PEPTIC ULCER DISEASE

An ulcer is an open sore. The word peptic means that the cause of the problem is due to acid. The two most common types of peptic ulcer are called gastric ulcers and duodenal ulcers. These names refer to the location where the ulcer is found. Gastric ulcers are located in the stomach. Duodenal ulcers are found at the beginning of the small intestine known as the duodenum. A person may have both gastric and duodenal ulcers at the same time. 5-10% of the U.S. population develops peptic ulcer disease (PUD). PUD has had a tremendous effect on morbidity and mortality until the last decades of the 20th century, when epidemiological trends started to point to an impressive fall in its incidence.

Abdominal pains are the most common symptoms. A burning sensation is felt in the stomach region between the breastbone and the belly button. This pain is often felt when the stomach is empty, between meals generally, but it can occur at any time. The pain last anywhere from a few minutes to several hours. Others symptoms of PUD include nausea, vomiting of blood, heartburn, bloating, and loss of appetite and unexplained weight loss which happens in severe causes.

First of the distinct causes of PUD is the bacterium Helicobacter pylori (previously named as Campylobacter pylori) which lives on the mucous lining of the stomach. The enzyme urease is produced by the bacterium which divides urea into ammonia and carbon dioxide. While shielding the bacterium form the acidity of the stomach, the ammonia also damages the protective mucous layer and the underlying gastric cells. H pylori also produce catalase, an enzyme that may protect the microbe from engulfing and ingesting neutrophils, plus several adhesion protein that allow the bacterium to attach itself to gastric cells. Symptoms of an H. pylori infection include gastritis, indigestion (dyspepsia) and signs of bleeding in the digestive tract. Transmission of H. pylori is unknown but it is believed it may spread from person to person through fecal-oral or oral-oral routes. It may also be transmitted by contaminated water sources. H. pylori are becoming less common in the UK as living standards are improving. H. pylori infection is acquired predominantly in childhood. 

Another common cause of PUD is the regular use of pain medications called non-steroidal anti-inflammatory drugs (NSAIDs), which include aspirin, ibuprofen, naproxen, ketoprofen, meloxicam and celecoxib. Risk of NSAIDs-induced ulcer is high when one is age 60 and above because the stomach lining becomes fragile with age. Past experiences of internal bleeding increase the risk of PUD. Taking steroid medications such as prednisone and blood thinners are among the risk factors of NSAIDs-induced ulcer. Excessive consumption of alcohol and tobacco is also a high risk factor of PUD. Taking large doses of NSAIDs and other medications containing aspirin over long period of time is another risk factor. NSAIDs are known to have certain side effects such as heartburn. 

Zollinger Ellison Syndrome (ZES) can also develop into PUD. People who have ZES develop tumours known as gastrinomas in the pancreas and duodenum. The gastrinomas caused by ZES secrete the hormone gastrin. Because gastrin creates excessive stomach acid. A person with ZES may have only one gastrinoma or have several. It’s believed that approximately, one-quarter of ZES patients also have a genetic disorder known as multiple endocrine neoplasia type 1, which causes tumours in the pituitary and parathyroid glands.  Another complication of ZES is that in up to two-thirds of cases, gastrinomas are cancerous. 

These malignant gastrinomas can spread to other parts of the body, including the liver, lymph nodes, spleen, bones, or skin. ZES do not have symptoms but when symptoms occur, they are similar to that of PUD such as heartburn, abdominal pain, bleeding and nausea. Research has proven that alcohol abuse is high risk factor of ZES.  ZES is treated by reducing the amount of acid your stomach produces. Medications called proton pump inhibitors are usually prescribed. These drugs, which include omeprazole, lansoprazole, pantoprazole and esomeprazole curb the production of stomach ulcers and allow the ulcers to heal. Also medications known as H2-blockers, such as cimetidine could be prescribed. However, these medications do not work as well to reduce stomach acids. In severe cases, surgery is undergone for the peptic ulcer and to remove the gastrinoma. However, only 20-25% of patients that undergo surgery are cured. For cancerous tumours, radiation and chemotherapy may be offered. 

PUD can be diagnosed by taking the urea breath test which a test is taken to detect the presence of H. pylori. It is not advised to take any antibiotics or proton pump inhibitors 2 weeks prior to the test. The stool antigen test can be also taken to check for the H. pylori. This test is taken to look for H. pylori in excreted faeces. Research has proven that the stool antigen test like the urea breath test is influenced by proton pump inhibitors. In a study conducted in Japan to investigate the effects of proton pump inhibitor treatment on the stool antigen treatment using the TestMate pylori enzyme immunoassay. 28 patients were assessed in this study of which 16 were men and 12 women with mean age (63.1 ±5.9) years and age range of 25-84 years, underwent stool antigen test and urea breath test before and after the administration of proton pump inhibitors (PPI). With standards set on the urea breath test, the sensitivity, specificity and the agreement of the stool antigen test in all 28 patients were 95.2%, 71.4%, and 89.3%, respectively, before PPI administration, and 88.9%, 90.9%, and 89.3%, respectively, after PPI treatment.  Mean values of urea breath test were 23.98% ± 5.33% before and 16.19% ± 4.75% after PPI treatment and, in 15 patients treated for 4 weeks or more, were significantly lower after than before the 4 weeks of PPI treatment. It was concluded that the stool antigen test was equally sensitive to the urea breath test, making it a useful and reliable diagnostic method, even during PPI administration.

Gastrointestinal endoscopy is the more advance way of treating ulcers. Gastrointestinal endoscopy has undergone a remarkable expansion in its capabilities as a result of sophisticated technological advances in recent years. New imaging technologies, novel ablation and resection techniques, cutting-edge endoscope development and creative extraluminal applications have taken gastrointestinal endoscopy to an exciting new level. An update on some of these advances is presented for the physician audience.

CORONARY HEART DISEASE

Coronary Heart Disease also known as CHD is a narrowing of the small blood vessel that supply blood and oxygen to the heart.
Coronary heart disease is usually caused by a condition called atheroscelerosis ( a condition which occurs when fatty material and other substances form a plaque build-up on the walls of your arteries). This causes them to get narrow. As the coronary arteries narrow, blood flow to the heart can slow down or stop. This can cause chest pain (stable angina), shortness of breath, heart attack, and other symptoms, usually when you are active.
Several factors increase the risk for heart disease, among them is;

• Heredity :- Bad genes can increase your risk. You are more likely to develop the condition if someone in your family has a history of heart disease — especially if they had it before age 50. Your risk for CHD goes up the older you get.
• Smokers have a much higher risk of heart disease than nonsmokers.
• High blood pressure increases your risks of coronary artery disease and heart failure.
• Abnormal Cholesterol Levels :- your Low-density lipoprotein (bad cholesterol) should be as low as possible, and your High-density lipoprotein (good cholesterol) should be as high as possible to reduce your risk of CHD.
• Other risk factors include alcohol abuse, not getting enough exercise, and having excessive amounts of stress.

Higher-than-normal levels of inflammation-related substances, such as C-reactive protein ( produced by the liver. The level of CRP rises when there is inflammation throughout the body) and fibrinogen (also protein produced by the liver. This protein helps stop bleeding by helping blood clots to form) are being studied as possible indicators of an increased risk for heart disease.
Symptoms of CHD may be very noticeable, but sometimes you can have the disease and not have any symptoms.

Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. How bad the pain is varies from person to person.

• It may feel heavy or like someone is squeezing your heart. You feel it under your breast bone (sternum), but also in your neck, arms, stomach, or upper back.
• The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin.
• Other symptoms include shortness of breath and fatigue with activity (exertion).

Women, elderly people, and people with diabetes are more likely to have symptoms other than chest pain, such as:

• Fatigue
• Shortness of breath
• Weakness
  
  

BURNS

A burn is tissue damage caused by excessive heat, electricity, radioactivity, or corrosive chemicals that denature (break down) the proteins in the skin cells. Burns destroy some of the skin’s important contributions to homeostasis - protection against microbial invasion and desiccation, and thermoregulation. Burns are graded according to their severity.
First-degree burns involve only the epidermis. It is characterized by mild pain and redness but no blisters. Skin functions remain intact. Immediate flushing with cold water may lessen the pain and damage caused by first-degree burn. Generally, healing of a first-degree burn will occur in 3 to 6 days and may be accompanied by flaking or peeling. One example of a first-degree burn is mild sunburn.




Second -degree burn destroys the epidermis and part of the dermis. Some skin functions are lost. In a second-degree burn, redness, blister formation, edema, and pain result. In a blister the epidermis separates from the dermis due to the accumulation of tissue fluid between them. Associated structures, such as hair follicles, sebaceous glands, and sweat glands, usually are not injured. If there is no infection, second-degree burns heal without skin grafting in about 3 to 4 weeks, but scarring may result. First- and second-degree burns are collectively referred to as partial-thickness burns.




Third-degree burns or full-thickness burns destroy the epidermis, dermis, and the subcutaneous layer. Most skin functions are lost. Such burns vary in appearance in marble-white to mahogany colored to charred, dry wounds. There is marked edema, the burned region is numb because sensory nerve endings have been destroyed. Regeneration occurs slowly, and much granulation tissue forms before being covered by epithelium. Skin grafting may be required to promote healing and to minimize scarring.




The injury to the skin tissues directly in contact with the damaging agent is the local effect of a burn. Generally, however, the systemic effects of a major burn are a greater threat to life. The systemic effects of a burn may include;

• a large loss of water, plasma, and plasma proteins, which causes shock
• bacterial infection
• reduced circulation of blood
• decreased production of urine
• diminished immune responses

The seriousness of a burn is determined by its depth and extent of area involved, as well as the person’s age and general health.
Many people who has been burned in fires also inhale smoke. If the smoke is unusually hot or dense or if inhalation is prolonged, serious problems can develop. The hot smoke can damage the trachea (windpipe), causing its lining to swell. As the swelling narrows the trachea, airflow into the the lungs is obstructed. Further, small airways inside the lungs can also narrow, producing wheezing or shortness pf breath. A person who has inhaled smoke is given oxygen through a face mask, a tube may be inserted into the trachea to assist breathing.

LEUKEMIA

The term leukemia refers to a group of red bone marrow cancers in which abnormal white blood cells multiply uncontrollably. The accumulation of the white cancerous white blood cells in red bone marrow interferes with the production of red blood cells, white blood cells, and platelets. As a result of oxygen-carrying capacity of the blood is reduced, an individual is more susceptible to infection, and blood clotting is abnormal. In most leukemias, the cancerous white blood cells spread to the lymph nodes, liver, and spleen, causing them to enlarge. All leukemias produce the usual symptoms of anemia (fatigue, intolerance of cold, and pale skin). In addition, weight loss, fever, night sweats, excessive bleeding, and recurrent infections may occur.


In general, leukemias are classified as acute (symptoms develop rapidly) and chronic (symptoms may take years to develop). Adults may have either types, but children usually have the acute type.
The cause of most types of leukemia is unknown. However, certain risk factors have been implicated. These include exposure to radiation or chemotherapy for other cancers, genetics (some genetic disorders such as Down syndrome), environmental factors (smoking and benzene), and microbes such as the human T cell leukemia-lymphoma virus-1 (HTLV-1) and the Epstein-Barr virus.
Treatment options include chemotherapy, radiation, stem cell transplantation, interferon, antibodies, and blood transfusion.

ERECTILE DYSFUNCTION

Erectile dysfunction previously termed impotence, is the consistent inability of an adult male to ejaculate or to attain or hold an erection long enough for sexual intercourse. Many cases of impotence are caused by nitric oxide (NO), which relaxes the smooth muscle of the penile arterioles and erectile tissue. The drug Viagara enhances smooth muscle relaxation by nitric oxide in the penis. Other causes of erectile dysfunction include diabetes mellitus, physical abnormalities of the penis, systemic disorders syphilis, vascular disturbances (arterial or venous obstructions), neurological disorders, surgery, testosterone deficiency, and drugs (alcohol, antidepressants, antihistamines, antihypertensives, narcotics, nicotine, and tranquilizers). Psychological factors such as anxiety or depression, fear of causing pregnancy, fear of sexually transmitted diseases, religious inhibitions, and emotional immaturity may also cause ED.

BLOOD TRANSFUSIONS - HOW SAFE?

Before submitting to any serious medical procedure, a thinking person will learn the possible benefits and the risks. What about the blood transfusions? They are now a prime tool in medicine. Many physicians who are genuinely interested in their patients may have little hesitation about giving blood. It has been called the gift of life.
Millions have donated or have accepted it. For 1986-87 Canada had 1.3 million donors in a population of 25 million. "[In] the most recent year for which figures are available, between 12 million and 14 million units of blood were used in transfusions in the United States alone." - The New York Times, February 18, 1990.
"Blood has always enjoyed a 'magical' quality," notes Dr. Louise J. Keating. "For its first 46 years, the blood supply was perceived as being safer than it actually was by both physicians and the public." (Cleveland Clinic Journal of Medicine, May 1989) What was the situation then, and what is it now?
Even 30 years ago, pathologists and blood-bank personnel were advised: "Blood is dynamite! It can do a great deal of good or a great deal of harm. The mortality from blood transfusion equals that from ether anesthesia or appendectomy. There is said to be approximately one death in 1,000 to 3,000 or possibly 5,000 transfusions. In the London area there has been reported one death for every 13,000 bottles of blood transfused" - New York State Journal of Medicine, January 15, 1960.
Have the dangers since been eliminated so that transfusions are now safe? Frankly, each year hundreds of thousands have adverse reactions to blood, and many die. In view of the preceding comments, what may come to your mind are blood-borne diseases. Before examining this aspect, consider some risks that are less well-known.