GastroinTestinal Disorders Celiac Disease

Definition

Celiac disease is the genetic autoimmune disease. The body immune system attacks the villi- the tiny, finger-like protrusions lining of the small intestine due to the intake of gluten ( a protein which is found in wheat, barley and rye. If the people have celiac disease, eating gluten will trigger the immune system and it responds by damaging finger-like villi in the small intestine. If the villi become damaged, it will not absorb nutrient into the bloodstream, which can lead to malnourishment. This damage causes diarrhea, fatigue, weight loss, bloating and anemia, and can lead to serious complications.

History

• Before World War II, Doctors and researchers thought that celiac disease affects mostly children, and had a death rate about 30%.
• During the war, a doctor noticed the death rate of celiac disease was zero. It is because of limited usage of wheat. Instead of wheat flour, people used potato starch as flour. The reason was found!
• Until 1970’s that celiac disease wasn’t noticed as an autoimmune disorder. Before 1970’s it was noticed as a food allergy.
• In 1990’s, the United States considered this disease as extremely rare and almost not exist. Even though in Europe, there was a rampage of epidemics of celiac disease all over.
• Fasano started to conduct research and it turned out that celiac disease has just as prevalent in the U.S as it was in Europe, but had been generally ignored.
• In the 2000’s, Fasano did a big study and found the prevalence of celiac disease in the US at around 1%, which was 10 times higher than previously thought.
• Without going into detail here (read the article), but at this time a potential connection between celiac and both autism and schizophrenia were found.
• In the 2010’s, celebrities begin to weigh in. (And here is where the fad begins).
• In 2012, Miley Cyrus says she lost weight on the gluten-free diet.
• By 2013, the gluten-free food and beverage industry grew to $10.5 billion.
• In 2017. Dr. Fasano says he hopes the pendulum swings back toward the middle, and people realize that gluten-free is not for weight loss and is not for everyone.

Epidemiology

Celiac disease is a common issue in the US and in Europe. A moderately uniform commonness has been found in numerous countries, range between 1 of every 67 and 1 of every 250 with a rough average of 1% in very much outlined investigations from differing regions, including North and South America, Eastern and Western Europe, Turkey, the Middle East, and North Africa. It is far less common in individuals from Southeast Asia and sub-Saharan Africa.

In populace studies, men and ladies are generally similarly influenced. In clinical practice, be that as it may, ladies tend to make up just about 66% of patients. The primary period time of introduction is in children around age 6 to 7 years; however, celiac disease can emerge when gluten is presented. A moment, bigger peaks happen in the fourth and fifth decades. In spite of the fact that the most widely recognized age at analysis in the US is around 40 years, the celiac disease might be analyzed at any age.

The silent celiac disease is serologic and histologic confirmation of celiac disease, however, with no apparent indications, signs, or insufficiency states. The extent of celiac disease that is genuinely quiet isn’t outstanding, yet it is thought to represent no less than 20% of cases.

The refractory celiac disease is a particular finding inside the classification of nonresponsive celiac ailment, characterized as the constancy of clinical side effects and histologic variations from the norm after no less than a half year on a strict sans gluten eat fewer carbs and without other clear causes or of unmistakable lymphoma. The frequency of headstrong celiac malady in patients with celiac sickness isn’t notable however is felt to be roughly 1%.

Types

There are four types of celiac diseases include:

• Silent
• Latent
• Classical
• Atypical

Silent

People who have the silent celiac disease will not have any symptoms, but they will get positive results for the test. This is usually discovered when your doctor is investigating other disease conditions while taking blood tests.

Latent

The latent celiac disease begins in adulthood, and along with silent celiac disease which has no symptoms can be felt. The doctor will diagnose small intestine or by having a blood test which shows protein in the bloodstream and in intestine shows the damaged villi and the abnormal cells on the wall of the intestine. There is no extra risk of other diseases from the latent celiac disease.

Classical

This type of celiac disease arises in your childhood. Symptoms you may feel, such as bloating and diarrhea.  There is no serious risk in this type of celiac disease. This disease has antibodies which are running in your bloodstream as does all other types. To treat classical celiac disease, gluten-free food should be taken for your diet.

Atypical

The atypical celiac disease begins when you are an adult. Symptoms of this type are totally different from other types. There is no symptom in the small intestine; instead, you will get symptoms such as bleeding, skin rash, and nerve damage. It causes risks of other diseases such as Cancer and Cirrhosis. This can be treated with gluten-free diet. The tissues and cells are removed from your small intestines abnormally.

Causes

• Celiac disease is occurring due to the interaction between the genes, intake of food which contains gluten and other environmental factors. But the main cause is not known.
• Stomach gut bacteria, gastrointestinal infections, and infant feeding practices may develop celiac disease.
• Sometimes, celiac disease is caused or becomes active by due to the surgery, pregnancy, childbirth, viral infections or emotional stress.
• Some gene variations also increase the risk of developing the disease. But having these gene variations doesn’t mean the person will get celiac disease.
• Having family members with celiac disease may also increase the chances of having a celiac disease to 1 in 10.

Risk factors

Celiac disease affects anyone. The people who have other autoimmune disease and some genetic disorders may also cause the risk of celiac disease such as follows.

• Type 1 diabetes
• Rheumatoid arthritis
• Addison’s disease
• Microscopic colitis
• Down syndrome or Turner syndrome
• Autoimmune thyroid disease
• A family member with celiac disease or dermatitis herpetiformis
  

Symptoms

Symptoms and signs of celiac disease show variations in children and adults. The most common symptoms that appear after eating gluten accidentally in their diet are as follows.

• Diarrhea
• Extreme weight loss
• Fatigue due to malnutrition
• Nausea
• Vomiting
• Bloating and gas
• Constipation
• Abdominal pain
• Mouth ulcers
• Pale foul smelling stool (steatorrhea)
• Heat burn and acid reflux

For children’s under 2 years old the symptoms are as follows.

• Muscle atrophy
• Children’s may not thrive at their expected growth rate
• Distended stomach
• Chronic diarrhea
• Vomiting
• Short Stature
• Delayed puberty
• Attention-deficit/hyperactivity disorder (ADHD)
• Learning disabilities
• Seizures

Celiac disease may have signs and symptoms that are not related to the digestive system include:

• Hyposplenism (less functioning of spleen)
• Blister, skin rash, and itching (dermatitis herpetiformis)
• Numbness and tingling feeling in the hands and limbs
• Cognitive impairment and the problem with body balance.
• Headache

Complications of celiac disease

• Malabsorption: Failure of the intestine to absorb nutrients is known as malabsorption. As a result, it can lead to vitamin and mineral deficiencies such as anemia.
• Early onset of osteoporosis (low bone density) and osteomalacia (soft bone).
• Lactose intolerance: inflammation of the lining of the intestine can stop producing enzymes that needed for the breakdown of lactose.
• Lymphoma and bowel cancer: Untreated and long duration of celiac disease throughout your life lead to adenocarcinoma and cancer of intestine and esophagus.
• Damage to dental enamel: malabsorption of calcium and other minerals lead to permanent damage to tooth enamel.
• Celiac disease in pregnant women can result in low birth weight baby delivery.
• Irritability and depression because of loss of energy due to malnutrition of vitamins.
• Loss of memory and concentration due to lack of important nutrients that produce a chemical called ‘neurotransmitters’ which stimulates the nerve cells.

How do doctors diagnosis and test celiac disease

Medical and family history

The doctor will ask for patient’s medical history if they had other bowel diseases earlier in their life. He also will ask information on family history of celiac disease.

Physical examination

The patient may be examined for the following conditions:

• The doctor will examine patient’s whole body whether rashes, blisters, and itchy feel are present. These are very common conditions of malnutrition.
• Using the stethoscope he may listen to the sounds of the bowel movements
• He may press your abdomen to check for fullness, pain, and swelling
• The doctor can check for dental enamel defects such as white, yellow, or brown spots on the teeth because people with celiac disease have these problems as first notable symptoms.

Blood test

These two tests can help a doctor to diagnose the celiac disease.

Serology test: Certain antibody proteins that are working in gluten tolerance mechanism can be elevated in the blood. A serology test reveals the antibodies that are responsible for an immune reaction to gluten.

Genetic test: Gene testing of human leukocyte antigens (HLA-DQ2 and HLA-DQ8) can be very useful for finding the celiac disease. If you are an absence of these antigens, then unlikely you are having celiac disease.

Endoscopy biopsy

If the above blood test results are positive for celiac disease then to confirm endoscopy biopsy is performed. Through the endoscopic device, a doctor views small intestine and take a sample of small tissue (biopsy) to examine the damage to the villi.

How celiac disease is treated

Gluten-free diet

There are no drugs to cure celiac disease. The only way to cure celiac disease is to stick with a gluten-free diet. Your doctor may direct you to visit a dietitian, who can assist with your gluten-free diet. A dietitian may help you to0

• Make everyday meal plans
• Prefer choices of healthy food to eat
• Check for food and product labels about the gluten

Once if the gluten-free diet is taken by the celiac patient, gradually the inflammation in the intestinal lining starts to heal in 3 to 6 months for children and complete heal for adults may take several years.

Foods that are free from gluten are as follow.

• Beans, seeds, and nuts in their natural, unprocessed form
• Eggs
• Meats, fish, and poultry (not breaded, batter-coated or marinated)
• Fruits and vegetables
  
• Dairy product
• 
  
  

Hidden gluten foods

• Barley (malt, malt flavoring, and malt vinegar are usually made from barley)
• Rye
• Triticale (a cross between wheat and rye)
• Wheat

Excluding wheat in the diet is very challenging because there are other products which are made from wheat are:

• Durum Flour
• Farina
• Graham flour
• Kamut
• Semolina
• Spelt

Avoid packed foods and drinks unless labeled ‘gluten-free’.

• Beer
• Breads
• Cakes and pies
• Candies
• Cereals
• Communion wafers
• Cookies and crackers
• Croutons
• French fries
• Gravies
• Imitation meat or seafood
• Matzo
• Pastas
• Processed luncheon meats
• Salad dressings
• Sauces, including soy sauce
• Seasoned rice mixes
• Seasoned snack foods, such as potato and tortilla chips
• Self-basting poultry
• Soups and soup bases
• Vegetables in sauce
• Diary product

Avoid medications, cosmetics, and other products unless labeled as ‘gluten-free’

• Prescription and over-the-counter medications
• Vitamin and mineral supplements
• Herbal and nutritional supplements
• Lipstick products
• Toothpaste and mouthwash
• Envelope and stamp glue
• Children’s modeling dough, such as Play-Doh

Prevention

• Do screening test and blood tests for elevated antibodies
• Gluten-free diet is the only way to prevent celiac disease
• Check food and medicine labels for wheat flour before ingestion.

Source Disease dictionary

Autoimmune Grace's Human Diseases

Introduction

Graves’ disease is an autoimmune disorder, meaning the body’s immune system acts against its own healthy cells and tissues. In Graves’ disease, the immune system makes antibodies called thyroid-stimulating immunoglobulin (TSI) that attach to thyroid cells. TSI mimics the action of TSH and stimulates the thyroid to make too much thyroid hormone. Sometimes the antibodies can instead block thyroid hormone production, leading to a confusing clinical picture.

Patient appearance during Graves’ disease

The Thyroid

The thyroid is a 2-inch-long, butterfly-shaped gland in the front of the neck below the larynx, or voice box. The thyroid makes two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). T3 is made from T4 and is the more active hormone, directly affecting the tissues. Thyroid hormones circulate throughout the body in the bloodstream and act on virtually every tissue and cell in the body.

Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels.

Thyroid hormone production is regulated by another hormone called thyroid-stimulating hormone (TSH), which is made by the pituitary gland in the brain. When thyroid hormone levels in the blood are low, the pituitary releases more TSH. When thyroid hormone levels are high, the pituitary responds by decreasing TSH production.

History

Graves’ disease owes its name to the Irish doctor Robert James Graves, who described a case of goiter with exophthalmos in 1835. The German Karl Adolph von Basedow independently reported the same constellation of symptoms in 1840.

As a result, on the European Continent, the terms Basedow’s syndrome, Basedow’s disease, or Morbus Basedow are more common than Graves’ disease. Graves’ disease has also been called exophthalmic goiter.

Less commonly, it has been known as Parry’s disease, Begbie’s disease, Flajani’s disease, Flajani–Basedow syndrome, and Marsh’s disease. These names for the disease were derived from Caleb Hillier Parry, James Begbie, Giuseppe Flajani, and Henry Marsh. Early reports, not widely circulated, of cases of goiter with exophthalmos were published by the Italians Giuseppe Flajina and Antonio Giuseppe Testa, in 1802 and 1810, respectively.

Prior to these, Caleb Hillier Parry, a notable provincial physician in England of the late 18th century (and a friend of Edward Miller-Gallus), described a case in 1786. This case was not published until 1825, but still 10 years ahead of Graves.

However, fair credit for the first description of Graves’ disease goes to the 12th century Persian physician Sayyid Ismail al-Jurjani, who noted the association of goiter and exophthalmos in his Thesaurus of the Shah of Khwarazm, the major medical dictionary of its time.

Epidemiology

Graves’ disease is the most common cause of thyrotoxicosis and it accounts for 60-80% cases of thyrotoxicosis. Prevalence of Graves’ disease varies with the degree of iodine sufficiency, and it is the most common cause of thyrotoxicosis in iodine sufficient countries. High dietary iodine intake is associated with an increased prevalence of Graves’ disease.

Prevalence of Graves’ disease is about 0.4% in USA, 0.6% in Italy,6 and 1.1% in UK. A recent meta-analysis of various studies showed that prevalence of the Graves’ disease is about 1% in general population. Prevalence of Graves’ disease is 1-2% in women, and it is about 10 fold more prevalent in women than men. Peak age of onset of Graves’ disease is in fourth to sixth decade of life, but it can occur in children and elderly.

What causes Graves’ disease?

• Graves’ disease is triggered by a process in the body’s immune system, which normally protects us from foreign invaders such as bacteria and viruses.
• The immune system destroys foreign invaders with substances called antibodies produced by blood cells known as lymphocytes.
• Sometimes the immune system can be tricked into making antibodies that cross-react with proteins on our own cells.

• In many cases these antibodies can cause destruction of those cells. In Graves’ disease these antibodies (called the thyrotropin receptor antibodies (TRAb) or thyroid stimulating immunoglobulins (TSI) do the opposite – they cause the cells to work overtime.
• The antibodies in Graves’ disease bind to receptors on the surface of thyroid cells and stimulate those cells to overproduce and release thyroid hormones. This results in an overactive thyroid (hyperthyroidism).

Risk factors

• Genetic factors for Graves’ disease

High prevalence of Graves’ disease in family members and relatives of Graves’ disease and Hashimoto’s thyroiditis support that genetic factors are involved in causation of Graves’ disease.

• Environmental Factors:

Infection

From very early it has been suggested that Graves’ disease is associated with infectious agents, but this hypothesis has not been confirmed. Incidence of recent viral infections are high in patients with Graves’ disease.

Stress

Severe emotional and physical stress, like separation from the loved one or following road traffic accident, cause release of cortisol ad corticotrophin releasing hormone. So, stress is a relatively immune suppression state.

Gender

Typically Graves’ disease is more prevalent in females than males. It is about 5-10 times more common in females at any age. In children this difference is smaller. The exact cause for female preponderance is not known, but it is similar to other autoimmune disorders.

Pregnancy

Postpartum period is an important risk factor for both the onset and relapse of Graves’ disease. Postpartum period is associated with a fourfold to eightfold increased risk for the onset of Graves’ disease. Rebound immunity is the likely explanation for this increased risk. Graves’ disease is associated with low pregnancy rate because thyrotoxicosis decreases the fertility rate. However in women with Graves’ disease who became pregnant, successful pregnancy outcome is low because Graves’ disease causes increased pregnancy loss and its complications.

Smoking

Smoking is a minor risk factor for Graves’ disease; however it is a major risk factor for Graves’ ophthalmopathy.

Other risk factors:

Direct trauma to the thyroid gland, ethanol injection for the treatment of autonomously functioning thyroid nodules, or thyroid injury following radio-iodine treatment for toxic adenoma or toxic multinodular goiter are associated with an increased risk of Graves’ disease. Radio-iodine treatment may also cause onset or worsening of ophthalmopathy.

Possible explanation is that thyroid injury by any means cause massive release of thyroid antigens, which in turn stimulate an autoimmune reaction to TSHR in susceptible individuals. Graves’ disease onset and recurrence is also associated with iodine and iodine containing drugs like amiodarone and radio-contrast media especially in iodine deficient population.

What are the symptoms of Graves’ disease?

People with Graves’ disease may have some of the common symptoms of hyperthyroidism such as

• Nervousness or irritability
• Fatigue or muscle weakness
• Heat intolerance
• Trouble sleeping
• Hand tremors
  
• Rapid and irregular heartbeat
• Frequent bowel movements or diarrhea
• Weight loss
• Hyperthyroidism
• Goiter, which is an enlarged thyroid that may cause the neck to look swollen
• In addition, the eyes of people with Graves’ disease may appear enlarged because their eyelids are retracted and their eyes bulge out from the eye sockets. This condition is called Graves’ ophthalmopathy.

Graves’ opthalmology

• A small number of people with Graves’ disease also experience thickening and reddening of the skin on their shins. This usually painless problem is called pretibial myxedema or Graves’ dermopathy.

Graves’ dermopathy

Graves’ disease Complications

If Graves’ disease isn’t treated, it can cause complications, such as:

• Heart disorders: In some people, the disease can cause heart rhythm problems or heart failure.
• Thyroid storm: This life-threatening complication of Graves’ disease involves a sudden increase in thyroid hormones. A thyroid storm is a rare event, but it can result in heart failure and pulmonary edema (a buildup of fluid in the lungs). In the event of a thyroid storm, immediate medical attention is required.
• Pregnancy problems: Miscarriage, preterm birth, fetal thyroid dysfunction, maternal heart failure, and preeclampsia (high blood pressure during pregnancy) are all possible complications of Graves’ disease.
• Brittle bones: Graves’ disease can lead to osteoporosis, a condition characterized by weak, porous bones.

How is Graves’ disease diagnosed?

Health care providers can sometimes diagnose Graves’ disease based only on a physical examination and a medical history. Blood tests and other diagnostic tests, such as the following, then confirm the diagnosis.

• TSH test. The ultrasensitive TSH test is usually the first test performed. This test detects even tiny amounts of TSH in the blood and is the most accurate measure of thyroid activity available.
• T3 and T4 test. Another blood test used to diagnose Graves’ disease measures T3 and T4 levels. In making a diagnosis, health care providers look for below-normal levels of TSH, normal to elevated levels of T4, and elevated levels of T3. Because the combination of low TSH and high T3 and T4 can occur with other thyroid problems, health care providers may order other tests to finalize the diagnosis. The following two tests use small, safe doses of radioactive iodine because the thyroid uses iodine to make thyroid hormone.
• Radioactive iodine uptake test. This test measures the amount of iodine the thyroid collects from the bloodstream. High levels of iodine uptake can indicate Graves’ disease.
• Thyroid scan. This scan shows how and where iodine is distributed in the thyroid. With Graves’ disease the entire thyroid is involved, so the iodine shows up throughout the gland. Other causes of hyperthyroidism such as nodules—small lumps in the gland—show a different pattern of iodine distribution.
• TSI test. Health care providers may also recommend the TSI test, although this test usually isn’t necessary to diagnose Graves’ disease. This test, also called a TSH antibody test, measures the level of TSI in the blood. Most people with Graves’ disease have this antibody, but people whose hyperthyroidism is caused by other conditions do not.
• Other Tests. Depending on your symptoms (e.g., exophthalmos), other tests may include a CT scan, MRI, or ultrasound (echography) of the eyes and eye sockets (called orbital imaging) in order to define the exact impact of Graves’ disease on the eyes and surrounding structures (e.g., muscles). The doctor combines your medical history, symptoms, and all test results to make a diagnosis of Graves’ disease.

Graves’ Disease Treatment

Treatments for Graves’ disease aim to control your overactive thyroid. Some treatment options include:

Anti-thyroid medicines

These drugs prevent your thyroid gland from producing too much of its hormones. Antithyroid medications interfere with thyroid hormone production but don’t usually have permanent results. Use of these medications requires frequent monitoring by a health care provider.

More often, antithyroid medications are used to pretreat patients before surgery or radioiodine therapy, or they are used as supplemental treatment after radioiodine therapy. Common anti-thyroid drugs include Tapazole (methimazole) and propylthiouracil. Antithyroid medications can cause side effects in some people, including

• Allergic reactions such as rashes and itching
• A decrease in the number of white blood cells in the body, which can lower a person’s resistance to infection
• Liver failure, in rare cases

Radioiodine Therapy

In radioiodine therapy, the patient takes radioactive iodine-131 by mouth. Because the thyroid gland collects iodine to make thyroid hormone, it will collect the radioactive iodine from the bloodstream in the same way. Iodine-131—stronger than the radioactive iodine used in diagnostic tests—will gradually destroy the cells that make up the thyroid gland but will not affect other tissues in the body. Surgery: Sometimes, doctors recommend a thyroidectomy (surgery to remove all or part of the thyroid gland) to treat Graves’ disease.

Beta blockers

Betablockers are a group of drugs that tend to improve some of the symptoms and manifestations of hyperthyroidism. In particular, they can improve palpitations, slow the heart down and improve tremor. They have no effect on curing the thyroid overactivity, but do make many people feel better. Betablockers should not be taken if the patient has asthma or a wheezy chest.

Thyroid Surgery

Surgery is the least-used option for treating Graves’ disease. Sometimes surgery may be used to treat

• Pregnant women who cannot tolerate antithyroid medications
• People suspected of having thyroid cancer, though Graves’ disease does not cause cancer
• People for whom other forms of treatment are not successful

Before surgery, the health care provider may prescribe antithyroid medications to temporarily bring a patient’s thyroid hormone levels into the normal range. This presurgical treatment prevents a condition called thyroid storm—a sudden, severe worsening of symptoms—that can occur when hyperthyroid patients have general anesthesia.

Eye Care

• The eye problems associated with Graves’ disease may not improve following thyroid treatment, so the two problems are often treated separately.
• Eye drops can relieve dry, gritty, irritated eyes—the most common of the milder symptoms. If pain and swelling occur, health care providers may prescribe a steroid such as prednisone.
• Other medications that suppress the immune response may also provide relief. Special lenses for glasses can help with light sensitivity and double vision.
• People with eye symptoms may be advised to sleep with their head elevated to reduce eyelid swelling. If the eyelids do not fully close, taping them shut at night can help prevent dry eyes.
• In more severe cases, external radiation may be applied to the eyes to reduce inflammation.
• Surgery may be used to improve bulging of the eyes and correct the vision changes caused by pressure on the optic nerve. A procedure called orbital decompression makes the eye socket bigger and gives the eye room to sink back to a more normal position. Eyelid surgery can return retracted eyelids to their normal position.

Dietary Supplements

• Iodine is an essential mineral for the thyroid. However, people with autoimmune thyroid disease may be sensitive to harmful side effects from iodine.
• Taking iodine drops or eating foods containing large amounts of iodine such as seaweed, dulse, or kelp may cause or worsen hyperthyroidism.
• Women need more iodine when they are pregnant about 250 micrograms a day because the baby gets iodine from the mother’s diet.

Prevention and control of Graves’ disease

• The key to prevention is therefore, to watch for the onset of Graves’ disease in the family and know that there is a chance to get it later in life.
• However, the genetic component is just a part of the big puzzle, and many environmental effects seem to trigger the genetic potential and help it come to life
• Therefore, people who are at the highest risk from Graves’ disease should try to live their lives as healthy as possible.
• It is important to avoid stress and incorporate various relaxation techniques into everyday routine.
• Stress is one of the main environmental causes of autoimmune diseases, but simple methods such as breathing exercises, yoga, and relaxation therapy can help to reduce the stress and live more calmly.
• One should also try to avoid smoking and other unhealthy habits. Keeping away from toxins from tobacco, foods and environment can dramatically increase one’s chances of preventing Graves’ disease.
• One should also try to avoid any injury to a thyroid gland, and try not to use any steroids, even in the medical treatment. A person should, if possible, substitute steroid treatment with some healthier approaches.

Source:HumanDiseases

Human Diseases Hair Loss Balding

Introduction

Hair loss is a disorder in which the hair falls out from skin areas where they are usually present, such as the scalp and the body. This loss interferes with the  many  useful  biologic  functions  of  the  hair,  including  sun  protection  (mainly  to  the  scalp)  and  dispersal of sweat gland products.

As hair cover to the   scalp   has   psychological   importance   in   our   society, patients with hair loss suffer tremendously. The   most   common   hair   disorder   is   termed   as   alopecia  which  is  frequently  used  to  express  the  patterned loss of scalp hair in genetically vulnerable men  and  women.

Hair structure

Each strand of hair is a complex weaving of lifeless protein produced by a teardrop-shaped hair follicle. The hair follicles are made of living cells that receive nourishment entirely from the blood supply under the skin. The hair itself is made up of completely dead cells. Dead hair shaft cells cannot be “revived” to bring your dull hair back to life.

There are hundreds of thousands of hair follicles in the skin covering almost every part of the body. Some hair follicles produce fine almost colorless “peach fuzz” hairs, and others produce thicker pigmented hair shafts. Each hair follicle is a miniature organ that grows a single hair during a phase of growth. That single hair can last for several months or several years, depending on how the follicle has been genetically programmed. Scalp hair follicles tend to have a longer growth phase than eyelash hair follicles.

Stages of hair growth

There are three phases of hair growth, and the hair follicle changes significantly from phase to phase.

• Anagen – Active hair growth that lasts between two to six years
• Catagen – Transitional hair growth that lasts two to three weeks
• Telogen – Resting phase that lasts about two to three months; at the end of the resting phase the hair is shed and a new hair replaces it and the growing cycle starts again

Types of Hair loss

There are many types of hair loss, also called alopecia:

• Involutional alopecia is a natural condition in which the hair gradually thins with age. More hair follicles go into the resting phase, and the remaining hairs become shorter and fewer in number.
• Androgenic alopecia is a genetic condition that can affect both men and women. Men with this condition, called male pattern baldness, can begin suffering hair loss as early as their teens or early 20s. It’s characterized by a receding hairline and gradual disappearance of hair from the crown and frontal scalp.Women with this condition, called female pattern baldness, don’t experience noticeable thinning until their 40s or later. Women experience a general thinning over the entire scalp, with the most extensive hair loss at the crown.

• Alopecia areata often starts suddenly and causes patchy hair loss in children and young adults. This condition may result in complete baldness (alopecia totalis). But in about 90% of people with the condition, the hair returns within a few years.
• Alopecia universalis causes all body hair to fall out, including the eyebrows, eyelashes, and pubic hair.
• Trichotillomania, seen most frequently in children, is a psychological disorder in which a person pulls out one’s own hair.
• Telogen effluvium is temporary hair thinning over the scalp that occurs because of changes in the growth cycle of hair.
• Scarring alopecias result in permanent loss of hair. Inflammatory skin conditions (cellulitis, folliculitis, acne), and other skin disorders (such as some forms of lupus and lichen planus) often result in scars that destroy the ability of the hair to regenerate. Hot combs and hair too tightly woven and pulled can also result in permanent hair loss.

History about Balding

• The Ebers Papyrus, written by the Egyptians, is the oldest medical text ever discovered. The text, believed to be a compendium of medical knowledge collected over the two thousand years that preceded it being written in the year 1553 B.C.
• Among the assembled remedies in the Ebers Papyrus there includes a solution for hair loss. Here are the ingredients: onions, honey, red lead, iron oxide, alabaster and the fat of animals that includes lions, snakes, hippopotamuses and crocodiles.
• In 1624, the French king Louis XIII began wearing a wig to shield his thinning scalp from the view of others. This saw the beginning of a craze in France that saw members of court – even those with a full-head of hair – wearing similar wigs because of their associations with power.
• The nineteenth century was the age of the ‘snake oil’ salesmen. These were essentially quacks that moulded themselves into the guise of reputable doctors to help sell their promise of curing baldness.
• In 1939, things started to take a turn towards the credible when Dr. Shoji Okuda created a method for the world’s first hair transplant. His technique was based on removing hair follicles from the back of the patient’s head in order to graft them on to the area of the scalp where hair no longer grew.
• Snake oil based medicines came with a whole plethora of fabulously imaginative names which included Mrs Allen’s World Hair Restorer, Skookum Root Hair Growth and Barry’s Tricopherous. Unbelievably, the last known sale of Barry’s Tricopherous was recorded in Honduras during the 1970s.
• In 1988, the first medicine to be scientifically proven to have hair replenishing qualities was approved by the US Food and Drug Administration (FDA), called Minoxidil. Despite originally only being available by prescription, Minoxidil lotion can now be bough over the counter across the world and is branded as Regaine in the UK.
• By 1995 the hair transplanting technique of micrografting matured into Follicular Unit Micrografting. To this day the technique remains the industry standard for hair transplant surgery.  The advancement focused on preserving natural hair follicles on strips of donor tissue, minimising the risk of damaging during the graft.
• In 2000’s smaller evolutions in the processes used during Follicular Unit Micrografting continued, increasing the effectiveness of this type of surgery. After 5,000 years, and many failed treatments, hair transplants and a select number of medicines finally exist which combat hair loss.

Epidemiology and prevalence

The prevalence of pattern hair loss may be as high as 98% and as low as 40%. In men, the age of onset usually is between 20 and 25 years, and prevalence and severity of disease increase with age. In general, 30% of white people are affected by age 30 years, 50% by age 50 years, and 80% by age 70 years. The global incidence varies among ethnic groups with the greatest incidence in white people, followed by Asians, African Americans, and Native Americans. In women, the onset of hair loss is usually before 40 years, and according to published data as many as 13% of premenopausal women have some evidence of pattern hair loss. However, the incidence increases in women around the time of menopause and may affect 70% of women over the age of 65 years.

Causes and risk factors of hair loss in both genders

• Physical stress: Any kind of physical trauma, surgery, a car accident, or a severe illness, even the flu can cause temporary hair loss. This can trigger a type of hair loss called telogen effluvium.
• Pregnancy: Pregnancy in women is one example of the type of physical stress that can cause hair loss (that and hormones). Pregnancy-related hair loss is seen more commonly after your baby has been delivered rather than actually during pregnancy.
• Too much vitamin A: Overdoing vitamin A-containing supplements or medications can trigger hair loss.
• Lack of protein: If you don’t get enough protein in your diet, your body may ration protein by shutting down hair growth. This can happen about two to three months after a drop in protein intake.
• Heredity: If you come from a family where women started to have hair loss at a certain age, then you might be more prone to it.
• Female hormones: Just as pregnancy hormone changes can cause hair loss, so can switching or going off birth-control pills. This can also cause telogen effluvium, and it may be more likely if you have a family history of hair loss. The change in the hormonal balance that occurs at menopause may also have the same result.
• Emotional stress: Emotional stress is less likely to cause hair loss than physical stress, but it can happen, for instance, in the case of divorce, after the death of a loved one, or while caring for an aging parent.
• Anemia: Almost one in 10 women aged 20 through 49 suffers from anemia due to an iron deficiency (the most common type of anemia), which is an easily fixable cause of hair loss.
• Hypothyroidism: Hypothyroidism is the medical term for having an underactive thyroid gland. This little gland located in your neck produces hormones that are critical to metabolism as well as growth and development and, when it’s not pumping out enough hormones, can contribute to hair loss.
• Vitamin B deficiency: Although relatively uncommon in the U.S., low levels of vitamin B are another correctible cause of hair loss.
• Autoimmune-related hair loss: This is also called alopecia areata and basically is a result of an overactive immune system. The body gets confused and the immune system sees the hair as foreign and targets it by mistake.
• Dramatic weight loss: Sudden weight loss is a form of physical trauma that can result in thinning hair. It’s possible that the weight loss itself is stressing your body or that not eating right can result in vitamin or mineral deficiencies.
• Chemotherapy: Some of the drugs used to beat back cancer unfortunately can also cause your hair to fall out. Chemotherapy is like a nuclear bomb. It destroys rapidly dividing cells but also rapidly dividing cells like hair.
• Polycystic ovary syndrome: Polycystic ovary syndrome (PCOS) is another imbalance in male and female sex hormones. An excess of androgens can lead to ovarian cysts, weight gain, a higher risk of diabetes, and changes in your menstrual period, infertility, as well as hair thinning.
• Antidepressants, blood thinners, and more:Drugs that might cause hair loss include methotrexate (used to treat rheumatic conditions and some skin conditions), lithium (for bipolar disorder), nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen, and possibly antidepressants.
• Overstyling: Vigorous styling and hair treatments over the years can cause your hair to fall out. Examples of extreme styling include tight braids, hair weaves or corn rows as well as chemical relaxers to straighten your hair, hot-oil treatments or any kind of harsh chemical or high heat.
• Trichotillomania: Trichotillomania, classified as an “impulse control disorder,” causes people to compulsively pull their hair out. Unfortunately, this constant playing and pulling can actually strip your head of its natural protection: hair. Trichotillomania often begins before the age of 17 and is four times as common in women as in men.
• Aging: It’s not uncommon to see hair loss or thinning of the hair in women as they enter their 50s and 60s.
• Anabolic steroids: If you take anabolic steroids—the type abused by some athletes to bulk up muscle—you could lose your hair, according to the American Academy of Dermatology.

Symptoms and signs

• Gradual thinning on top of head. This is the most common type of hair loss, affecting both men and women as they age. In men, hair often begins to recede from the forehead in a line that resembles the letter M. Women typically retain the hairline on the forehead but have a broadening of the part in their hair.
• Circular or patchy bald spots. Some people experience smooth, coin-sized bald spots. This type of hair loss usually affects just the scalp, but it sometimes also occurs in beards or eyebrows. In some cases, your skin may become itchy or painful before the hair falls out.
• Sudden loosening of hair. A physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing your hair or even after gentle tugging. This type of hair loss usually causes overall hair thinning and not bald patches.
• Full-body hair loss. Some conditions and medical treatments, such as chemotherapy for cancer, can result in the loss of hair all over your body. The hair usually grows back.
• Patches of scaling that spread over the scalp. This is a sign of ringworm. It may be accompanied by broken hair, redness, swelling and, at times, oozing.

Complications associated with balding

Autoimmune conditions

Someone with alopecia areata is more likely to have or to develop other autoimmune conditions, such as:

• Thyroid disease – conditions that affect your thyroid gland, such as an overactive thyroid (hyperthyroidism)
• Diabetes -a condition that is caused by too much glucose (sugar) in the blood
• Vitiligo a condition that produces white patches on the skin

These conditions are all linked to problems with the immune system (the body’s natural defence against infection and illness). In autoimmune conditions, your immune system produces antibodies (proteins) that should fight infections, but instead they attack your body’s healthy tissues.

Emotional issues

• Hair loss can be difficult to come to terms with. The hair on your head can be a defining part of your identity. It reflects the image that you have of yourself and how you want others to see you.
• If you start to lose your hair, it can feel as if you are losing part of your identity. This can affect your self-confidence and sometimes lead to depression
• Speak to your GP if you are finding it difficult to deal with your hair loss. They may suggest counselling, which is a type of talking therapy where you can discuss your issues with a trained healthcare professional.

Diagnosis and Test

Before making a diagnosis, your doctor will likely give you a physical exam and ask about your medical history and family history. He or she may also perform tests, such as the following:

• Blood test. This may help uncover medical conditions related to hair loss, such as thyroid disease.
• Pull test. Your doctor gently pulls several dozen hairs to see how many come out. This helps determine the stage of the shedding process.
• Scalp biopsy. Your doctor scrapes samples from the skin or from a few hairs plucked from the scalp to examine the hair roots. This can help determine whether an infection is causing hair loss.
• Light microscopy. Your doctor uses a special instrument to examine hairs trimmed at their bases. Microscopy helps uncover possible disorders of the hair shaft.

Treatment and Medications

Hair loss remedies range from the mild to the extreme and the inexpensive to the costly. Much depends on how much hair is gone and how high a priority it is to mask its absence or replace it.

Topical creams and lotions: Over-the-counter minoxidil (also known as the brand name Rogaine) can restore some hair growth, especially in those with hereditary hair loss. It is applied directly to the scalp. Prescription-strength finasteride (Propecia) comes in pill form and is only for men.

Anti-inflammatory medications: Prescription steroid-based creams or injections can calm follicles damaged or inflamed by harsh chemicals or excessive pulling.

Surgery: Men tend to be better candidates for surgical hair-replacement techniques because their hair loss is often limited to one or two areas of the scalp. Procedures include grafting, which transplants from one to 15 hairs per disc-shaped graft to other locations. Scalp reduction removes bald skin from the scalp so hair-covered scalp can be stretched to fill in the bald areas. Side effects include swelling, bruising and headaches.

Hair Transplantation with Grafts Obtained from an Elliptical Strip from the Back of the Scalp.

Hair-growth laser treatment can also help to stimulate hair follicles and improve growth. People often see results when they combine laser treatment with another intervention.

Hair weaves or wigs: Typically expensive, wigs and hair weaves either completely cover the head or add to existing hair, restoring the appearance of a full head of hair. They are especially practical for cancer patients and those whose hair loss is temporary.

Immunotherapy

Immunotherapy may be an effective form of treatment for extensive or total hair loss, although fewer than half of those who are treated will see worthwhile hair regrowth. A chemical solution called diphencyprone (DPCP) is applied to a small area of bald skin. This is repeated every week using a stronger dose of DPCP each time.

Ultraviolet light treatment

Two to three sessions of light therapy (phototherapy) are given every week in hospital. The skin is exposed to ultraviolet (UVA or UVB) rays. In some cases, before your skin is exposed to UV light you may be given a medicine called psoralen, which makes your skin more sensitive to the light. The results of light therapy are often poor. The treatment can take up to a year to produce maximum results and responses.

It’s often not a recommended treatment because side effects can include:

• Nausea (feeling sick)
• Pigment changes to the skin
• An increased risk of skin cancer

Tattooing

For many people, it’s possible to replicate hair with a tattoo. This is known as dermatography and generally produces good long-term results, although it is usually expensive and can only be used to replicate very short hair. This is usually carried out for eyebrows over a few hourly sessions and can even be used as a treatment for scalp hair loss caused by male-pattern baldness.

Hair Loss Tattoo Micropigmentation

Complementary therapy

Aromatherapy, acupuncture and massage are often used for alopecia, but there isn’t enough evidence to support their use as effective treatments.

Prevention and control of hair loss in both men and women

Avoiding Damaging your Hair

• Limit your use of hair dryers. Heat weakens hair proteins. Constant heating and drying can lead to brittleness and fragility that can cause hair loss
• Avoid perms. Perming refers to either chemical straightening or chemical curling, both of which can damage your hair.
• Cut down on dyes and chemicals. Frequent use of hair colouring chemicals increases the chances of serious damage being done to your hair.
• Don’t bleach your hair. Bleaching your hair removes your natural pigment when the cuticles are penetrated by chemicals. By doing this you are changing the structure of your hair and making it more susceptible to damage.
• Don’t pull your hair too tight. Some hairstyles that require tight pulling and elastics or clips can be a cause of hair loss if done on a daily basis. For example, tight ponytails, tight braids, cornrows, and plaits can lead to significant hair loss when done daily.

Caring Actively for your Hair

• Wash hair with mild shampoo. Hair washing helps prevent hair loss as it can keep your hair and scalp clean (preventing the chances of infections that might cause hair loss).
• Choose a suitable shampoo for your hair type. Getting a good shampoo will really help you to have a healthy head of hair, so take some time to find that matches your hair type.
• Look at the ingredients to find a mild shampoo. Using a mild shampoo can help you maintain a healthy scalp and head of hair. Checking the ingredients in your shampoo can give you a good idea of whether or not it is mild. Avoid anything with sulfate, parabens, and/or sulfonate. Instead look for Isethionate or Glucoside to be the first ingredient after water.
• Use a good hairbrush. How you brush your hair can have a big impact on the condition of your hair. Go for a soft brush made from natural fibres, and don’t brush from the top down, but from the underside out. Be as gentle as you can and don’t pull too hard.
• Try a scalp massage. A scalp massage with a nourishing oil (such as coconut, rosemary, lavender, or almond oil) will increase the blood flow to the surface of the skin on your head and your hair follicles.
• Test your hair for thinning if you’re concerned. Testing whether or not you’re suffering from hair loss can be done using what is known as the “tug test”. Take a small bunch of hair, about 20–30 hairs, and hold it between your thumb and index finger. Pull slowly but firmly; if more than six hairs come out at the same time, you may have a hair loss problem.

Eating Right for Healthy Hair

• Have a healthy balanced diet. Nutritional responses to preventing hair loss are simple common sense approaches to keeping you, your hair, and your scalp healthy.
• Consume plenty of iron. Iron is an essential mineral that is known as heme iron in animal food sources and non-heme iron in plant sources.
  
  
  
• Eat enough protein. Protein is essential for strong hair. A deficiency in protein can lead to dry and weak hair, and ultimately, hair loss.
• Consume Vitamin C. Foods with plenty of vitamin C help in the good absorption of iron, so try to combine iron-rich foods with those that are high in vitamin C to get the most out of the iron. Vitamin C also help with your body’s production of collagen, which in turn strengthens the capillaries which supply your hair shafts.
• Ensure you get enough Omega-3 fatty acids. These fats keep hair healthy and have a role in preventing hair from becoming dry and brittle.
• Eat foods rich in biotin. Biotin is a B vitamin that is water soluble. It is of particular importance for your hair, as a deficiency can cause your hair to become brittle and could accelerate hair loss.
• Consider taking supplements. Talk with your medical practitioner first, but you might like to consider using supplements to prevent hair loss.
• Know what to avoid eating. As well as knowing what’s good to consume, it’s best to know what to avoid too

Source:human resource

Arterial Disorders Aneurysm

Definition

About 13,000 deaths occur each year in the United States from aortic aneurysms. An aneurysm occurs when an artery’s wall weakens and causes an abnormally large bulge. This bulge can rupture and cause internal bleeding. Although an aneurysm can occur in any part of your body, they’re most common in the:

• Brain
• Aorta
• Legs
• Spleen

Brief history about Aneurysm

Earliest records of abdominal aorta aneurysm in history come from Ancient Rome in the 2nd century AD. Greek surgeon Antyllus tried to treat the aneurysm with proximal and distal ligature, central incision and removal of thrombotic material from the aneurysm. The surgical management of aneurysms however dates back to 3000 years.

Surgical history of Aneurysm

Surgery was unsuccessful until 1923. In that year, Rudolph Matas performed the first successful aortic ligation on a human. Other non-conventional methods that were tried included wrapping the aorta with polyethene cellophane, which induced fibrosis and restricted the growth of the aneurysm. Over the course of surgical history arose three landmark developments in aortic surgery. These were:

• Ligation or tying up of the aorta
• Open repair of the bulging artery
• Endovascular repair of the artery

Epidemiology about aneurysm

The prevalence of AAA varies with a number of factors, including advancing age, family history, gender and tobacco use. The prevalence of AAAs larger than 2.9 cm in diameter ranges from 1.9% to 18.5% in men and 0% to 4.2% in women, the ranges being explained by the different age groups used and the differences in case-mix.

The prevalence of AAAs in women is currently considered too low for their inclusion in ultrasonographic screening programmes and stratified analyses in the various RCTs. Wanhainen recently demonstrated that prevalence in women is underestimated by using the standard definition for AAA of a 30 mm diameter. The prevalence for 65–75-year-old was 16.9% for men and 3.5% for women, whereas when using another definition, ≥1.5 × normal infrarenal aortic diameter (predicted from a nomogram), the prevalence was 12.9% for men and 9.8% for women.

Types of Aneurysms

1. Abdominal aortic aneurysm

An aortic aneurysm is a weakened or bulging area on the wall of the aorta. An abdominal aortic aneurysm occurs when the large blood vessel (the aorta) that supplies blood to the abdomen, pelvis and legs becomes abnormally large or balloons outward. This type of aneurysm is most often found in men over age 60 who have at least one or more risk factor, including emphysema, family history, high blood pressure, high cholesterol, obesity and smoking. The rupture of an abdominal aortic aneurysm is a medical emergency, and only about 20 percent of patients survive.

An aortic aneurysm is a weakened or bulging area on the wall of the aorta.

Symptoms of abdominal aortic aneurysm includes:

• Chest pain and Jaw pain, are generally associated with a heart attack, but the sudden stabbing, radiating pain, fainting, difficulty breathing, and sometimes even sudden weakness on one side are also symptoms of an aortic event.

2. Cerebral Aneurysm or Brain Aneurysm

Cerebral aneurysms, which affect about 5 percent of the population, occur when the wall of a blood vessel in the brain becomes weakened and bulges or balloons out. There are many types of aneurysms. The most common, a “berry aneurysm,” is more common in adults. It can range in size from a few millimeters to more than a centimeter. A family history of multiple berry aneurysms may increase your risk.

Conditions that injure or weaken the walls of the blood vessel, including atherosclerosis, trauma or infection, may also cause cerebral aneurysms. Other risk factors include medical conditions such as polycystic kidney disease, narrowing of the aorta and endocarditis. Like other types of aneurysm, cerebral aneurysms may not have any symptoms. Symptoms may include:

• Severe headache
• Double vision
• Loss of vision
• Headaches
• Eye pain
• Neck pain
• Stiff neck

3. Thoracic Aortic Aneurysm

A thoracic aortic aneurysm is an abnormal bulging or ballooning of the portion of the aorta that passes through the chest.

The most common cause is atherosclerosis, or hardening of the arteries. Other risk factors include:

• Aging
• Genetic conditions, such as Marfan syndrome
• Inflammation of the aorta
• Injury from falls or other trauma
• Syphilis

A patient with an aneurysm may not experience any symptoms until the aneurysm begins to “leak” blood into nearby tissue or expand. Symptoms of a thoracic aortic aneurysm may include:

• Hoarseness
• Swallowing problems
• High-pitched breathing
• Swelling in the neck
• Chest or upper back pain
• Clammy skin
• Nausea and vomiting
• Rapid heart rate
• Sense of impending doom

Causes

A person may inherit the tendency to form aneurysms, or aneurysms may develop because of hardening of the arteries (atherosclerosis) and aging. The following risk factors may increase your risk for an aneurysm or, if you already have an aneurysm, may increase your risk of it rupturing:

• Surgical clipping. This surgery involves placing a small metal clip around the base of the aneurysm to isolate it from normal blood circulation. This decreases the pressure on the aneurysm and prevents it from rupturing. Whether this surgery can be done depends on the location of the aneurysm, its size, and your general health.
• 

Prevention

The best way to prevent an aortic aneurysm is to avoid the factors that put you at higher risk for one. They are as follows:

• Smoking is a greater risk factor for aneurysm than it is for atherosclerosis, the cardiovascular disease where fatty deposits accumulate on the arterial wall and which can weaken artery walls.
• A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, Tran’s fat, cholesterol, sodium (salt), and added sugar.

Source Arterial Disorders