Parkinson's Disease Phimosis Pneumonia Prostate Cancer Ptosis

Penicillium Marneffei Plantar Fasciitis Postpartum Depression Psychosis

 

Parkinson's Disease

 

Definition:

Parkinson's disease is a disease of the central nervous system causing problems with body motions including tremor, muscle stiffness and a slowed body movement. Nerve cells (neurons) in particular part of a brain (substantia nigra) normally produce dopamine. The death of these nerve cells leads to abnormally low levels of dopamine, which makes it difficult for a person with Parkinson's disease to control muscle tension and muscle movement, both at rest and during periods of activity.

 

Who is at risk?

• The elderly. Age is one of the main risk factors for Parkinson's disease;
• Individual with family history of Parkinson's disease. Having one close relative with Parkinson's increases the chances that you'll also develop the disease. If you have two or more close relatives with Parkinson's, your risk increases two- to three-fold, although the overall risk is still less than 5 percent;
• Men are more likely to develop Parkinson's disease than women;
• Exposure to pesticides and herbicides. Direct contact with herbicides and pesticides puts you at increased risk of Parkinson's disease. You also have a higher risk if you're involved in farming, live in a rural area or drink well water and the risk is cumulative and increases with ageing;
• Environmental agents: There is a similarity between Parkinson's disease and the disorder produced by MTPT (a byproduct of illicit production of a street drug);
• Individual with reduced estrogen levels. Menopausal women who receive little or no Hormone Replacement Therapy (HRT) and those who have had hysterectomies may be at higher risk of developing Parkinson's disease. However, the current trend is against HRT because of the associated increased risk of breast cancer.

 

Symptoms:

(Think of the late Pope)

Classical triads are:

• Tremors. These often start with a slight shaking in one finger that later may spread to the whole arm.
• Rigid muscles (rigidity). Muscle stiffness often occurs in the limbs and neck. Sometimes the stiffness can be so severe that it limits the movements.
• Slowed motion (bradykinesia). Feature of slow, shuffling walk with an unsteady gait and stooped posture. Even the functioning of the digestive tract may slow down, causing problems with swallowing and constipation.

Other symptoms include:

• Loss of automatic movements. Blinking, smiling and swinging your arms when walking tend to be diminished. Some people may develop a fixed staring expression and unblinking eyes.
• Impaired speech. Voices often become monotonous and very soft.
• Difficulty with swallowing: This may develop in the later stages of the disease.
• Small drawing: Especially when asked to draw a clock face.
• Dementia: A small percentage of people with Parkinson's disease would develop dementia late in the course of the disease.

 

Treatment:

1. Physical therapy can help improve mobility, gait and balance, range of motion and muscle tone.
2. A speech pathologist can help improve problems with speaking and swallowing.
3. Medications include Levodopa, dopamine agonists (bromocriptine), Selegiline, COMT inhibitors, (Tolcapone), anticholinergics, Amantadine (Symmetrel) and Coenzyme Q-10.
4. Surgical options include deep brain stimulation, with electrodes placed after brain mapping, and precise destruction of targeted areas in the brain responsible for the most troubling symptoms. A hotly debated procedure, holding great promise is the transplantation of fetal brain tissue. Cells that can make dopamine are either transplanted from a nonviable fetus or from genetically engineered brain tissue grown in culture.

 

Prevention:

There are no current ways to prevent Parkinson's disease.

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Penicillium Marneffei

 

Definition:

Penicillium marneffei is a fungus first isolated in 1956 from the gut of a kind of rat in Vietnam. This fungus can cause a serious infection called "Penicilliosis" in patients with poor immune system, for example AIDS.

 

Who is at risk?

• Infection by this fungus has become increasingly common among HIV-infected persons in Southeast Asia, including Hong Kong, Taiwan, and southern China.
• Systemic infection with this fungus is recognized as one of the top three indicator diseases of AIDS in Southeast Asia.
• The most likely route of infection is inhalation of P. marneffei spores that can be present in the soil.

 

Symptoms:

• Patients typically present with a chronic illness averaging 4 weeks in duration, with low-grade fever, weight loss, anemia, swellings of the lymphatic glands and liver enlargement.
• These symptoms can also be caused by HIV or other HIV-related opportunistic infections.
• A more specific finding is a characteristic skin rash, which can be seen in about 70% of patients.

 

Treatment:

• The fungus has to be treated vigorously with powerful anti-fungal drugs.
• Patients usually respond well if diagnosed and treated early.
• Patients diagnosed late may die from disseminated infection.

 

Prevention:

This fungal infection frequently relapses after successful treatment. Hence, recovered patients may still need to take prophylactic antifungal drugs for life.

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Phimosis

 

Definition:

Phimosis is a condition that makes it difficult to pull the foreskin back from the head of the penis. Circumcision may be necessary to correct the problem. In a male who is not circumcised, the foreskin may be so tight that it can't be easily pulled back over the head of the penis. It is usually caused by infection and scarring but may be present at birth (congenital). It is common in young boys (up to 4 years old). As long as the child can pass urine, no treatment is needed right away. This condition should improve by itself, as he gets older.

 

Who is at risk?

• Uncircumcised individuals;
• Individual who had poor hygiene or chronic balanoposthitis (infection of the penile gland and foreskin) which eventually leads to the formation of a fibrotic ring of tissue close to the opening of the prepuce.

 

Symptoms:

The foreskin may look swollen, red, and feel tender. There might be pus in the area. This may mean there is an infection. The patient may not be able to pass urine because of the tight foreskin.

 

Treatment:

• Congenital phimosis (in infancy) would be treated only if complications arise. e.g. urinary obstruction.
• If phimosis in older children or adults is not causing acute and severe problems, nonsurgical measures may be effective. Application of topical steriod cream for 4-6 weeks to the narrow part of the foreskin is relatively simple and less expensive than surgical treatments.
• Circumcision is still the traditional surgical solution for pathologic phimosis.

 

Prevention:

• Parental education of congenital phimosis, even into the school-aged years, is very important. This education should stress the danger of forcibly retracting the foreskin for hygienic purposes. After time, the adhesions present between the inner prepuce and the glands will lyse on their own.
• Patients and parents of children with acquired phimosis should be educated on the importance of proper genital hygiene with reduction of the foreskin after each cleaning. They should also be made aware of the complications that may result from an acquired phimosis such as paraphimosis, obstructed urinary stream and hematuria.
• All adult patients and their caregivers should be made aware of the risk of paraphimosis associated with bladder catheterization. In this acute condition, the glans is swollen and painful, and the foreskin is immobilized by the swelling in a partially retracted position. Remindances should be given to always reduce the foreskin after cleaning and catheterization.

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Plantar Fasciitis

 

Definition:

A painful condition of the foot caused by inflammation of the thick tough, fibrous band of tissue (fascia) connecting the heel bone to the base of the toes. The condition is usually self-limiting.

 

Who is at risk?

• Woman and pregnancy
• After middle age
• Overweight
• Occupation that requires a lot of walking or standing on hard surfaces
• Sport activities that stress on the heel bone and soft tissues
• People with flat feet or very high foot arches
• Wearing poorly designed shoes with inadequate arch support

 

Symptoms:

Pain in the foot or the heel is the most common symptom, though the pattern and severity of pain can vary:

1. Severe sharp stabbing pain with the first few steps in the early morning. The pain lessens after warming up.
2. Pain that comes on gradually with prolonged standing or after exercise.
3. Pain experienced when climbing stairs or standing on tiptoe. The pain may worsen toward the end of the day.

 

Treatment:

• Rest:
  Keep the weight off the foot as much as possible, until the inflammation has healed. This can take 6 to 18 months.
• Ice:
  Applying ice to the painful area may relieve acute pain.
• Medications:
  Seek advice from doctors if you need pain-killers or anti-inflammatory drugs to alleviate the condition.
• Exercises:
  Exercises that stretch the Achilles tendon, plantar fascia or the small muscles of the feet can help.
• Special shoes or Orthotic Devices:
  Choose shoes with good arch support and shock-absorbing soles. Some may need an orthotic device, which can be custom-made or purchased over-the-counter.
• Local Injections:
  Orthopedics surgeons may give local injections of steroids to the heel if symptoms cannot be controlled. In extreme cases, surgical treatment may be necessary.

 

Prevention:

• Maintain a healthy weight
• Choose shoes with good support and shock absorbency
• Perform regular stretching exercise to the calf, foot, toes and Achilles tendon.
• Pay attention to adequate warm up before sport activities.

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Pneumonia

 

Definition:

Pneumonia is an infection of the lungs. Most types of pneumonias are caused by bacterial infections. The most common cause is the bacteria Streptococcus Pneumoniae. Other bacteria such as Mycoplasma and Legionella as well as certain viruses, can also cause pneumonia. However, because these less common infections do not always cause all of the classic pneumonia symptoms, they often are called atypical pneumonias. Atypical pneumonias most commonly occur in people under the age of 40. Pneumonia that develops when someone is hospitalized for another illness tends to be more serious, because the organisms found in a hospital have become resistant to many antibiotics. Aspiration pneumonia develops when chemical irritants and bacteria from the mouth or stomach are inhaled into the lungs. It is more common in people who have had strokes and have difficulty controlling their swallowing reflexes or people who are unconscious as a result of alcohol or other drug overdoses.

 

Who is at risk?

• Adults age 65 or older and very young children, whose immune systems aren't fully developed;
• Diseases that compromise the immune system. These include HIV/AIDS and chronic illnesses such as cardiovascular disease, emphysema or diabetes;
• Spleen removed (Splenectomy), long-term use of immunosuppressant drugs or chemotherapy;
• Smokers: Millions of microscopic hairs (cilia) cover the surface of the cells lining your bronchial tubes. The hairs beat in a wave-like fashion to clear your airways of normal secretions, but irritants such as tobacco smoke paralyze the cilia, causing secretions to accumulate. If these secretions contain bacteria, they can develop into pneumonia;
• Heavy drinkers: Alcohol interferes with your normal gag reflex as well as with the action of the white blood cells that fight infection;
• People hospitalized in an intensive care unit: People who require mechanical ventilation are particularly at risk because the breathing tube (endotracheal tube) bypasses the normal defenses of the respiratory tract, prevents coughing, and can harbor bacteria and other harmful organisms;
• People who are exposed to certain chemicals or pollutants: e.g. work in agriculture, construction or around certain industrial chemicals or animals. Exposure to air pollution or toxic fumes can also contribute to lung inflammation.

 

Symptoms:

Most pneumonias cause fever, cough with sputum (coughed-up mucus), shortness of breath and fatigue. In older patients, fatigue or confusion can be the only or most noticeable symptom. In atypical and viral pneumonias, a dry cough without sputum is more common.

 

Treatment:

• The main treatment for pneumonia is antibiotics.
• In addition to antibiotics, other treatments for pneumonia include rest, adequate fluids, and supplemental oxygen to raise the level of oxygen in the blood.
• If your pneumonia is severe, you may be placed on a mechanical ventilator to get enough oxygen into your blood.
• Coughing is important because it helps to clear infected material from the lungs, so your doctor may not want to give you medication to suppress your cough completely.

 

Prevention:

• Get vaccinated with a flu vaccine and pneumoncoccal vaccines (pneumococcal polysaccharide vaccine in adult and pneumococcal conjugate vaccine for child under the age of 2).
• Wash your hands.
• Don't smoke.
• Self care with rest and a diet rich in fruits, vegetables and whole grains along with moderate exercise that can keep the immune system strong.
• Protect others from infection. If you have pneumonia, try to stay away from anyone with a compromised immune system. When that isn't possible, you can help protect others by wearing a face and mask and always coughing into a tissue.

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Postpartum Depression

 

Definition:

Many women have mood swings about 3 to 4 days after giving birth to a baby. The so called "baby blues" are common and last only for a few days. When symptoms are unusually severe and prolonged, so much that the woman's well being is affected, the condition is called "postpartum depression."

 

Who is at risk?

Postpartum depression is more likely in the following situations:

• History of depression or substance abuse;
• Family history of mental illness;
• Anxiety about the fetus;
• Problems with previous pregnancy or birth ;
• Marital or financial problems;
• Socially isolated.

 

Symptoms:

Postpartum depression can happen anytime within the first year after childbirth. A woman feels worthless and hopeless. She has no energy to do anything. She may lose interest in what she uses to enjoy, and is often irritable, restless and anxious about minor things. She has lost her appetite and may have hard time falling asleep or wakes up in the middle of the night. She has intense feelings of guilt. She is often in tears for no reason, and may have thoughts about hurting herself or her baby.

 

Treatment:

A mother's depression can affect her baby's development and wellbeing, so getting treatment is important for both mother and baby. Postpartum depression can be treated with counseling, therapy, support networks and drugs, including antidepressants. Consult with your doctor if you could continue breastfeeding.

 

Prevention:

Find someone to talk to. Seek help in taking care of your child and the household. Childbirth brings many changes, and parenting is a challenging task. No matter how demanding your baby is, save an hour for yourself only-taking a walk, sing some songs, or do anything that amuses you. Don't be afraid to seek help. Talk with your doctor about how you feel.

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Prostate Cancer

 

Definition:

Prostate cancer is a malignant tumor of the prostate gland. Very early prostate cancer is contained within the prostate gland and called localized cancers. These early cancers do not usually produce symptoms and may not develop into a serious cancer. Such cancers may not require treatment. However, some prostate cancers grow within the prostate gland and spread to the surrounding tissues. This is called invasive prostate cancer. Cancer that develops in the prostate may spread (or metastasize) via the lymphatic system or bloodstream to other parts of the body, such as the bones.

 

Who is at risk?

1. Men who eat food high in fat;
2. Men who have sex with multiple partners;
3. Men with venereal diseases;
4. Men who worked around the chemical (e.g. cadmium);
5. Men over the age of 50;
6. African American men;
7. Men who have a family history of prostate cancer.

 

Symptoms:

Most men with prostate cancer have no symptoms. This is particularly true of early prostate cancer. Most prostate cancers are discovered incidentally when a digital rectal exam is performed. Symptoms usually appear when the tumor causes some degree of urinary blockage at the bladder neck or the urethra such as:

1. Difficulty in starting and stopping the urinary stream
2. Frequency: Increased need of urination
3. Dysuria: Pain while urinating
4. Poor urinary stream or dribbling out
5. Residual urine with a sense of bladder fullness
6. Men with such advanced cancers sometimes experience recurring urinary tract infections

 

Treatment:

Surgery: Radical prostatectomy (removal of prostate gland) is often recommended. Orchiectomy alters the testosterone hormone production and may be recommended for metastatic cancer.

Radiation therapy: Often the alternative in patients whose health status would not tolerate the risk of surgery or with bone pain due to spreading of cancer. It may be performed by external beam radiation therapy or by implanting small pellets of radioactive iodine or gold directly into the prostate tissue via a small incision.

Medication:

• Luteinizing hormone releasing hormone (e.g. Zoladex): This medication suppresses testostorone production and is often called chemical castration.
• Androgen-blocking agents (e.g. flutamide): Prevent testosterone from attaching to prostate cells.

Chemotherapy: Often used to treat prostate cancers that are resistant to hormonal treatments.

Lifestyles changes: Surgery, radiation therapy, and hormonal manipulation all have the potential to disrupt sexual desire in a temporary or permanent basis. Discussion with doctor regarding this concern is adamant.

Monitoring post treatment:

• Bone scan or CT scan to evaluate for metastasis;
• Serial PSA blood test for clinical correlation of the diseases activity;
• Complete blood count to monitor for signs and symptoms of anaemia;
• Monitor for other signs and symptoms indicating disease progression, such as fatigue, weight loss, increased pain, decreased bowel and bladder function.

 

Prevention:

1. No preventive measures are known.
2. Adopting a vegetarian, low-fat diet or one that mimics the traditional Japanese diet may lower risk.
3. Early identification (as opposed to prevention) is now possible by yearly screening of men over 40 years old through digital rectal examination and PSA blood test.

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Psychosis

 

Definition:

Psychosis is a symptom of severe mental illness, but not a diagnosis in itself. Traditionally, the term applies to those mental diseases that result in a patient losing insight into his illness and has "lost of contact with reality". The word, however, has been used loosely in the past, and modern disease classification is replacing the term with specific disease categories.

 

Who is at risk?

Psychosis is most commonly caused by schizophrenia, but patients suffering from severe depression and related disorders can also present with psychosis. Patients can also present as psychosis when their command centres in the brain are affected by diseases such as tumours and infections, or are poisoned with drugs or chemicals.

 

Symptoms:

Psychotics may experience hallucinations. Hearing voices is one of the most common. They hold beliefs that cannot be rationally explained, and which are often paranoid in nature. Personality change is common and their thoughts are disorganized. They have no insight in their diseases as well as in the social situation, and perform bizarre behaviours. A psychotic individual may be able to perform actions that require a high level of intellectual effort in clear consciousness.

 

Treatment:

A psychotic episode, if violent, may require physical restrain and powerful sedative in order to prevent the patients from harming themselves and the others. Specific treatment would then depend on the underlying cause.

 

Prevention:

Drug abuse is an increasingly common, yet the most preventable, cause of acute psychosis.

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Ptosis

 

Definition:

Ptosis means drooping of the upper eyelid. During normal vision, our upper eyelid is maintained in the opening position by a tiny piece of muscle. Weakness of this muscle or nerve damage causing its paralysis can result in ptosis.

 

Who is at risk?

Some children are born with drooping eyelids. When there is no other associated abnormality, the condition is called congenital ptosis. Ptosis can be the early symptom of a disease affecting muscles, such as myasthenia gravis (a chronic disease characterized by fatigue and muscular weakness). Brain tumors can cause ptosis when they are compressing on the cranial nerve supplying the upper eyelid. Ptosis is common in stroke or diabetic patients. Elderly people are also more prone to ptosis.

 

Symptoms:

When only one eye is affected, the facial asymmetry is characteristic. One eye is open while the other eye half open or closed. The drooping eyelid can block clear vision. There is also increased tearing because blinking is ineffective.

 

Treatment:

Doctors must first find out if there is any treatable primary cause for the ptosis. Surgical repair is usually very successful in restoring appearance and function.

 

Prevention:

Children with ptosis that causes impaired vision must be treated early so as to prevent amblyopia. New or rapidly changing ptosis in adults requires prompt evaluation by an ophthalmologist or neurologist.

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