary
  • Be tested for HIV infection

Prevention of Syphilis

Preventive measures that can decrease the risk of contracting it, include:

  • Abstinence from sex
  • Long-term mutual monogamy with an uninfected partner
  • Condom use, although these protect only against genital sores and not those on the body
  • Use of a dental dam, or plastic square, during oral sex
  • Not sharing sex toys
  • Avoiding alcohol and drugs that could potentially lead to unsafe sexual practices

Having it once does not mean a person is protected from it. Once it is cured, it is possible to contract it again.

Frozen shoulder is also referred to as adhesive capsulitis and is characterized by pain and loss of motion of the shoulder joint.


Frozen shoulder is also referred to as adhesive capsulitis and is characterized by pain and loss of motion of the shoulder joint. The exact cause of it is unknown, even though it has been found to affect somewhere between two and five percent of people during their lifetime. Diabetes, thyroid disorder, a history of shoulder trauma, and periods of shoulder immobilization have been found to be risk factors that may lead to frozen shoulder. Females are also at higher risk. Occasionally, patients develop it after shoulder surgery or traumatic injury to the shoulder. Research suggests that the process is started with an inflammation of the lining of the joint within the shoulder. Gradually this area thickens and results in the shoulder becomes stiffer and more painful.

Frozen shoulder


The prevalence of frozen shoulder is estimated to be 2 to 5 percent of the general population. The condition is most common in the fifth and sixth decades of life, with the peak age in the mid-50s. Onset before the age of 40 is rare. Women are more often affected than men. The non-dominant shoulder is slightly more likely to be affected. In 6 to 17 percent of patients, the other shoulder becomes affected within five years.

It occurs predominantly unilaterally and is usually self-limited, although evidence about prognosis is limited, and the course can be prolonged, in some cases lasting over two to three years. Some studies suggest that up to 40 percent of patients have persistent but mostly mild symptoms beyond three years, and 15 percent have long-term disability.

Risk factors of frozen shoulder

Some risk factors may play a role in increasing your risk of developing frozen shoulder. Some of them include:

Age and sex: People who are 40 and above, especially women have a greater risk of frozen shoulder.

Reduced mobility or immobility: Reduced or prolonged shoulder immobility may increase your risk of frozen shoulder. Some cases that may increase risk include a broken arm, stroke, rotator cuff injury and recovery post-surgery.

Systemic diseases: People with certain diseases such as diabetes, tuberculosis, hypothyroidism, hyperthyroidism, cardiovascular disease and Parkinson’s disease may have a greater risk of frozen shoulder.


The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk of developing frozen shoulder.

Diabetes: It occurs much more often in people with diabetes. The reason for this is not known. In addition, diabetic patients with frozen shoulder tend to have a greater degree of stiffness that continues for a long time before “thawing.”

Other diseases: Some additional medical problems associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease.

Immobilization:  It can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or another injury. Having patients move their shoulders soon after injury or surgery is one measure prescribed to prevent frozen shoulder.

Stages of frozen shoulder

It has three stages.

Painful stage: Pain is present most or all of the time. Sleeping is difficult and all movements aggravate the pain. Usually lasts three to six months, sometimes more.

Frozen stage: Pain lessens but shoulder continues to stiffen. Can last up to 12 months.

Recovery stage: Pain goes away and shoulder movements begin to come back. Can last up to 24 months.


Main symptoms are:

  • Decreased motion of the shoulder
  • Pain
  • Stiffness

Frozen shoulder without any known cause starts with pain. This pain prevents you from moving your arm. This lack of movement can lead to stiffness and even less motion. Over time, you are not able to do movements such as reaching over your head or behind you.

Complications of frozen shoulder

Complications may include:

  • Stiffness and pain continue even with therapy
  • The arm can break if the shoulder is moved forcefully during surgery

Diagnosis and test

  • A frozen shoulder can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination.
  • The main feature on examination is increasing restriction of movement at the shoulder. This gradually progresses to involve all movements over a few months ( The freezing phase)
  • X-rays and scans are not routinely required

Treatment and medications

A frozen shoulder will self-resolve in most cases. Treatment will depend on the stage of the condition and the levels of pain experienced. Initial management will focus on maintaining range of movement and strength.

Exercises: Exercises to help regain flexibility to the affected shoulder joint:

These are suggested exercises only. If you are at all concerned about whether these exercises are suitable for you or if you experience any pain while doing them, please seek appropriate clinical advice from your GP or Physiotherapist.

Using painkillers when needed: Over-the-counter analgesia is available through pharmacies when needed. Paracetamol is most commonly prescribed. Anti-inflammatories, such as Ibuprofen, are also used, but as there is little or no inflammation involved in osteoarthritis these are best avoided without discussing with your GP. Side effects are even more common than with paracetamol so please ensure to take appropriate medical advice. There is a good booklet on the Arthritis Research UK website with information about the various drug options.

Corticosteroid injection therapy:

The severe pain which can be a feature of frozen shoulder in stage 1 will often settle with no treatment. However, some individuals experience significant sleep disturbance and limited function. In these circumstances, a corticosteroid injection into the shoulder joint is an effective option to settle pain and expedite recovery.

Further treatment options

If the above treatments are ineffective, other treatments listed below can be considered:

  • Hydro dilatation Procedure – Involves injecting the shoulder joint with a large volume of fluid (containing saline, steroid, and local anesthetic) to “stretch” the shoulder capsule.
  • Capsular Release Surgery (keyhole surgery which releases the stiff areas of the shoulder joint capsule)
  • Manipulation Under Anaesthetic (MUA) Surgery (Manual manipulation of the shoulder joint with the patient asleep)

The two surgical procedures above carry small risks and would be considered only when other treatment options have been exhausted.

Prevention of frozen shoulder

One of the most common causes of frozen shoulder is the immobility that may result in recovery from a shoulder injury, broken arm or a stroke. If you’ve had an injury that makes it difficult to move your shoulder, talk to your doctor about exercises you can do to maintain the range of motion in your shoulder joint.

Felty syndrome is a condition that includes rheumatoid arthritis.


Felty syndrome is a condition that includes rheumatoid arthritis, splenomegaly (enlargement of the spleen) and granulocytopenia (decreased level of the certain type of white blood cells). In Felty syndrome, rheumatoid arthritis is seropositive, which means that rheumatoid factor can be found in the blood. This syndrome is sometimes seen as a complication of rheumatoid arthritis

Felty syndrome

This syndrome usually includes:

  • Leukopenia, a low overall white blood cell count
  • Neutropenia, a low number of neutrophils (a type of white blood cells)
  • Splenomegaly, an enlarged spleen
  • Occasionally, a swollen liver


The condition was named after its founder Augustus Roi Felty, after the doctor reportedly saw patients in 1924 with a combination of conditions never before documented. The presence of chronic arthritis, splenomegaly, and leucopenia in all 5 patients prompted him to use his name to define the unknown syndrome.

Epidemiology of Felty Syndrome

More than one percent of individuals with rheumatoid arthritis suffer from Felty’s syndrome. Felty’s syndrome is more frequent in individuals suffering from rheumatoid arthritis for about 10 years of duration. In the course of rheumatoid arthritis, is men get affected with Felty’s syndrome earlier when compared to women. Women are three times more prone to Felty’s syndrome when compared to men. Whites more commonly get affected with Felty’s syndrome than blacks. Presently, a decline is seen in the incidence of Felty’s syndrome with the evolution of better and more effective treatment for rheumatoid arthritis.

Risk factors

Some of the risk factors of FS include

  • Having a positive test result for the HLA-DR4 gene
  • Having inflammation of tissues lining the joints
  • Testing positive for rheumatoid factor, which is an antibody used to diagnose RA
  • Having RA symptoms outside of the joints
  • Being Caucasian
  • Being older than age 50

Causes of Felty Syndrome

There is currently no evidence for the exact cause of FS.

  • However, both genetics and immunosuppressive drugs, used to treat previous aggressive and seropositive RA, tend to play a large role in its etiology.
  • It is thought that genetics and the use of immunosuppressive drugs weaken the immune system, lowering the body’s natural defences and allowing for an increased risk of infection.
  • Research shows that about 86% of those who have FS are positive for HLA-DR4, which is a cell surface receptor antigen.
  • More specifically, literature illustrates that the presence of two HLA-DRB1*04 alleles increases the susceptibility for extra-articular manifestations of RA and increases the chance of getting FS.
  • Unfortunately, those who have the RA with extra-articular manifestations component of FS tend to have a worse prognosis and a higher risk for mortality.


Some of the symptoms are as follows:

  • Loss of appetite.
  • Weight loss.
  • Feeling discomfort or malaise.
  • Joint pain.
  • Stiffness in the joints.
  • Pale colored skin.
  • Joint swelling.
  • Eye burning and discharge.
  • Joint deformity.
  • Repeated infections.

Complications of Felty Syndrome

In some cases, Felty syndrome can cause severe and life threatening conditions like:

  • Rupture of the spleen
  • Life-threatening infection
  • Toxic reaction to drug therapy, that can cause conditions like Steven-Johnson syndrome
  • Portal hypertension
  • Gastrointestinal bleeding

Diagnosis and test

There is no specific diagnostic criterion for Felty’s syndrome. It is a clinical diagnosis in patients with RA with unexplained neutropenia and splenomegaly.

Relevant investigations may include:

Blood tests:

  • FBC – for neutropenia ± anaemia of chronic disease.
  • Autoantibodies – rheumatoid factor and anti-CCP antibody.
  • Inflammatory markers (ESR and CRP) may be elevated.
  • LFTs – may be raised if there is liver involvement (see ‘Complications’, below).


  • Ultrasound or CT scan to evaluate splenomegaly.

X-Ray of patient hand with the felty syndrome

Bone marrow biopsy:

  • May be required to differentiate Felty’s syndrome from haematological malignancies – eg, non-Hodgkin’s lymphoma.


The best way of treating Felty syndrome (FS) is to control the underlying rheumatoid arthritis (RA). Immunosuppressive therapy for RA often improves granulocytopenia and splenomegaly; this finding reflects the immune-mediated nature of FS. Most of the traditional medications used to treat RA have been used in the treatment of FS. No well-conducted, randomized, controlled trials support the use of any single agent. Most reports on treatment regimens involve small numbers of patients.

Surgical Treatment

Splenectomy is sometimes performed in some patients who:

  • Have a severe condition
  • Do not respond to pharmacological treatment
  • Experience constant, serious infections
  • Have hemolysis or recurrent skin ulcers


  • Methotrexateis usually the first choice
  • Hydroxychloroquine,
  • Ciclosporin,
  • Leflunomide± methotrexate,
  • Gold,
  • Sulfasalazine,
  • Cyclophosphamide,
  • Rituximab± methotrexate,
  • Splenectomy: Generally reserved for those not responding to medical treatment. Splenectomy improves neutropenia in most patients (80%).
  • Immunisationagainst influenza and pneumococcus

Prevention of Felty Syndrome

No. There is no prevention for Felty’s syndrome. But the prompt treatment of RA with currently available medicines markedly decreases the risk of developing Felty syndrome.