Vaginal Infection Causes

vaginal infection causes 

Vaginal infection, or vaginitis, is a medical terminology that means infection and/or inflammation of the vagina. There are many causes of vaginal infection, such as bacteria, yeast, viral, and also local irritations caused by clothing, creams, and so on. 

The most common vaginal infection causes are bacterial, yeast, and trichomoniasis. The origin of them are different but the symptoms are generally similar as described below.

1. Bacterial vaginosis. It is the most common cause of vaginal infection. Gardnerella vaginalis is the name of organism causes bacterial vaginosis. It happens when there is an imbalance in the types of the bacteria normally found in the vulva and vagina. Here are some risk factors that cause them:
• Multiple sexual partner
• Frequent douching habit
• Pregnancy
• Intrauterine device (IUD) use 
• Swimming pools and toilet seats CAN'T spread the bacteria.
2. Vaginal yeast infection. It is mainly caused by fungus named Candida albicans, so it is called candidiasis. The overgrowth of yeast in vagina is possibly caused by any of these events:
• Use of steroid
• Immunocompromized condition (HIV/AIDS)
• Use of antibiotics. Vaginal yeast infection may happen after taking antibiotics therapy for another condition in the body such as strep throat. Antibiotics kill protective bacteria and make the fungus overgrow.
• Pregnancy and diabetes mellitus. In these two conditions, there is a low glycogen store in certain vaginal cells. This causes increasing in vaginal pH that is suitable for fungal growth.
• Menopause.
• Use of birth control pills. Estrogen in birth control pills can change the normal vaginal environment.
• Wearing tight underwear can cause irritation that tends to candidal overgrowth.
3. Trichomonas vaginalis. It is a kind of sexually transmitted disease (STDs) that mostly affects the urinary tract.
4. Viral vaginal infection. It is caused by non specific viruses.

Vaginal infection symptoms

General symptoms of vaginal infection are:

• Itching around the vagina
• Abnormal vaginal discharge with bad odor
• Burning in urinating
• Pain on sexual intercourse.

Vaginal infection treatment

Before taking treatment, we have to confirm the diagnosis. Diagnosis can be based on symptoms and also other diagnostic tests such as: urine tests and vaginal cultures/sensitivity test. The proper treatment is actually based on the cause. If bacterial, take antibiotics as recommended in the sensitivity test. Vaginal yeast infection may be treated by vaginal suppositories and/or antifungal pills.

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Testosterone Booster Effects

 testosterone booster effects 

Testosterone is a sexual hormone that is needed for the growth of male sexual characteristics. The hormone is mainly present in men but actually also found in women, in small amounts. Besides the sexual property, testosterone is also necessary in bone and muscle production. In certain conditions, such as decline in muscle mass and bone density, low libido, mood swings, and gain weight, those are symptoms of low testosterone levels. Sometimes it can also lead to premature ejaculation and impotence in men. Aging can also cause "andropause" in men, and the main problem of it is hypotestosteronism. 

Many people, such as athletes, body builder, etc, want to gain muscle by taking testosterone booster. Testosterone booster effects are mainly caused by raising of testosterone levels in the body. Besides that, testosterone booster can also stimulate fast muscle growth and recovery, burns fat, increase sexual performance, enhance endurance, energy, and stamina. 

By indication, doctors prescribe testosterone booster to the concerned persons. In the market, there are some testosterone boosters. They are available in two types, the legal and the illegal one. Testosterone boosters that include creatine are generally safe, but testosterone booster that is combined with anabolic steroids can have many side effects, especially in long term use.

Taking testosterone booster is not always safe. Taking testosterone booster for a long period can make the body unable to produce the hormone naturally. Besides that, here are another testosterone booster side effects:

• Acne because of oily skin
• Baldness in men because of fast hair loss
• Because testosterone is metabolized in the liver, long term use of it can cause liver damage and in some cases it can cause liver cancer
• For diabetics, testosterone is harmful because it can cause impaired glucose tolerance.
• Kidney failure is also reported after long term use of testosterone booster.
• Prostate enlargement and prostate hypertrophy
• In women, testosterone may lead to the development of male sex characteristics, such as facial hair and deep voice like men.

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Diabetic Foot Infection Treatment

diabetic foot infection treatment 

As we have already seen before, if we have diabetes mellitus, we are at a great risk to develop diabetic foot infection. Diabetic foot infection, ulceration, and gangrene are the most common problem that makes diabetics need hospitalization. The healing process of diabetic foot infection needs several weeks to months. Proper management should be done to prevent amputation. 

People with diabetic foot infection are usually asymptomatic. Because of the nerve damage, diabetic foot ulcers are painless.

Diabetic foot infection treatment

The management of diabetic foot infection is primarily to obtain wound closure. It depends on the grade or severity (as we talk before). Here are step by step of diabetic foot infection treatment.

• Basic wound care
• Control you blood glucose level at normal limits to fasten the healing process.
• Keep the ulcer bandaged and clean.
• Use a wound dressing
• Do not walk barefoot
• Debridement. It is a process to remove dead tissue that covers the wound so the foot ulcer is able to be seen. Your doctor may use a scalpel and surgical scissors.
• Clean and disinfect the skin around the wound (by betadine)
• Check the wound with a metal instrument to know its depth, and if there is any foreign objects in the wound
• Cut the dead tissue, wash it with special liquid
• After debridement, the wound may look bigger and deeper, fresh like meat
• Wound dressing and care. The doctor or nurse usually use the wet-to-dry dressing: applying a wet dressing to the wound and it will absorb the foreign materials as it dries. When we remove the dressing, some tissues will come off with the dressing. Please do not do this by yourself, you may need a visiting nurse to help you. Keep it dry and change it regularly.
• Oral antibiotics. The doctor may give you a prescribed drug to support the healing process. If there is no improvement in a week, you may need hospitalization because the doctor will give you a more potent IV antibiotics.
• Referral to wound care center or orthopaedic surgeon. In complicated case, the doctor will refer you to a wound care center that consists of multidisciplinary interventions. You will receive a treatment plan to recover your foot.

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Clozapine Side Effects

clozapine side effects

Clozapine is a drug for schizophrenia patients who are not responsive to or intolerant of classical anti psychotics. Non-responsiveness here means a lack of satisfactory clinical improvement after adequate doses of at least two antipsychotics for enough durations. The definition of intolerance is the improbability of reaching clinical benefit after classical antipsychotic using because of a serious neurological side effects, such as extrapiramidal syndrome or dyskinesia.

The use of clozapine can reduce the risk of recurrent suicidal behavior in patients with schizophrenia who are at high risk for re-experiencing suicidal behavior. 

Clozapine dosage

Clozapine is an oral drug. The dosage must be given individually. The lowest effective dose must be maintained for each patient. 

• To begin therapy, dosage of clozapine is 12.5 mg once or twice in the first day, then 25 mg on the second day. 
• For elderly: only12.5 mg once (for the first day). Doses may be added for only maximum 25 mg/day.
• Maximum permissible dose is 900 mg/day. The possibility of increased clozapine side effects (such as: seizure) occuring at dosage of more than 450 mg/day.
• To terminate the therapy, a gradual reduction should be done over 1 to 2 weeks period. Patients should be monitored for recurrence of psychotic symptoms and cholinergic rebound such as headache, nausea, sweating, vomiting, and diarrhea.

Clozapine side effects

According to MIMS-UBM Medica, clozapine side effects are:

• Agranulocytosis. Clozapine and agranulocytosis are proven related. Drugs known to have a potential to depress bone marrow function such as chloramphenicol, cotrimoxazole, analgesics, penicillamine, and carbamazepine must not be used simultaneously with clozapine.
• The most common disorders: fatigue, over sweating, hyperthermia.  
• Psychiatric disorder (rare): restlessness, agitation
• Metabolic disorder: weight gain (very common), mild increased of blood glucose, hypercholesterol.
• Brain and nerve disorder (common): sedation, dizziness, headache, tremor, blurred vision, seizure, confusion, delirium.
• Cardiac disorder (very common): tachycardia, arrythmia, hypertension, syncope.
• Gastrointestinal disorder (very common): hypersalivation, constipation, nausea, vomiting, dry mouth.
• Reproductive disorder: priapism

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Treatment Of Migraine During Pregnancy

treatment of migraine during pregnancy

Migraine may be the  common disease that affects people around the world. People with migraine experience headache (from mild, moderate, and severe), nausea, vomiting, and sometimes photophobia (hypersensitivity with light). The causes of migraine is definitely uncertain. The role of hormones makes migraine more frequently happen in women, especially between ages 20-45. According to National Center for Biotechnology Information, a beneficial effect of migraine during pregnancy, mainly in the last 2 trimesters, has been observed in 55 to 90% of women who are pregnant, irrespective of their migraine type. In fact, there is a higher percentage of women with menstrual migraine find that their condition becomes worse when they are pregnant. Migraine during pregnancy however may appear only in the first time of pregnancy. The effect of migraine during pregnancy which becomes worse after birth delivery is because the high and stable estrogen levels during pregnancy and the rapid fall off after pregnancy. 

Treatment of migraine during pregnancy

1. Non pharmacological therapy. It is better for you to try such as: relaxation, smooth massage, aromatherapy, sleep, ice packs, before you start taking drugs that probably have more side effects to the fetus.
2. Pharmacological treatment of migraine during pregnancy  
• Acetaminophen (paracetamol) 1000 mg used as rectal suppository is highly recommended for acute migraine.
• Ibuprofen and aspirin are second line drugs. They are avoided to take in the third trimester.
• Triptans (sumatriptan, naratriptan, zolmitriptan) are probably safe but we have lack of data that support them. Please review the last part below.
• Metoclopramide is recommended to treat disturbed nausea, and safe to use in the second and third trimester.
• Ergotamine tartrate is contraindicated for pregnant women.
• Betablockers (propanolol, metoprolol) can be used as prophylactic drugs but they are less indicated for pregnant women.

Correlation of NSAIDs drugs during pregnancy and the risk of spontaneous abortion

All types of non aspirin NSAIDs are proven to increase the risk of spontaneous abortion. Please avoid using NSAIDs to treat migraine while you are pregnant or actively trying to get pregnant. The better choice to treat migraine and headache during pregnancy is acetaminophen.

Correlation of Triptan during pregnancy and the risk of adverse pregnancy outcomes and major congenital disorders

Based on FDA, triptans includes in Category C during pregnancy and there are no increased risk shown in fetal abnormalities. The use of triptans during the first trimester is NOT proven to increase the risk of congenital malformation, but triptans that are used in the last trimester of pregnancy was found to be associated with a mild increase of bleeding during labor and atonic uterus.

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Strep Throat Symptoms In Children

strep throat symptoms in children

Strep throat, or also known as streptococcal pharyngitis, is a bacterial infection of throat that is most common in children between age 5 and 15. It is very contagious, spread by person to person contact with saliva or nasal secretions. It easily spreads among family members. 

Strep throat symptoms in children

Strep throat symptoms may be both mild and severe. Children looks unhealthy about 2 to 4 days after having contact with the infectious matter that contains streptococcal bacteria. In most cases, symptoms begin suddenly, and include:

• Fever, begins with slightly fever and become highest on day 2-3. Followed by chills.
• Difficulty and pain in swallowing
• Red throat, with white patches (sometimes confusing with dyphteria)
• Headache
• Nausea, appetite loss, vomiting
• Swollen lymph in the neck
• Rash. Some strain of streptococcal pharyngitis can lead to a scarlet fever-like rash. It is an allergic reaction to the bacterial toxins.

Your child may have those symptoms but actually he don't have strep throat. It may caused by viral infection and self limiting. Please consult your pediatrician to have a specific test of strep throat. In the other hand, it is also possible that your children have the bacteria but not having strep throat, because they are carriers of strep, which means that those children can spread strep to others but the bacteria are not now not making them sick.

Strep throat treatment

• The causative therapy is antibiotics. The goal of antibiotics is to reduce the duration and the severity of the symptoms, as well as likelihood that the strep throat will spread to family members or school mates. The doctor may prescribe an oral antibiotics such as:
• Amoxicillin. It is a penicilline derivative. Available in chewable tablet and syrup.
• Cefadroxil, cephalexin, or other cephalosporin derivative.
• Erythromycin
• Azythromycin
• Penicillin, for severe cases. The children should be hospitalized because it is given by injection. 
• Symptomatic therapy:
• Paracetamol syrup (follow the usage directions because it is harmful for the liver)
• Ibuprofen syrup
• Do not give aspirin because it has possibility to develop Reye syndrome.
• Give warm drink and soft foods such as porridge.

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Testosterone Injections Side Effects

testosterone injections side effects

We have already known that testosterone is a male sex hormone that is produced in the testicles. It is the principal hormone responsible to promote development and growth of male sexual organs and maintain secondary sexual characteristics. In women, testosterone is also produced in small amounts in ovaries and adrenal system.  Nowadays, testosterone therapy is indicated for both sexes to treat conditions caused by a lack of this sex hormone, such as: impotence, puberty disorder, metastatic breast cancer (cancer that spreads to other parts of the body).

As listed in MIMS-UBM Medica, the indications of testosterone and derivative therapy are:

• Delayed puberty, male hypogonadism
• Inoperable metastatic breast cancer

Before getting testosterone injections therapy please make sure that you don't have contraindications for this such as:

• Male breast cancer
• Prostate cancer
• Pregnancy
• Allergic history to hormonal treatment

After getting the therapy, you have to be aware of the testosterone injections side effects. What are they?

• Most common: headache, nausea, confusion, appetite loss, weakness, increased thirst
• Increased frequency and erection of the penis
• Rapid weight gain
• Fluid and electrolyte retention
• Spermatogenesis disorder, priapism, gynaecomastia, prostate hyperplasia, prostate tumor (rare)
• Suppression of lactation, increased libido, oily skin, acne, hirsutism, clitoral enlargement
• Local irritation of the injection site
• Increased cholesterol, especially LDL.
• Fatal side effects: hepatitis, liver toxicity, malignant neoplasm.

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What Are High Cholesterol Symptoms

what are high cholesterol symptoms

High cholesterol, or known as hypercholesterolemia, is a condition where there is too much cholesterol in the body. Cholesterol is a fat-like substance that becomes part of body components. Our body makes its own cholesterol to support some important function. Added cholesterol from fatty food we eat, can make harm to our body if the level is too high.

It is already known that high cholesterol plays an important role in mechanism of stroke, metabolic syndromes, and heart attack. Too much cholesterol inside the blood can create plaque along the artery walls. In the next time, plaque that forms clot can block the blood flow to the heart (causes heart attack), the brain (causes stroke), and any other body parts.

Cholesterol is divided into 2 groups: good cholesterol (HDL, high density lipoproteins) and bad cholesterol (LDL, low density lipoproteins). Besides that, there is a third type of fatty substance, called triglycerides. This is considered as bad fat. The normal range of total cholesterol is between 140-200 mg/dl. If your blood cholesterol level is more than 200, it usually means that you have high levels of bad cholesterol, low or normal level of good cholesterol, and normal or high level of triglycerides. There is also a condition called primary hypercholesterolemia. It is a congenital condition that affects an individual's LDL cholesterol. This is a rare case. 

There are some risk factors that contribute in high cholesterol symptoms, such as: 

• Obesity
• Bad diet, consist of high trans fatty acids and saturated fat; less fiber
• Less physical exercise.
• Hypertension
• Smoking habit
• Alcoholism habit
• Diabetes mellitus
• Post menopausal women
• Having the same family history

What are high cholesterol symptoms? 

Most of people with hypercholesterolemia is generally asymptomatic, especially at early stages. They found hypercholesterolemia accidentally through medical check up. The only way to know about high cholesterol is having a blood test. Before doing this test (called lipid profile test), you should be abstain for food at least 12 hours before the test. Advanced stages of high cholesterol usually shows some organ-specific symptoms such as: transient ischemic attack (caused by brain vessel atherosclerosis), chest pain (caused by bad blood supply to the heart or coronary artery disease), bad vision, and a yellowish patch around the eyelid called xanthelasma palpebrarum.

Further reading please open: PubMed Health

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Chlamydia Trachomatis Infection

chlamydia trachomatis infection 

Chlamydia trachomatis infection is one kind of sexually transmitted disease (STD) that caused by a bacteria named Chlamydia trachomatis. Chlamydia trachomatis infection can cause a damage on reproductive organs, although the infection are usually asymptomatic. Serious infection can cause complications such as infertility. And it can happen in both men and women.

Epidemiologically, chlamydia trachomatis infection is the most frequently  bacterial STD in the United States. The prevalence number tends to be under reported, because most people with chlamydial infection are not aware of the infection and do not seek testing. Women is reported more common than men because they are frequently reinfected if their sex partners are not properly treated.

Chlamydia trachomatis infection can be transmitted in many ways:

• Sexual activities: oral, vaginal, or anal sex. People who are sexually active are at risk of chlamydial infection. Multiple sexual partners also increase the risk. Young women and teenage girls are susceptible to chlamydial infection because the opening of uterus (called cervix), is still immature. Homosexual people are also at risk for chlamydial infection.
• Vaginal childbirth (from mother to newborn)

According to American Family Physician, most of chlamydia trachomatis infections affect the urogenital tract. The symptoms of  chlamydial infection are:

• Women: 
• Abnormal vaginal discharge with burning sensation while urinating. 
• Low back pain
• Nausea
• Fever
• Lower abdominal pain: if the infection spreads from cervix to fallopian tubes.
• Pain during intercourse
• Bleeding between periods.
• Rectal pain, discharge, bleeding: after anal sex.
• Men:
• Burning sensation when urinating
• Itching around the opening of the penis
• Discharge from penis
• Rare cases: pain and swelling in the testicles
• Rectal pain, discharge, bleeding: after anal sex.

Chlamydia infection treatment

• The main treatment is antibiotics. 
• Azithromycin single dose, or
• Doxycycline twice daily, a week
• Sexual partners must be tested and treated. If no, there will be a high risk for re-infection
• No sexual intercourse during treatment to prevent transmitting from infected people to their partners.
• Evaluation test should be done at least 3 months after treatment.

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Psoriasis Vulgaris Treatment

psoriasis vulgaris treatment

Psoriasis is derived from "psora", a Greek word, that means itch. Psoriasis is a kind of skin disease that is chronic and recurring. The symptoms of psoriasis vulgaris varies from mild to severe. Severe cases may be life threatening. Basically all ages can get psoriasis, but the most common happens to people in 16 to 22 years olds. The late onset of psoriasis vulgaris affects people between 50 and 60 years old.

Psoriasis vulgaris: Causes

Many studies have proven that psoriasis vulgaris is a hereditary disease. The tendency to get psoriasis is stored inside the genes. However, certain stimuli can cause a psoriasis outbreak in people who already have predisposition. Basically there are two types of psoriasis: psoriasis vulgaris and psoriasis pustulosa. Psoriasis vulgaris is plaque form while psoriasis pustulosa is pustular form. Here are some stimuli that can generate psoriasis attack:

• Bacterial infection, such as: streptococcal infection in the throat
• Certain drugs
• Alcohol
• Any damage to the skin
• Sunlight exposure

Psoriasis vulgaris: symptoms

The symptoms of psoriasis vulgaris are:

• Red patches
• The patches become scally and wider
• If the scales are scrapped off, bleeding points can be seen
• Most common locations: skin folds (armpits, under the breasts, groin, buttocks)

Psoriasis vulgaris treatment

Psoriasis vulgaris needs comprehensive treatment. Psoriasis drugs can be both oral or topical. Choices of treatment depends on patient's age, general health, and the cause of psoriasis.

• Local/topical treatment:
• Skin moisturizer: to reduce dryness and scaling
• Specific treatment: vitamin D preparat, eg calcipotriol (Dovonex), tacalcitol (Curatoderm), calcitriol (Silkis), and coal tar preparat (Zorac)
• Corticosteroid: betamethasone, hydrocortisone. Corticosteroid can be used in conjunction with specific treatment above. It is good for chronic psoriasis vulgaris.
• Scalp treatment may consist of salicylic acid, coal tar, and sulphur. 
• Phototherapy (ultraviolet) and photochemotherapy are used by dermatologists to treat widespread psoriasis.
• Oral medications, for widespread psoriasis that is unresponsive with usual treatment:
• Immunosupressants such as methotrexate (Maxtrex), cyclosporine (Neoral)
• Vitamin A preparat : acitretin (Neotigason)

Psoriasis vulgaris treatment is basically individual and different from person to person. Please consult you dermatologist to confirm the diagnosis and get the proper therapy.

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Urinary Tract Infection Treatment

urinary tract infection treatment

Urinary tract infection is infection that occurs in the urinary system. Urinary system consists of kidneys, ureters, bladders, and urethra. Urinary tract infection can occur in every part but the most common part is th lower urinary tracts especially bladder and urethra. Because of the anatomy of urinary system (short distance between urethra opening and bladder), women have a greater risk to develop urinary tract infection. Urinary tract infection can be mild and severe if it spreads to the kidneys.  

Urinary tract infection: Causes

The infection starts when bacteria enter the urinary tracts through urethra, stay in the bladder, grow and spread around. The most common forms and causes of urinary tract infection are:

1. Cystitis. It is bladder infection usually caused by E. coli (bacteria commonly found in gastrointestinal tract. It may be caused by sexual intercourse, but people who are sexually inactive also have chance to get cystitis.
2. Urethritis. It is urethra infection, typically caused by bacterial spreading from anus to urethra. The causes of urethritis are mostly sexually transmitted diseases such as gonorrhea, chlamydia, and herpes virus infection.

Urinary tract infection: Symptoms

Most of urinary tract infection is asymptomatic. But here are symptoms that easy to be recognized:

• Pelvic pain (women), rectal pain (men)
• Burning sensation while urinating
• Frequent urinating with small amounts each
• Persistent urge of urinating
• Cloudy urine
• Bad smell urine
• Hematuria or presence of blood in the urine.

Urinary tract infection treatment

Antibiotics are the main treatment. The choice of drug is principally based on urine culture and sensitivity test of antibiotic. Antibiotics that are proven potent to treat urinary tract infection are:

• Trimethoprim-sulfamethoxazole (Bactrim)
• Nitrofurantoin (Macrodantin)
• Penicillin derivate: Amoxicillin (Larotid), Ampicillin 
• Quinolones: Ciprofloxacin, Levofloxacin (Lovequin)

Doctor sometimes also give you analgetics to relieve the symptoms. Be sure to take water at least 2 liters per day. Severe, recurrent infection, infection on the kidneys, and other complicated urinary tract infection need hospitalization. Drugs should be given intravenously.

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Food Allergy Test

food allergy test

Food allergy is an immune system reaction that happens directly after eating an allergen. The immune system reaction is variable between persons, from mild to severe and may be life-threatening known as anaphylaxis reaction. Food allergy is different with food intolerance while food intolerance is likely unserious condition that does not involve the immune system. To confirm the diagnosis of food allergy, you have to take food allergy test.

Food allergy symptoms

The symptoms of food allergy may be mild and severe. The symptoms can happen even the first time ingestion of food and develop between minutes to hours. The most common mild symptoms are:

• Itchy mouth
• Skin eczema
• Tissue swelling in many body parts: mouth, face, throat, tongue, etc.
• Difficulty in breathing, wheezing, nasal congestion
• Nausea, vomiting
• Diarrhea
• Syncope, dizziness, headache.

Severe symptoms that can be life threatening is called anaphylaxis reaction. Please pay attention to these:

• Tightening of airways, very difficult to breathe caused by a swollen throat
• Shock, known by severe hypotension.
• Tachycardia, or rapid pulse
• Symptoms of brain ischemia, can be dizziness until loss of consciousness.

Food allergy test

There is no standard rule of food allergy test. According to Mayo Clinic, there are some diagnostic options that doctors may do to determine if you're allergic to a food or if your symptoms are caused by another.

• Specific description of the symptoms. Tell your doctor specifically about what food that seem to cause allergy, how much you ate, and if you or your family have history to food allergy or another allergies.
• Physical examination.
• Food diary. Your doctor may ask you to make a food diary about your eating habit and symptoms related to it.
• Blood test. It does not work for every possible allergen. The test used to detect IgE antibodies in certain allergen, called RAST, or Radio AllergoSorben Test. The score from RAST will be compared to known predictive value. If the score is higher, it is more likely that the allergy is present in that person. RAST can test many allergens simultaneously.
• Skin prick test. It can determine your reaction to a specific food. If you have allergy to a particular food being tested, you will have a raised reaction or bump. Remember that a positive reaction to this test alone is not enough to confirm the diagnosis of food allergy.
• Food challenge test. This test must be done in the hospital. The suspected allergen will be given to the person to be directly ingested. Doctor will look for signs and symptoms of food allergy. \

Food allergy treatment

In case of food allergy, the best way is avoiding the particular food. But you may still experience some symptoms, here are the food allergy remedies:

• Mild reaction: you can buy OTC drugs (antihistamines) to reduce symptoms. Take this drugs after exposure to relieve itching and nausea-vomiting. However, antihistamines alone can not treat severe reaction of food allergy.
• Severe reaction: all you have to do is going to the emergency room. Doctor will give you an emergency epinephrine injected under your skin. The next time you may visit the doctor to consult about the food allergy and he may give you an epinephrine autoinjector (EpiPen, TwinJect). You have to bring it all the time.

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Diabetic Foot Ulcer Treatment

diabetic foot ulcer treatment

Diabetic foot ulcer is the most common non traumatic foot injury that end up as lower extremity amputation. Many factors are considered to be causes of diabetic foot ulcer such as infection, foot deformity, mechanical changes, atherosclerotic peripheral arterial disease, and peripheral neuropathy. 

Risk factors of diabetic foot ulcer

According to American Academy of Family Physicians, there are some risk factors for lower extremity amputation in the diabetic foot:

• Obesity
• Diabetic retinopathy (impaired vision)
• Arterial insufficiency
• Foot deformity resulting in focal areas of high pressure
• Absence of sensation because of peripheral neuropathy
• Limited joint mobility
• Uncontrolled diabetes mellitus
• Poor footwear that causes skin breakdown
• Previous history of diabetic foot ulcer

Diabetic foot ulcer staging
According to PubMed, it is important to be aware of the natural history of the diabetic foot ulcer that can be divided into five stages:

1. Stage 1 : normal foot
2. Stage 2 : high risk foot
3. Stage 3 : ulcerated foot
4. Stage 4 : infected foot
5. Stage 5 : necrotic foot

Diabetic foot ulcer treatment 

Diabetic foot ulcer treatment needs multidisciplinary management to control all aspects of healing: mechanical, microbiological, vascular, metabolic, and also educational aspects. The first thing that should be done is a good control of blood glucose, lipid profile, and blood pressure.

1. Stage 1. Goal of therapy is to prevent the development of ulcers and to promote healthy footware habit and foot care. Diabetic patients should be encouraged to use the suitable diabetic footwear and control his blood glucose, lipids, and blood pressure.
2. Stage 2. Stage 2 is when the foot has one or more these risk factors for ulceration: ischaemia, neuropathy (sensory loss), foot deformity, swelling, and callus. The presence of callus should be agressively treated.
3. Stage 3. The foot is neuropathic and neuroischaemic. Diabetic foot ulcers in stage 3 need mechanical control (relief of pressure), wound control (wound dressing, wound toilet, debridement), and may also need vascular control.
4. Stage 4. Infected foot needs antibiotics as microbiological control, and urgent wound control (surgical drainage and debridement). The goal of therapy in stage 4 is to prevent severe infection that will progress to necrosis.
5. Stage 5. Necrotic foot can be divided into wet and dry necrosis. Wet necrosis needs intravenous antibiotics, surgical care, and vascular reconstruction. Proper management of diabetic foot ulceration will reduce the number of amputations in diabetic patients. 

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Nasopharyngeal Cancer Symptoms

nasopharyngeal cancer symptoms

Nasopharyngeal cancer is the most common cancer found in the ear, nose, and throat area. It is a malignant cancer originated from nasopharynx tissue. What is nasopharynx? The nasopharynx is an area behind the nose and also the upper part of the throat. Throat or pharynx, is a tube with 5 inches long that starts behind the nose and ends at the top of esophagus (a tube connecting throat to stomach) and trachea (wind pipe). Each side of the nasopharynx leads into an ear. Nasopharynx is an area consists of squamous cells that make it likely probable to have malignant cancer.

Nasopharyngeal cancer is associated with some risk factors as listed below.

• Epstein-Barr virus exposure. Many studies show that this virus is closely related with certain cancers such as lymphomas and also nasopharyngeal cancer.
• Asian or Chinese ancestry.

Nasopharyngeal cancer symptoms 

There are main symptoms of nasopharyngeal cancer you have to pay attention, and please consult your physician when you find these:

• A chronic sore throat
• Followed by a lump in the nose or neck area
• Nosebleeds
• Trouble in speaking or breathing
• Hearing loss from mild to severe
• Otalgia (ear pain), or ringing ear
• Chronic headache

How to diagnose nasopharyngeal cancer?

When you find suspected symptoms of nasopharyngeal cancer, you should go to the physician, especially an ENT specialist. These procedures may be done to make a definite diagnosis of nasopharyngeal cancer:

• Physical examination: about the lymph node enlargement, abnormal condition of ear, nose, throat
• Neurological examination: to check the function of brain and nerve.
• CT-scan: it is a detailed imaging of suspected cancer area.
• Biopsy: it is a gold standard of nasopharyngeal cancer diagnosis. Small cells will be removed and examined under a microscope to check for cancer signs and also cancer staging. 
• Laboratory tests: it may include blood and urine tests, or other necessary substances in the body. The goal of laboratory test is to help diagnose, know about cancer metastase, and plan the proper treatment according to cancer staging.

Nasopharyngeal cancer treatment

Nasopharyngeal cancer treatment options and its chance of recovery depend on these factors:

• Cancer stage (known by biopsy)
• Cancer type (known by biopsy)
• The patient's age and underlying medical condition
• The size of cancer

Generally, there are five specific treatments to cure nasopharyngeal cancer:

1. Surgery
2. Radiotherapy
3. Chemotherapy
4. Immunotherapy
5. IMRT (Intensity-modulated radiation therapy)

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Adderall Dosage For Adults Chart

adderall dosage for adults chart

Adderall is a brand name of amphetamine-salt based drug that  manufactured by Shire US Inc, indicated for the treatment of Attention Deficit Hyperactive Disorder (ADHD) and narcolepsy.

According to MIMS, a diagnosis of ADHD marked by the presence of hyperactive, impulsive and inattentive symptoms that were present before the age of seven years old. ADHD consists of symptoms that can cause a significant impairment such as in social, occupational, academic ability, etc.  There are lack of attention to details, lack of sustained attention, failure to follow orders, poor listener, poor organization, easily distracted, and forgetful. For the hyperactive and impulsive type, at least 6 of these following symptoms must be presented for 6 months or more: leaving seat, inappropriate climbing and/or running, difficulty with quiet activities, fidgeting, excessive talking, blurting answers, intrusive, can't wait turn, etc. The combined type needs both hyperactive impulsive and inattentive criteria to be found.

Adderall is indicated as a part of holistic treatment program for ADHD that consists of psychological, educational, and social therapy. Drug treatment only are not indicated for all ADHD children. Appropriate educational placement and psychosocial treatment is very needed. The decision to prescribe Adderall depends on the physician's assessment on the severity and chronicity of the symptoms. There is no sufficient data to support the long term use of Adderall.

Adderall dosage for adults chart

Adderall should be administered at the individual dosage, e.g. the lowest effective one and must be reviewed and adjusted depends on the therapeutic needs and patients' respond.

• ADHD: not recommended for children under 3 years old.
• For 2-5 years old : start with 2.5 mg daily, and may be raised slowly
• More than 6 years: start with 5 mg once or twice daily
• Narcolepsy: start with 5 mg daily.

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Herpes Simplex Virus Infection Symptoms

herpes simplex virus infection symptoms

Herpes simplex virus infection can occur at the mouth, face, buttocks, skin, anal and genital area. Most of herpes simplex virus infection symptoms are not specific, and may be asymptomatic. But in some cases, it appears as painful blister located at the port d'entree (area where the virus entered the body). Those blisters usually heal spontaneously complete but can reappear again in the future, in the same location when least expected. Between two attacks, the virus resides deep in the nerves that supply the involved area. People often refer herpes simplex virus infection as "cold sores" or "fever blisters", because the most common infected area is around the mouth and lips.

Once you're affected by the virus, it can hide in the body for years. Many things are considered as trigger for herpes simplex virus reinfection, include:

• Decreased immune system
• Having another viral infection such as influenza, common cold, etc
• Exposure to the sun
• Menstrual period
• Psychical stress

Herpes simplex virus infection can rapidly spread between persons. Infected saliva is a common means of virus transmission. Transmission via towels, washclothes, and surfaces are actually impossible. The most common area of cold sores are lips, under the nose, chin, and another facial area. Healing time needs 7-10 days without scarring.

Herpes simplex virus infection symptoms

• Some patients may have prodrome symptoms such as burning sensation that precedes the appearance of blisters.
• The most characteristic symptoms of herpes simplex virus is a group of blister on a red base. The blisters dry up shortly and leave scabs that last anywhere for days, depending on its severity and the host's immune system. What makes it different from another skin infection is, if something lasts for weeks, it is unlikely to be herpes simplex virus infection. 
• Area affected is itchy, dry and crusty. 

Herpes simplex virus infection: treatment

• There is no specific cure for herpes simplex virus infection.
• Cold sores often clear spontaneously without treatment
• The goal of herpes simplex virus treatment is to relieve symptoms and shorten an outbreak. 
• You can buy OTC drugs to relieve discomfort, such as paracetamol, benzocaine and L-lysine, and apply them to the blisters.
• Avoid sun exposure and stress.
• Put ice on the blister.
• Some drugs prescribed are antiviral groups and they can treat both types of herpes simplex infection. The can lessen the severity infection, frequency of relaps, and prevent viral transmissions:
• Acyclovir
• Famciclovir
• Valacyclovir

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Chronic Inflammatory Demyelinating Polyneuropathy CIDP

chronic inflammatory demyelinating polyneuropathy cidp

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired, rare,  and autoimmune disorder of nerve the peripheral nerves, characterized by gradually increasing weakness of the lower extremities and, to a lesser extent, the upper extremities. It is also called chronic inflammatory demyelinating polyradiculoneuropathy. 

Chronic inflammatory demyelinating polyneuropathy is caused by myelin damage. Myelin is nerve's cover. The weakness happens at least two month or more. The exact cause of CIDP is auto immune disorder in which the body's immune system recognizes myelin as foreign substance and attacks it. 

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) : Signs and symptoms

There are some symptoms of suspected CIDP:

• First complain: walking difficulty which worsens progressively. Sensory function may be altered if the patients' sensory nerve myelin is damaged. 
• On physical examination: decreased or loss of reflexes, such as knee and ankle reflexes
• Electromyography (EMG): slowing of conduction of electrical signals and in worse condition, it may be totally blocked conduction
• Cerebrospinal fluid (CSF) analysis: elevated protein levels with normal CSF white cell count.
• Blood and urine tests: to define the causes of CIDP and if there is any underlying diseases.
• Nerve biopsy: to establish the diagnosis.
• MRI. It is a useful tool to support the diagnosis criteria of CIDP.
• Holistic evaluation of genetic neuropathy.

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) : Treatment and Management

Basically, the treatment for all kinds of autoimmune disease is slightly similar. Here are several protocols to manage patient with CIDP:

• Steroid. The goal of steroid is reduce inflammation. It can be used for initial treatment because it can improve strength, can be taken orally, and relatively cheap. Please be careful of the side effects of long term steroid.
• Intravenous Immunoglobulins (IVIG). It is a blood protein that taken from healthy individuals, given through arm vein 
• Plasmapheresis or plasma exchange. The goal is removing harmful antibodies that found in plasma. CIDP patient's blood will be removed, and the blood cells returned without its plasma.

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Autism Spectrum Disorder Symptoms In Children

autism spectrum disorder symptoms in children

What is autism? And what is Autism Spectrum Disorder?

Autism is a very complex developmental disabilities that cause problems with communication and social interaction. Signs and symptoms of autism start at 18 months old and then will cause delays in social developmental from infancy to adulthood. 

According to National Institute of Child Health and Human Development, people with autism have variable different symptoms so health care providers conclude autism as a "spectrum" disorder: a group of disorders with similar features. One children may show mild symptoms but another may have very serious symptoms. But both of them have an autism spectrum disorder. There are three categories of autism spectrum disorder:

1. Classic autism or autistic disorder
2. Asperger syndrome
3. Atypical autism or Pervasive Developmental Disorder Not Otherwise Specified, or shortened as pervasive developmental disorder.

So we use terminology "autism spectrum disorder" and "autism" to mean the same disorder.

Autism spectrum disorder symptoms in children

There are three main points of autism spectrum disorder:

• Communication disorder: both verbal and non verbal communication. There are difficulties in speaking, pointing, smiling, eye contact, etc.
• Social interaction incapability, such as how to give empathy, sharing emotions to others, how others think and feel, and how to hold a conversation
• Routines or repetitive behaviors disorder, such as playing in repetitive ways, repeating actions or words, obsessively following certain routines.

Autism spectrum disorder treatments

• As quoted from Center for Disease Control, there is no single best treatment for all children with autism spectrum disorders.
• The most important of treatment program is structured teaching of specific skills.
• Regular medical and dental examination should also be included in the treatment program.
• Three basic treatments:

1. Behavioral therapy, based on Applied Behavior Analysis (ABA). Speech therapy can help autism children improve their communication ability. Occupational therapy can help children adjust tasks to match their needs and abilities. Physical therapy is also important to build motor control and improve posture and balance.
2. School-based options. Public schools are required to provide appropriate public education from age 3 until high school. Parents should consult to the teachers, school psychologists, and child developmental specialists to design an individual plan for their children.
3. Medication. There are no medications that can cure autism spectrum disorder symptoms in children. SSRIs (Selective Serotonin Reuptake Inhibitor), anti psychotics, stimulants, tricyclics, and anti anxiety are often prescribed. A hormone that helps digestion called secretin is not recommended as autism spectrum disorder treatment.

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Heat Stroke Symptoms And Treatment

heat stroke symptoms and treatment

One of true medical emergency that can be fatal and needs proper treatment is heat stroke. It is one kind of hyperthermia which the body temperature is rapidly increased, accompanied by nervous system disturbances. In extreme heat, the body temperature can dramatically raises, it can reach 42 C and may be higher. Heat stroke can be caused by dehydration. As quoted from MedicineNet, a dehydrated person may not be able to dissipate heat, which causes the body temperature to rise. Infants, high activities people (such as athletes), people who work under the sun, and elderly people are very susceptible to heat stroke. 

Heat stroke symptoms and treatment

Symptoms and signs of rapidly heat stroke are:

• Nausea and vomiting
• Brain and nervous system disorders: dizziness, disorientation anxiety, unconsciousness, seizure, confusion, severe restlessness, until coma
• Difficulty of breathing, from moderate to severe
• Increased heart rate until cardiac arrythmia
• A rectal temperature over 40 C (104 F)
• Red, hot, and very dry skin
• Muscle cramps

When you find someone with suspected heat stroke, please remember that he must receive immediate treatment to prevent permanent organ damage. Here are some steps of heat stroke treatment.

• Find a help, call 911
• Remove the victim from heat
• Begin cooling: apply cool water to the skin, place ice packs under groins and armpits, give him cool water to drink
• Monitor body temperature, especially by rectal temperature examination
• In most cases, victims must be hospitalized.

Heat stroke management in a medical facility (taken from American Academy of Family Physicians)

• Continue cooling until core temperature of 38 C (100.4 F)
• Laboratory tests to rule out other entities, such as: electrolyte imbalance, hyperthyroid storm, neuroleptic malignant syndrome, phechromocytoma, etc
• Monitor renal function 
• Caution patient about re-exposure

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How To Lower Androgenic Hormones

how to lower androgenic hormones

Androgenic hormones are steroid hormones that control the development and maintenance of masculine characteristics. The main source of androgenic hormones in the body is the testes. Androgenic hormones are also the original anabolic steroids and also precursors for female sex hormones called estrogens. Testosterone is the most famous androgen that has profound effects throughout the body. Testosterone also plays a role in governing behaviors such as risk taking, aggression, territoriality, and mitigating depression.

Androgenic hormones can be stimulated by such things below.

• Physical exercises, such as sprinting and resistance training, but avoid overtraining.
• Have a good night sleep everyday. It will reduce cortisol levels and directly promote testosterone levels. 
• Take a relaxation during your busy time. Take time to go out with friends, read some books, etc.
• Eat dairy and animal products. Be sure you choose the clean and natural ones.
• Eat more essential fatty acids, such as peanuts, avocado, fish, and healthy oils like flax seed, canola, and olive. As we've known, cholesterol is the basic material to make testosterone. High fiber diet tends to lower androgenic hormones, so sometimes we have to make it balanced.
• Take vitamin D supplement and more activity under the morning sun.
• Take zinc supplement. Zinc deficiency will lower androgenic hormones.
• Reduce alcohol consumption.
• In females, reduce soy intake because it increases estrogen levels and lowers androgenic levels.
• Increase sexual activity can also stimulates androgenic hormones.  

How to lower androgenic hormones?

High level of androgenic hormones is bad for women, because it is associated with hirsutism, or unwanted hair growth. Here are some natural ways you can try.

• Dietary soy-phytoestrogens. Recent study concludes the beneficial effects of dietary phytoestrogens on regulatory behaviors (food/water intake, body weight, and locomotor activity), prostate enzyme activity, prostate weight, and reproductive hormon levels.
• Consume these natural remedies: herbal tea (like spearmint tea), black cohosh capsules, saw palmetto and chaste tree capsules.
• Consume natural supplement made from broccoli and cauliflower called DIM (Diindolylmethane). The dose is 120 mg daily
• Consult an acupuncturist to have a serial therapy to lower androgenic hormones.

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