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1,"2018-04-20 02:27:11","What is Babesiosis?","By Dr Tomislav Meštrović, MD, PhD Notwithstanding notable progress in medicine and biomedical science, parasitic diseases still represent a burden and a threat to human health. Among a myriad of parasitic diseases, those transmitted by vectors (mainly arthropods) play a significant role. Furthermore, such diseases are very prevalent in the poorest countries of the world, affecting an extensive portion of the human population, as well as posing a health hazard in developed countries. One of these parasitoses is Babesiosis, an infectious diseases caused by the protozoan parasites of the genus Babesia. Already recognized for some time as pathogens that impose a substantial health burden on domesticated animals, Babesia parasites have been progressively ascertained over the last fifty years to be a cause of human morbidity around the globe. In short, Babesia parasites infect vertebrate animals and humans, causing the lysis of red blood cells of the host. The disease is generally considered a zoonosis, since it is acquired by a tick bite when individuals unintentionally interact with the natural life cycle of the parasite. Nonetheless, Babesiosis transmitted via blood-transfusion represents a significant problem in highly endemic areas. The Hallmarks of Babesiosis Infection with Babesia parasites in a human host occurs when the vector (i.e. an infected tick) takes the blood meal from an infected rodent. The parasite can enter the human’s body together with the tick’s saliva as it feeds on the human host. Once in the body, Babesias penetrate the erythrocytes or red blood cells, proliferate and then cause their lysis – resulting in a hemolytic anemia. Even though the first case was characterized by a fatal outcome, Babesia infections range in clinical presentation from asymptomatic to severe forms of the disease. In any case, the severity of infection largely depends on the Babesia species and the underlying immune status of the affected host. Therefore many (otherwise healthy) people infected with Babesia parasites remain asymptomatic and do not exhibit any symptoms. On the other hand, some individuals develop non-specific flu-like symptoms (such as fever, sweats, chills, body aches, headache, nausea, loss of appetite or unexplained fatigue). A life-threatening disease may emerge in people who do not have a spleen, have a weak immune system, have other serious health conditions, or in the elderly. Most human cases of Babesiosis are due to Babesia microti species complex or to Babesia divergens, although other species (some of them newly described) are now emerging. The joint occurrence of Babesiosis and Lyme disease results in a more severe and protracted illness when compared with either of those infections alone. In the diagnosis of Babesiosis, standard diagnostic techniques (investigation of Giemsa-stained thin blood smears and serologic tests) have been supplemented with modern molecular techniques, such as polymerase chain reaction (PCR). Current treatment recommendations for Babesiosis are focused on clindamycin and quinine as the drugs of choice, but certain novel drugs have shown some promise. Epidemiology of the Disease The constantly changing ecology has contributed significantly to the expansion of human Babesiosis in the United States (US), and also around the world. It is often considered an increasing problem due to the spread of tick habitats and the intensified mobility of animals, promoting in turn the dissemination of parasites to new geographical regions. Since 1957, approximately forty cases of human infection with bovine Babesias (usually Babesia divergens) have been identified. A total of 84% of those European cases were patients that previously underwent splenectomy. Nevertheless, infection with Babesia divergens confirmed with PCR was also found in an immunocompetent adult patient from France, emphasizing the fact that this parasite may also cause illness in previously healthy people. The highest number of human Babesiosis cases is found in the US, with Babesia microti being the predominant species (endemic in the Northeast and upper Midwest). In Washington State and California there were cases caused by Babesia duncani, and infections with parasites considered to be Babesia divergens were reported from Kentucky, Missouri and Washington State. Human Babesiosis has also been found in Australia, Taiwan, Japan, Korea and India, and there were reports from Africa and South America. The disease also appears to be endemic on the China-Myanmar border. Serosurveys were also introduced as a useful technique to survey a population for babesial infection, which may result in finding this infection in other parts of the world as well. Reviewed by Liji Thomas, MD Sources https://www.cdc.gov/parasites/Babesiosis/ http://cmr.asm.org/content/13/3/451.long https://www.ncbi.nlm.nih.gov/pubmed/26568987 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998201/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458703/ parasitesandvectors.biomedcentral.com/.../s13071-014-0509-3 Chiodini PL. Babesiois. In: Farrar J, Hotez P, Junghanss T, Kang G, Lalloo D, White NJ, editors. Manson's Tropical Diseases, 23rd Edition. Elsevier Health Sciences, 2014; pp. 601-605. // Last Updated: Feb 26, 2017","{
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2,"2018-04-20 02:27:14","What Causes Babesiosis?","By Dr Tomislav Meštrović, MD, PhD Babesiosis is a parasitic enzootic disease that is triggered by the infection of vertebrate erythrocytes with the protozoan Babesia species. Babesiosis is considered one of the most significant tick-borne infectious diseases in both domestic and wild mammals, and when it infects humans, it still poses substantial diagnostic and therapeutic challenges. This condition shares a plethora of clinical features with malaria (one of the most important parasitic diseases) and can be fatal – especially in the immunocompromised and the elderly. The characteristic causative organism now identified as Babesia was discovered in 1888, by the researcher Babes, who was trying to find the pathogen that caused hemoglobinuria in cattle. Only five years after that, Kilbourne and Smith identified that ticks served as the arthropod vector for the species Babesia bigemina that was recognized to cause Texas cattle fever. This event is significant in that it established the first arthropod vector known to transmit an infectious microbe. In humans, babesiosis was initially found in a splenectomized patient from Europe. However, most cases have been reported from the United States (especially in the northeastern states, as well as the upper midwestern parts). Most affected individuals have an intact spleen and are not known to have any immune deficiencies. Today sporadic cases are reported in Asia, Australia, South America and Europe. Characteristics and Life Cycle of the Pathogen Species of the genus Babesia are from the phylum Sporozoa that contains several important human pathogens, such as Plasmodium, Cryptosporidium and Toxoplasma. They also belong in the order Piroplasmida in the family Babesiidae (the other family is Theileriidae that lacks transovarial transmission which is a characteristic of Babesia). The Babesia species infecting humans belong to four distinct clades: Babesia microti (a small Babesia) that itself exists as a species complex, other small Babesias (like Babesia duncani), small Babesia (including Babesia divergens) which are related to large Babesia, and finally, large Babesias infecting ungulates (including the KO1 strain). As phylogenetic analysis based on stringent molecular criteria develops further, new Babesia species will likely emerge with further revision of the taxonomy of this genus. Apicomplexans (which includes the genus Babesia, as already mentioned) generally show at least three distinct stages of reproduction. These are gamogony (characterized by the formation and coalescence of gametes in the tick gut), sporogony (asexual reproduction that takes place in the salivary glands of the tick), and merogony (which is a term for asexual reproduction in the host). Transmission Patterns A majority of human cases of babesiosis are the result of infection with Babesia microti species complex, but may also be caused by Babesia divergens (which infects cattle) or by Babesia odocoilei (which infect cervids). The primary tick vector of Babesia microti is Ixodes scapularis (commonly known as deer or blacklegged ticks), and its primary reservoir is the white-footed mouse (which may also harbor Borrela burgdorferi, a causative agent of Lyme disease). During the life cycle of Ixodes scapularis, the three known active stages (i.e. larva, nymph and adult) require a meal of vertebrate blood to develop further to the next stage. The life cycle in the tick starts in the latter part of summer, with new larvae. These feed on blood from an infected mouse, which contains Babesia. The larvae then molt to become nymphs, while the parasites remain dormant. Nymphs then transmit the parasite to the vertebrate hosts in the next season, which is usually in in late spring and early summer. Although all three developmental stages do feed on humans, the nymph is the most important vector, because of its minute size (akin to the size of a poppy seed) and summer activity. Therefore infected individuals may not recall a tick bite. Once the parasite is in the human host, Babesias enter erythrocytes (red blood cells) where they undergo asexual replication (also known as budding). The multiplication of blood-stage parasites results in the clinical manifestations that arise after infections. It must be emphasized that humans are usually dead-end hosts. Other potential ways of acquiring infection with Babesia parasites include receiving contaminated blood transfusion (as at the moment there are no tests licensed for donor screening), as well as transplacental/perinatal transmission from an infected mother to her baby. Babesia microti is responsible for most transfusion-mediated infections. About one in five of such cases end in fatality. Reviewed by Liji Thomas, MD Sources https://www.cdc.gov/parasites/babesiosis/ http://cmr.asm.org/content/13/3/451.long https://www.ncbi.nlm.nih.gov/pubmed/17691604 https://www.ncbi.nlm.nih.gov/pubmed/11113258 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998201/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458703/ Chiodini PL. Babesiois. In: Farrar J, Hotez P, Junghanss T, Kang G, Lalloo D, White NJ, editors. Manson's Tropical Diseases, 23rd Edition. Elsevier Health Sciences, 2014; pp. 601-605. // Last Updated: Feb 26, 2017","{
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3,"2018-04-20 02:27:16","Diagnosis of Babesiosis","By Dr Tomislav Meštrović, MD, PhD Babesiosis is an emerging, zoonotic, tick-borne disease caused by intraerythrocytic protozoan parasites of the genus Babesia, which are transmitted by hard-bodied (Ixodes) ticks. Several different species are known to cause disease in humans, most notably Babesia microti, Babesia divergens and Babesia duncani. Babesia infection may be completely asymptomatic or may present with illness. The severity of that illness may range from mild to fulminant and sometimes even results in death. Diagnosis should therefore involve a complete descriptive history that includes any clinical manifestations, travel history to endemic areas, tick bite exposure, splenectomy and recent blood transfusion. Since symptoms and signs of the disease can be relatively non-specific, laboratory testing is essential to establishing a correct diagnosis. The primary diagnostic method is microscopic detection of parasites on blood film examination, although the use of polymerase chain reaction (PCR) is increasing and serodiagnosis can be useful. Microscopy Detection Methods The examination of thin blood smears to detect parasites within erythrocytes is the most commonly used technique for diagnosing infections with Babesia microti in the United States (US) and Babesia divergens in Europe. After adequate staining of peripheral blood smears with Giemsa or Wright’s stain, the Babesia parasites can be seen within erythrocytes as darkly-stained ring shapes with pale blue cytoplasm. It is necessary to examine multiple smears, since, during the early stage of disease (when people tend to seek medical advice,) only a few red blood cells may be infected. Among individuals with healthy immune systems, the extent of parasitemia is rarely more than 5%, but can be up to 85% in asplenic people. Furthermore, the duration of parasitemia that is detectable on blood smears varies form person to person, ranging from three weeks to twelve weeks. There are certain points to consider regarding such blood smear analyses. The ring forms seen within red blood cells can vary significantly and may be mistaken for Plasmodium falciparum (a parasite that causes malaria), although absence of the hemozoin pigment should point to Babesia parasites. Indeed, cases have been described in scientific literature where patients have been misdiagnosed with malaria, which may result in misguided treatment choices and pose a serious risk to the patient. Generally, blood smear analysis is a rather subjective process, which inevitably depends on the observer’s experience and the time dedicated to smear examination. The need to differentiate babesial morphology and the likelihood of low-level parasitemia may lead to inaccurate diagnoses, which is why diagnostic approaches are constantly being refined. Serologic Methods The indirect immunofluorescence assay (IFA) is a commonly used, sensitive and specific serologic test used to diagnose human babesiosis. The cut-off titer for a positive test result varies between laboratories, although higher titers (1:128 to 1:256) are linked to improved diagnostic specificity. In the case of Babesia microti infection, antibodies are generally detectable when patients are initially diagnosed, whereas serological diagnosis in the case of Babesia divergens infection is not usually possible due to the infection being too serious or severe, since the antibodies are only identifiable 7 to 10 days following the onset of hemoglobinuria. A potential drawback to serologic testing is the possibility of cross-reactivity due to the presence of other protozoal parasites. This would generate false-positive results. The presence of connective tissue disorders such as rheumatoid arthritis, for example, may also result in a false-positive, whereas a false-negative result may be generated in the case of an immunosuppressed patient. Molecular Methods Adequate detection of mild babesiosis infection often entails more sensitive methods than those so far discussed. The development of more sensitive techniques based on PCR, has made it possible to diagnose and monitor even mild cases of infection. In the case of Babesia microti infection and Babesia divergens infection, PCR-based detection assays usually involve the amplification of DNA sequences that are highly conserved and comparison of the resulting fragments with known sequences stored in a database. This enables accurate identification of the infecting parasite. Sources https://www.ncbi.nlm.nih.gov/pubmed/11113258 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88943/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355466/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998201/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557163/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734943/ Chiodini PL. Babesiois. In: Farrar J, Hotez P, Junghanss T, Kang G, Lalloo D, White NJ, editors. Manson's Tropical Diseases, 23rd Edition. Elsevier Health Sciences, 2014; pp. 601-605. Further ReadingWhat is Babesiosis?What Causes Babesiosis?Treatment and Prevention of BabesiosisPathogenesis and Clinical Presentation of Babesiosis // Last Updated: Feb 20, 2017","{
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4,"2018-04-20 02:27:19","Treatment and Prevention of Babesiosis","By Dr Tomislav Meštrović, MD, PhD Human babesiosis is an emerging tick-transmitted infection caused by protozoal hematotropic parasites that belong to the genus Babesia. Although this condition is rare, fatal outcomes have been described. For this reason, timely detection, adequate treatment, and prevention efforts are essential tools to control babesiosis. The selection of treatment strategies largely depends on the species responsible for the infection, severity of the disease, as well as the underlying immune status of the affected individual. Individuals without any symptoms usually do not necessitate any treatment. Although there is no vaccine available to prevent human babesiosis, several other preventive measures are successfully used. The Babesia microti life cycle involves - image and information courtesy of DPDx / CDC Therapeutic Modalities After the diagnosis of babesiosis is confirmed by the examination of thin blood smears under the microscope or by polymerase chain reaction (PCR), patients who exhibit symptomatic babesiosis are candidates for a course of antimicrobial treatment. Two commonly employed antimicrobial regimens show high effectiveness: the combination of atovaquone with azithromycin, and the combination of clindamycin with quinine. Atovaquone and azithromycin are used for the treatment of immunocompetent patients facing mild to moderate babesiosis, while clindamycin and quinine are reserved for more severe infections. Significantly fewer adverse effects are seen in those treated with the combination of atovaquone and azithromycin when compared to those treated with clindamycin and quinine. Adverse drug reactions can be seen in three-fourths of patients on clindamycin-quinine combination, with a third of them forced to decrease the dose or to end the treatment prematurely. Some adverse effects that are seen include decreased hearing, tinnitus, gastrointestinal symptoms, visual disturbances, headache, vertigo, and rash. On the other hand, only fifteen percent of patients treated with atovaquone and azithromycin experienced symptoms that were congruous with an adverse drug reaction. Individuals with babesiosis should be strictly monitored during therapy. In a majority of cases, improvement occurs within a day or two after the treatment is instituted. Still, it must be noted that certain patients may have persistent low-grade parasitemia for several months after infection, and if the symptoms do not improve, the possibility of co-infection with Lyme disease or human granulocytic anaplasmosis should be suspected. Whole blood or red cell exchange transfusion can produce a swift and a notable fall in parasitemia, thus its use as an adjunct treatment to chemotherapy should be considered in gravely ill patients with high parasitemia counts. Exchange transfusion can also rapidly correct anemia and remove toxic byproducts of babesia parasites. Prevention Efforts Preventive measures for tackling babesiosis vary, from avoiding exposure to ticks to the modification of habitat. Simple measures involve using tick-repellent chemicals on the skin before visiting a region known to be infested by ticks; minimization or complete avoidance of such areas; and meticulous skin examination after exposure. Diverse public health policies have come into use to reduce the density of tick population in infested areas. This includes the spraying of acaricidal formulations, which is the most commonly employed method. It has been shown that applying such pesticides on the fur of animal reservoir hosts helps to break the cycle of transmission of Babesia parasites successfully. In conclusion, the recognition of human infection with Babesia parasites will probably improve, as physicians (as well as the public) become more cognizant of this condition. The number of known cases is likely to go up as people recreate and live in rural tick-infested regions, and as the number of immunocompromised patients continues to increase. Reviewed by Liji Thomas, MD Sources https://www.ncbi.nlm.nih.gov/pubmed/12804380 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88943/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355466/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734943/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557163/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998201/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458703/ Chiodini PL. Babesiois. In: Farrar J, Hotez P, Junghanss T, Kang G, Lalloo D, White NJ, editors. Manson's Tropical Diseases, 23rd Edition. Elsevier Health Sciences, 2014; pp. 601-605. Further ReadingWhat is Babesiosis?What Causes Babesiosis?Diagnosis of BabesiosisPathogenesis and Clinical Presentation of Babesiosis Last Updated: Feb 27, 2017","{
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        ""category_2.title"": ""Babesiosis"",
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5,"2018-04-20 02:27:22","Pathogenesis and Clinical Presentation of Babesiosis","By Dr Tomislav Meštrović, MD, PhD Babesiosis is an illness similar to malaria, that is caused by the intraerythrocytic parasitic species from the genus Babesia, transmitted by ticks. In the last fifty years the epidemiology of babesiosis in humans has shifted from a handful of isolated cases to the established endemic disease in Europe and northeastern and midwestern United States. The first human case of babesiosis was described in 1957 near Zagreb, a capital of Croatia. The affected individual was a young farmer without a spleen who had been taking care of cattle on tick-infested pastures. He subsequently presented with anemia, hemoglobinuria and fever, and succumbed to renal insufficiency in the second week of the illness. Although the causative agent was initially reported as Babesia bovis, it was most likely Babesia divergens (also a pathogen of cattle). Pathogenesis of Babesiosis As the parasite infects red blood cells in the human body, erythrocyte lysis occurs, which is associated with most of the clinical manifestations and complications of babesiosis – including hemolytic anemia, jaundice as a result of unconjugated hyperbilirubinemia, hemoglobinemia, hemoglobinuria, as well as renal failure due to acute tubular necrosis. Proinflammatory cytokine release may be instigated when immune cells come into contact with the glycosylphosphatidylinositol anchors of babesial proteins, expressed either at the surface of the pathogen or the surface of infected erythrocytes. These cytokines thereupon prompt the production of downstream mediators (such as nitric oxide) which may destroy parasites, but can also be responsible for cellular damage when excessively produced. The development of immunity to Babesia parasites in humans depends upon cellular and humoral factors, although the bulk of the evidence shows that the latter is of limited significance. The role of antibodies is restricted to a period when the parasites have found their way into the bloodstream, but not have yet become intracellular. Therefore T cells are considered pivotal in the development of resistance to Babesia parasites, with CD4+ T helper cell subpopulation as the main player. Moreover, non-specific responses via macrophages and natural killer cells are also noteworthy in resistance to babesial infection. Clinical Features of the Disease In Europe, a majority of cases of human babesiosis are a result of infection by Babesia divergens, whereas in the US the main pathogenic species is Babesia microti. The severity of infection can be highly variable, and is primarily determined by the immune status of the infected host. Various clinical syndromes have been described – from completely asymptomatic infections, through mild or moderate viral-like illnesses, to severe presentations with a fulminant course that may result in death. Most human infections with Babesia microti are subclinical. When clinical illness arises, the incubation period is between one and three weeks, although it can be up to six months (but typically one to nine weeks) when acquired through blood transfusions. The disease usually appears gradually, with fatigue and anorexia as dominant signs, as well as fever and generalized myalgia. In cases of Babesia divergens infection the incubation period varies from one to four weeks. Initially the patient may feel slightly unwell, but at the time of the diagnosis the condition is more severe and characterized by fever, anemia, jaundice, prostration, nausea, vomiting and myalgia. Furthermore, hepatomegaly, pulmonary edema and oliguric renal failure may also occur. Although animal studies suggest that Babeisa duncani, a rare species responsible for only several human infections recorded thus far, is more pathogenic than Babesia microti, its sparse occurrence does not allow any firm conclusions at this moment. Of the nine reported human cases there was one fatal account, one renal insufficiency and pulmonary edema, and the remainder had a somewhat mild clinical course or were without any symptoms. Reviewed by Liji Thomas, MD Sources https://www.cdc.gov/parasites/babesiosis/ http://cmr.asm.org/content/13/3/451.long https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88943/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734943/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458703/ Chiodini PL. Babesiois. In: Farrar J, Hotez P, Junghanss T, Kang G, Lalloo D, White NJ, editors. Manson's Tropical Diseases, 23rd Edition. Elsevier Health Sciences, 2014; pp. 601-605. Further ReadingMiddle East Respiratory Syndrome Coronavirus (MERS-CoV) OverviewMiddle East Respiratory Syndrome Coronavirus (MERS-CoV) SymptomsMiddle East Respiratory Syndrome Coronavirus (MERS-CoV) DiagnosisMiddle East Respiratory Syndrome Coronavirus (MERS-CoV) EpidemiologyMiddle East Respiratory Syndrome Coronavirus (MERS-CoV) Treatment and PreventionMore... // Last Updated: Feb 28, 2017","{
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        ""category_2.title"": ""Babesiosis"",
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6,"2018-04-20 02:27:25","Malrotation of the Gastrointestinal Tract","By Jonas Wilson, Ing. Med. Gastrointestinal (GI) malrotation, sometimes referred to as incomplete rotation or intestinal nonrotation, is any deviation from the physiological rotation and/or fixation of the GI tract during embryonic development. During the development of the GI tract, the 3 parts of the tract, namely the fore-, mid- and hindgut, normally bulge out of the abdominal cavity and undergo a counterclockwise rotation of 270 degrees. This rotation occurs around the superior mesenteric blood vessels. Following its physiological rotation, the gut then returns the cavity within the abdomen where it is fixated at the duodenojejunal junction and cecum. Clinical presentation Patients presenting with GI malrotation may have a distended abdomen with tenderness accompanied by guarding (tensing of the abdominal muscles) on physical examination. Abnormal rotation of the GI tract can lead to comprised vascular supply to the affected portions of the intestines and this in turn can cause intraluminal hemorrhage, which manifests as hematemesis (vomiting blood) and/or melena (blood in stools). In addition to hemorrhage, patients may develop shock with signs such as a decrease in urine output, low blood pressure, and poor perfusion. Other signs of compromised vascular supply include inflammation of the peritoneum and skin discoloration. Pathophysiology GI malrotation, has been recently suggested to result from genetic mutations. The gene implicated is the fork head transcription factor (FOXF1) gene. In addition to abnormal rotation, it has been cited that these patients may also have congenital short bowel. FOXF1 is believed to play a crucial role in mediating the physiological rotation of the intestines and the forming of the dorsal mesentery. Inactivating mutations of this gene may result in GI malrotation. In addition to a mutation in FOXF1, mutations in genes that control left-right (L-R) patterning in the embryo and other genes not yet identified may also be associated with GI malrotation. Related StoriesRoutine screenings and early detection can help protect from colorectal cancerMany Australians not using free bowel cancer testing kitsResearchers develop wearable system to monitor electrical activity in the stomach over 24 hoursThere are four suggested etiological groups for GI malrotation: (i) abnormal L-R patterning, (ii) dorsal mesentery, (FOXF1) anomalies, (iii) irregularities of the intestine itself, and (iv) abnormalities of other abdominal contents. Irregularities of the intestine itself include atresias (closed or missing orifices/passages) and congenital short bowel. The fourth category has been postulated on the basis of incorrectly placed intestines and/ or abdominal organs within the abdominal cavity during organogenesis, which subsequently leads to GI malrotation. Epidemiology In the United States, for example, asymptomatic GI malrotation occurs with an incidence somewhere between 1 in 200 to 1 in 500. Symptomatic GI malrotation, on the other hand, has a much lower incidence, being somewhere around 1 in 6000 live births. Nearly 80% of patients will present with malrotation within their first year of life. Moreover, the incidence in males is double that of females in those patients younger than 1 year. Up to 6 out of every 10 children with GI malrotation may have an accompanying congenital anomaly. By default, all children with hernia of the diaphragm, omphalocele (protrusion of abdominal organs into umbilical cord), and gastroschisis (intestines protruding through the abdominal wall) have malrotation. Management Diagnosis of GI malrotation may be confirmed with abdominal radiographs, ultrasound, CT, and fluoroscopy. Emergency surgical treatment is required in cases where volvulus (twisting) and/ or obstruction accompanies GI malrotation. Patients should not be fed orally to avoid exacerbating the situation. Instead, a feeding tube through the nose or mouth is used, while electrolyte and fluid balances are maintained. Shock, if present, is treated with vasopressive agents to correct low blood pressure, appropriate fluid resuscitation and blood products, if applicable. Surgery is done by means of the Ladd procedure. This procedure entails an appendectomy, dividing Ladd’s bands (tissue connecting the cecum to the abdominal wall), proper placement of the small of the large intestines within the abdominal cavity and, if necessary, the treatment of volvulus. Reviewed by Susha Cheriyedath, MSc Sources http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908440/ http://radiopaedia.org/articles/intestinal-malrotation my.clevelandclinic.org/.../hic-Malrotation http://pubs.rsna.org/doi/full/10.1148/rg.265055167 Further ReadingSymptoms and Diagnosis of Intestinal MalrotationSymptoms and Diagnosis of Intestinal MalrotationTreatment and Prognosis for Intestinal Malrotation // Last Updated: Jan 17, 2017","{
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        ""category_2.id"": 2,
        ""category_2.ts"": ""2018-04-18 05:30:54"",
        ""category_2.title"": ""Baby Health"",
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        ""category_2.id"": 424,
        ""category_2.ts"": ""2018-04-18 05:31:23"",
        ""category_2.title"": ""Gastroenterology"",
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        ""category_1.ts"": ""2018-04-18 05:17:00"",
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        ""category_2.id"": 428,
        ""category_2.ts"": ""2018-04-18 05:31:23"",
        ""category_2.title"": ""Gastrointestinal Tract"",
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        ""category_2.id"": 626,
        ""category_2.ts"": ""2018-04-18 05:31:30"",
        ""category_2.title"": ""Intestinal Malrotation"",
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7,"2018-04-20 02:27:29",Fontanelle,"By Cashmere Lashkari What is a fontanelle? The soft parts of the newborn baby’s skull are known as fontanelles. While there are six fontanelles found in the skull of a newborn, only two are commonly known. The one in the middle of the head, on the top portion is known as the Anterior fontanelle. It is shaped like a diamond and takes about a year to close. The one in the rear portion of the head is called the posterior fontanelle. It is triangular in shape and closes within a couple of months after birth. How is a fontanelle formed? The newborn human baby has a skull that consists of six different bones. These are also called cranial bones and include a frontal bone, an occipital bone, two parietal bones and two temporal bones. The six cranial bones are held in place by strong and flexible tissues known as sutures. Over a period of time these tissues tend to solidify, knitting the different bones of the cranium together to form the skull. The six different fontanelles are formed along the lines of these six bones. Besides the anterior and posterior fontanelles, there are also two mastoid and two sphenoid fontanelles formed at birth. However these four fontanelles quickly seal up to form the skull leaving just the anterior and posterior fontanelles open for a few months longer. Why do the fontanelles exist? The primary reason for the existence of fontanelles is for child birth. The flexible and elastic sutures let the cranial bones overlap into a smaller and more compact form to allow it safe passage through the birth canal. The brain is protected from any pressure during the birth process and is not damaged due to the protection of the bones. As the infant begins to hold his head up, rolls onto his stomach and even tries to sit up, the neck muscles are not developed enough to support the weight of the head. This results in a fair number of minor impacts to the head. Fontanelles are essential for the proper development of the baby’s brain as they are held together by the flexible sutures which protect the brain from the head impacts. Also the skull bones or cranium grows along with the brain. This happens as the suture lines increase. By the age of two the baby’s skull would have achieved two third of its adult size. The bones continue to reposition themselves as growth adds new layers to the edge of the suture tissue. Finally by the second decade of the child’s life the brain reaches maximum size and the sutures get fused to the bone growth forming a whole skull structure. How fontanelles help doctors Doctors can actually trace the growth and development of the baby by feeling the cranial sutures. The fontanelle must feel firm and be flat when touched. Should there be a bulging of the fontanelle it may be indicative of an increase in pressure inside the brain. The swelling of the fontanelle could be due to an infection of the membrane covering the brain. This condition is also known as meningitis and can be harmful to the normal development of the child. The bulge may be caused by a fluid build up inside the skull. The condition is called hydrocephalus. It is also possible that the fontanelle is sunken or shrunk inside. This could be an indication that the baby is dehydrated and needs more fluids. It can also be an indication of malnutrition in a newborn. Thus, the fontanelle can tell the health care provider a lot about the internal health of the baby. Caring for the fontanelle The shape of the baby’s skull is constantly changing for the first couple of months. This is due to the shifting of the cranial bones as the flexible sutures hold them in position. The two primary soft spots on the skull are located on top of the skull and behind the head. Since the bone there is yet to knit into a solid skull, these are vulnerable regions where the baby may get hurt. The baby’s head should be handledcarefully at all times. When lifting the head of the baby the adult’s hand should support the neck and cover the posterior fontanelle. Also since the soft spots may not be enough to keep out the chill, it is advisable to cover the head of the baby with a soft cap when the temperature drops. That way both anterior and posterior fontanelles are afforded protection from the cold. The skin of the skull should be kept clean to prevent infection. The cranial bones of most babies are sealed by the time they reach about 18 months of age. After that, the sutures will remain somewhat flexible to accommodate the continued growth of the brain and expansion of the skull. Reviewed by Catherine Shaffer, M.Sc. References Medline Plus, Cranial Sutures, https://medlineplus.gov/ency/article/002320.htm Babycentre, Soft Spots, http://www.babycentre.co.uk/x552709/what-are-the-soft-spots-on-my-newborns-head American Family Physician, The Abnormal Fontanelle, http://www.aafp.org/afp/2003/0615/p2547.html Further ReadingMalrotation of the Gastrointestinal TractHeat Rash in BabiesWhy Do Babies Cry?How to Stop a Baby Crying?How to Understand your Baby’s Crying?More... Last Updated: Aug 3, 2017","{
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8,"2018-04-20 02:27:36","Heat Rash in Babies","By Cashmere Lashkari Rashes occur easily in the summer on the delicate skin of a baby. There are many kinds of rashes that the baby could suffer from. One of the most common skin conditions, not just for babies but also for adults, is developing a heat rash in summer. The baby may also develop a heat rash if he has fever and his temperature does not come down quickly. What causes heat rash? A heat rash normally occurs in hot and humid weather. The humidity along with the heat makes the body sweat profusely in order to regulate the body temperature. When the sweat increases so much that the evaporation from the skin is delayed, a heat rash will begin to develop. The skin is irritated when the sweat ducts get blocked and trap the sweat under the skin. Heat rash is also known as prickly heat and miliaria. They are very common and most people will suffer from a mild case of this skin condition in the summers. It is especially prevalent in babies because of the many skin folds making it difficult for the sweat to dry up and not clog the sweat ducts. Essentially a heat rash forms on the skin when the sweat is collected under the skin due to blocked sweat ducts. What does heat rash look like? The skin will be clustered with small pimple-like blisters which may be red compared to the surrounding skin. Heat rash is most often seen in the folds of the skin of the neck, the groin area and in elbow and knee creases. A heat rash may also come up on areas where clothing hugs the skin tightly, such as the back, stomach and bottom. The scalp and forehead may also be affected if the baby wears a hat. Symptoms of heat rash The prickly heat rash is easy to identify. There are raised pimple like bumps on the skin and the area is red. There may be mild swelling anditching. The skin maybe tender when touched. The red bumpy skin can also cause an intense prickling or stinging sensation. . The baby may be irritable if the skin rash is repeatedly rubbed by cloth touching. The rash can become worse if the baby is wearing synthetic clothing . Treating heat rash in babies Mild cases of heat rash may clear up without treatment. However if the rash is troubling the baby, it may be advisable to get a doctor’s opinion. A hydrocortisone cream of low strength canrelieve the itch. If the rash is severe, the doctor maydecide to add an antihistamine syrup. Skin soothing treatment options include: Calamine lotion Aloe-based lotion or gel Powder to dry the skin Use only products recommended by your doctor. Avoid using over- the- counter medicated ointments as they may be harmful. Remember that a baby’s skin is sensitive and may not handle over the counter products well. The primary requirement is to keep the baby cool so that excessive sweat is not generated. Spend time in a cool room indoors. If you need be outdoors ensure that the baby is in the shade. A small fan can be used to ensure circulation of cool air if you are planning on sitting outdoors for an extended period of time with the baby. Keep baby comfortable when she has a rash: Ensure that the baby has plenty of cool fluids and is dressed comfortably in loose cotton clothing Avoidsynthetic material. Ittraps more heat next to the skin Avoid synthetic clothing Give the baby regular baths to keep the body temperature down. Make sure that the water is not hot as that will make a heat rash worse Use a cold compress on the heat rash area. Wet a clean cotton cloth in ice water and wring it dry, then apply to skin for a few minutes at a time Reviewed by Catherine Shaffer, M.Sc. References CDC, Frequently Asked Questions (FAQ) About Extreme Heat, https://www.cdc.gov/disasters/extremeheat/faq.html Babycenter, Heat Rash, https://www.babycenter.com/0_heat-rash_10881.bc NHS, Prickly Heat, http://www.nhs.uk/conditions/prickly-heat/Pages/Introduction.aspx Further ReadingMalrotation of the Gastrointestinal TractFontanelleWhy Do Babies Cry?How to Stop a Baby Crying?How to Understand your Baby’s Crying?More... Last Updated: Aug 3, 2017","{
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9,"2018-04-20 02:27:39","Why Do Babies Cry?","By Jonas Wilson, Ing. Med. Babies cry and a lot. It’s just something they all do. Arguably, some are less fussy than others, but the fact remains that it’s impossible to find a baby who will not cry at some point. Crying is a sign that a baby is alive when he or she is born. This process allows for air to enter their lungs for the first time in their lives. From birth onwards, babies quickly learn to use their cry as a primary communication tool in the outside world. This may be particularly demanding for parents, especially those who may have had unrealistic expectations about their infant. Newborns, for quite some time, will not be able to have a real conversation and this makes it easy for people to overlook the reality that babies too have needs. They are just unable to communicate those needs in a way that their caretakers could understand. As we can well imagine, they need to eat, be comfortable and, above all, kept as healthy as possible and free of any morbidity. Babies, like all humans, require attention and affection and they also can experience emotions, like fear, pain, and anger. When their needs are not met, most of them will cry, because that’s their greatest weapon from a communication standpoint. The first cry in the moments after birth For anyone in a delivery room, the absence of crying when the baby arrives is particularly worrying especially as time elapses. It is a signal that something may be gravely wrong. Before a child is born, the blood is oxygenated via the placenta. During intrauterine life, our blood circulates differently. There are several bypasses or unique features, namely, the ductus venosus (i.e. shunt for oxygenated placental blood to bypass the liver), ductus arteriosus (i.e. shunt for oxygenated blood to bypass non-functioning amniotic fluid-filled lungs), and foramen ovale (i.e. passage for oxygenated blood to go from right atrium to the left atrium). In addition to the shunts, the pulmonary vessels are constricted in utero. At birth, all of the shunts are closed and the intense pulmonary vasoconstriction is reversed. This reversal and closing of shunts happens within minutes and are triggered by reflexes. The cold extra-utero environment and being born wet causes great discomfort to the newborn and he or she attempts to cry. To cry, the neonate must breathe and this results in the first inspiratory gasp. Air is sucked into the lungs with the help of the respiratory muscles. This begins the process of transforming fetal into newborn circulation. Common reasons for crying One of the main and most common reasons babies cry is to tell the caregiver that they are hungry. If truth be told, the younger an infant is, the more likely the cause of his or her cry is hunger. If food is not the problem, then a baby may protest if the diaper is soiled or wet or even if clothes are not comfortable enough. So it’s always wise for parents to take a peak and make sure the diapers are dry and clean. Babies, like all of us, can also feel hot or cold. They are even more vulnerable to changes in the environment, because their little bodies are still learning to adapt to the outside world. If a baby is well fed, clean, and comfortable, then may be he or she just wants some attention. After all, who doesn’t like to be cuddled? Physical contact gives children that sense of reassurance that they are well protected by their guardians. Parental concerns about ‘spoiling’ babies by holding them too much can cause parents to neglect giving their babies enough attention. Sometimes babies may cry for no reason at all and it is important for parents to remember that it is ok to let them cry it out. It is imperative that caregivers learn to recognize different tones in their babies’ cries. These vary depending on the reason. Children who are sick may cry differently compared to children who are hungry or just sleepy and need rest. This is a very useful skill that parents develop along the way. If attention is paid close enough, then a parent will be able to decode exactly what their child wants or needs. Reviewed by Susha Cheriyedath, MSc References https://www.nct.org.uk/parenting/coping-crying-baby https://www.helpguide.org/articles/secure-attachment/when-your-baby-wont-stop-crying.htm http://whale.to/a/morley4.html http://www.nhs.uk/conditions/pregnancy-and-baby/pages/soothing-crying-baby.aspx Further ReadingMalrotation of the Gastrointestinal TractFontanelleHeat Rash in BabiesHow to Stop a Baby Crying?How to Understand your Baby’s Crying?More... Last Updated: Aug 3, 2017","{
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10,"2018-04-20 02:27:42","How to Stop a Baby Crying?","By Jonas Wilson, Ing. Med. Babies cry, because that is their primary means of communicating to their caregivers. While some babies are fussier than others, all babies cry. For the reason that babies cannot talk, it is easy for people to overlook their needs and wants. Understanding why the child is crying in the first instance may be particularly demanding for parents, especially those who are first timers. At birth, crying is a sign that a baby is alive and is at least able to breathe. In the hours, weeks, months, and years thereafter, crying may be for a number of reasons. Reasons why infants cry The first thing a parent or caregiver should try to identify when confronted with a crying baby is the reason for the child’s crying. This becomes easier the more time that is spent with the child or with experience nurturing infants. The reasons why infants cry may be many, but there are some common ones. Heading the top of the list is hunger. The younger an infant is, the greater the chances are that the reason for his or her crying is food. In other circumstances, it may be separation anxiety, illness, sleepiness, overstimulation, colic, or illness. Soothing a crying infant Although all babies are individuals and unique in their own respects, some tips and tricks, with regards to soothing them when crying, do seem to be universal. The first and most important thing a parent or caregiver should remember is to never ever shake a baby. Shaking an infant can cause what is called Shaken Baby Syndrome (SBS). Its hallmarks are retinal and subdural hemorrhages. These babies may die as a consequence or suffer long-term neurological deficits, such as hearing loss, blindness, paralysis, seizures, and mental retardation. SBS is completely preventable by simply refraining from shaking an infant. If a parent can identify the reason why an infant is crying, then the problem is solved immediately. A hungry child will stop crying when given a breast or bottle to suckle on. An uncomfortable baby will be happy if the cause for his or her discomfort is taken care of, such as the removal of a wet or soiled diaper or the adjustment of the temperature in the baby’s room. A baby who is well-fed and comfortable without any signs of illness may just actually want some attention. Some tips to soothe a baby who appears to be crying for no reason include wrapping the child in a blanket or swaddling to create a sense of security. In addition to this, rhythmically swinging the baby, sucking on a pacifier, or positioning the child on the stomach or side may create a soothing effect. Singing to a child may also help to calm him or her. Warm baths may prove effective in some babies, but in others it may agitate them more. Colic Although poorly understood with a yet to be identified clear cause, colic is the term used for crying in babies that lasts longer than 3 hours in a day for more than 3 days in a week over the course of 3 or more weeks in a child who is otherwise healthy. Some studies indicate that the cause may be linked to intestinal problems, such as food allergies or reflux. These babies have a higher pitched crying and often look like they are in pain with rigid tummies and bodies as well as flexed limbs. Colic tends to go away on its own after some time and parents are often asked to wait it out, but gripe water may be used to help alleviate symptoms. Coping with a crying infant It is very normal that many parents, especially those who are new to parenthood, may become worried by not being able to understand all of their baby’s cries. Furthermore, it may even be frustrating at times. It is imperative to remember that crying is a part of the baby package. Parents should take time out to understanding their babies more and always seek support from family and close friends when they feel overwhelmed. If they sense something is wrong with the baby, then consultation with a pediatrician is recommended. Reviewed by Susha Cheriyedath, MSc References http://www.nhs.uk/conditions/pregnancy-and-baby/pages/soothing-crying-baby.aspx https://www.nct.org.uk/parenting/coping-crying-baby https://www.helpguide.org/articles/secure-attachment/when-your-baby-wont-stop-crying.htm https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183958/ Further ReadingMalrotation of the Gastrointestinal TractFontanelleHeat Rash in BabiesWhy Do Babies Cry?How to Understand your Baby’s Crying?More... Last Updated: Aug 3, 2017","{
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11,"2018-04-20 02:29:25","How to Understand your Baby’s Crying?","By Jonas Wilson, Ing. Med. Babies, like all of us, have needs and wants. However, they are unable to communicate these in manner that older children and adults do. Thus, they use their most basic, yet effective, means of communicating their wishes – crying. Infants need to eat, sleep, be kept comfortable and healthy. In addition to these, they require attention as well as affection and have emotions like anyone else. In order to understand an infant’s crying, parents and caregivers must first know the reasons why these precious beings cry and the differences in crying for different purposes. Decoding the signals Babies are individuals. Something that upsets one child may not bother another, but all at some point will cry for one reason or the other. It’s crucial that parents take time to pay attention to their babies, because in doing so they’ll be quicker able to identify and understand why their infants cry. Changes in a baby’s mood, although difficult to detect at times, can be used to preemptively avoid crying spells. For instance, an infant may be like clockwork with his or her daily nap and feeding routine, allowing parents to ‘prepare’ in advance. Children who follow biological routines may become easily upset if there is a sudden change to their schedule or environment. While at first, to the untrained ear, all cries may sound the same, parents soon begin to notice subtle differences in their children’s cries. A hungry child may cry differently compared to a child who is sleepy or in pain. Differences in cry may be noted based on pitch, level, intensity, and duration of the cry. It is rather difficult to decode the cries of very young infants, because these cries may overlap. However, those infants who are older may show subtle, yet distinct differences. A hungry child may have a cry that is low-pitched and rather short, which oscillates up and down. Infants who want to be left alone, perhaps due to overstimulation, may also have a similar cry to the hunger cry. In contrast, babies who are in distress, pain, or are ill, may have a high-pitch and long cry that contains a pause and flattening wail at the end. Turbulent cries, on the other hand, may denote anger. Responding to a crying baby It goes without saying that the reason for causing the child’s crying must be dealt with in order for that child to stop crying. A hungry child should be fed, while one with a soiled or wet diaper should have it changed. Taking care of an infant’s needs will no doubt soothe him or her. By paying attention and trying to pinpoint differences in their babies’ cries, parents will be able to quicker address their infants’ needs. It’s normal that parents may feel helpless when they are unable to decipher what is wrong with their children. In cases where babies are fed, comfortable, and healthy, it’s ok to let them cry, as it is well known that this may help them to fall asleep. Reviewed by Susha Cheriyedath, MSc References https://www.helpguide.org/articles/secure-attachment/when-your-baby-wont-stop-crying.htm https://www.nct.org.uk/parenting/coping-crying-baby http://www.peps.org/ParentResources/by-topic/baby-care/infant-crying Further ReadingMalrotation of the Gastrointestinal TractFontanelleHeat Rash in BabiesWhy Do Babies Cry?How to Stop a Baby Crying?More... Last Updated: Aug 3, 2017","{
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12,"2018-04-20 02:29:31","Baby Holding Techniques: The Hold","By Jonas Wilson, Ing. Med. ‘The Hold’ is a baby calming technique that is the brainchild of Dr. Robert Hamilton, who is an American pediatrician. Dr. Hamilton’s technique can be found brilliantly explained on YouTube, and was seen and liked millions of times in a very short period. This was a clear indication that there are, without doubt, many parents and caregivers out there who are eager to find a means of calming their babies. With more than 3 decades of working with children under his belt, as well as having 6 children of his own, it is safe to assume that Dr. Hamilton anticipated parents would be eager to dip their hands on such information. The hold – procedure Dr. Hamilton’s holding technique consists of some 4 very simple steps. In the first step, the baby’s arms are folded across the baby’s chest. Next, the arms are gently secured. Following this, the baby’s diaper area is grasped before the fourth and final step, which is rocking the infant at an angle of 45 degrees. The parent or caregiver holds the infant with one hand around the infant’s chest, while the other hand is positioned under the bottom while gently rocking the infant back and forth. ‘The Hold’ appears to have an immediate effect, as Dr. Hamilton points out in his YouTube video. Does it work? In a media interview, Dr. Hamilton said that his technique is optimal on children between the first 2 and 3 months of life. The objective of the technique is to attempt recreating an intrauterine feeling. This gives the baby a sense of security and calms him or her. While there is no further evidence to prove or disprove that Dr. Hamilton’s technique is foolproof, one thing that’s for certain is his technique is quite popular. Dr. Hamilton himself has expressed awe about the popularity ‘The Hold’ has received and stated that he never would have expected this to happen in his wildest dreams, but he is humbled by it. Other baby calming techniques Soothing babies can be tricky, especially if they are well-fed, comfortable, and not ill. It’s important to take care of the baby’s most pressing need, as doing this will immediately solve the crying problem. Some means of calming a baby include singing or talking to the baby in a tranquil voice, while gently stroking or rubbing his or her back. Rattle toys and pacifiers are clever ways of distracting a baby. Sometimes all a baby needs is a little walk or a ride in the stroller, or perhaps some music. All babies are unique; thus, what may work for one may not work for another. The trick is for parents or caregivers to pay close attention to the little details that work best for them. One important thing to remember is that sometimes it’s totally ok to let the baby cry, if it is certain that all the baby’s needs have been adequately met. Babies cry. It’s just what they do and is their primary means of communication. Parents just need to have patience and strong support from a family member or close friend for those times when they feel overwhelmed. Reviewed by Susha Cheriyedath, MSc References http://www.today.com/parents/pediatrician-shows-how-calm-your-baby-seconds-hold-t59466 https://www.youtube.com/watch?v=j2C8MkY7Co8 https://www.childrenscolorado.org/conditions-and-advice/calm-a-crying-baby/calming-techniques/ Further ReadingMalrotation of the Gastrointestinal TractFontanelleHeat Rash in BabiesWhy Do Babies Cry?How to Stop a Baby Crying?More... // Last Updated: Jan 25, 2017","{
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14,"2018-04-20 02:29:34","What Causes Back Pain?","By Dr Ananya Mandal, MD The back is a complex structure made up of: Bones of the vertebrae Muscles Nerves Joints Because of this complex structure it is difficult to pinpoint the exact cause of the pain. In most cases the pain is not caused by serious damage or disease but by sprains, minor strains, minor injuries or an irritated nerve ending. These may be triggered by an awkward position, everyday activities at home and at work, lifting or standing awkwardly or as a result of longstanding bad posture. Common causes of back pain Common causes include: Lifting, carrying, pushing or pulling incorrectly Twisting the back Sprains and injuries Bending awkwardly Sleeping or getting up from the bed awkwardly Overreaching or stretching Slouching while sitting Driving in a hunched position Bending or standing for long periods of time Driving for long hours without breaks Sitting at the desk for long hours without change in posture Repetitive strain injury Unaccustomed exercise Bad or uneven heeled shoes Ankylosing spondylosis Whiplash injury Frozen shoulder Slipped or bulging disc (this disc lies like a cushion between two vertebrae) Sciatica Arthritis Osteoporosis and vertebral fractures Skeletal irregularities (e.g., scoliosis, kyphosis, lordosis, back extension, back flexion) and conditions such as fibromyalgia, kidney stones or infections, endometriosis etc. More serious causes include cauda equine syndrome, bone cancers, spine infections Risk factors for back pain Some persons are typically more prone to getting back pain. Most persons however get back pain at some point in their lifetime. The following are risk factors for back pain: Age – Back pain typically occurs between the ages of 30 and 40. It becomes more common with age Level of fitness - Back pain is more common among people who are not physically fit. these individuals have weak back muscles. Pregnancy – Pregnancy may put a great strain on the back especially at later stages and there may be a dull back pain. Occupation – Persons who need to lift, push or pull and twist their backs at work, they may be at risk of back pain. Those working for long hours at their desks are also at risk of back pain. Stress – this leads to strain of the back muscles and stiffness that may give rise to back pain. Being overweight or obese – These individuals have too much stress on their spine that may lead to pain. Inherited - Some causes of back pain, such as disc disease may be inherited. Ethnicity and race - African American women are found to be two to three times more likely than white women to develop spondylolisthesis. Caucasian women of northern European heritage, on the other hand, are at the highest risk of developing osteoporosis. Smoking - Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate. Long term use of medications like corticosteroids. These weaken the bones and make them prone to fractures and injury. Depressive illness – those with depression are also prone to getting back pain. Other diseases – Those with arthritis and cancers with spread to bones may also experience back pain. The muscles in your shoulder are connected to your arm by tendons. Between the tendons and bones are small sacs of fluid called bursa. They lubricate the shoulder so it moves easily. Continual stress on your shoulder can cause the bursa to get squeezed, swollen, stiff, and inflamed (bursitis). Bursitis can make it painful, or even impossible, to raise your arm. Image Credit: CDC If you bend forward over and over for months or years, the discs are weakened, which may lead to disc rupture (or ""herniation""). Image Credit: CDC Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://www.nhs.uk/Conditions/Back-pain/Pages/Introduction.aspx www.patient.co.uk/.../Assessment-and-Management-of-Low-Back-Pain.htm www.bbc.co.uk/.../index.shtml http://fcs.tamu.edu/health/healthhints/2009/jul/back-pain.pdf http://www.who.int/bulletin/volumes/81/9/Ehrlich.pdf http://www.sportspinerehab.com/Back%20Pain.pdf http://www.niams.nih.gov/health_info/back_pain/back_pain_ff.pdf Further Reading What is Back Pain? Back Pain in Pregnancy Back Pain Research Back Pain Treatment Last Updated: Dec 3, 2012","{
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15,"2018-04-20 02:29:38","What is Back Pain?","By Dr Ananya Mandal, MD Back pain is a common symptom and affects most people at some point in their life. An estimated 75 to 85 percent of all Americans will experience some form of back pain during their lifetime. Most countries take a major blow to their productivity due to back pain through loss of workers on sick leave. Some national governments, notably Australia and the United Kingdom, have launched campaigns of public health awareness to help combat the problem. One of these is the Health and Safety Executive's Better Backs campaign. What does back pain feel like? In most cases rather than an acute stabbing pain, it is a dull stiffness or tension in the back. The pain can be triggered by an awkward posture, bending or sitting awkwardly, or lifting incorrectly. Usually back pain is not a serious disease and usually gets better by 12 weeks. Exercises and pain relievers and advice of good posture maintenance is the treatment of choice. Types of back pain Back pain may occur at any part of the back but commonly affects the lower back. The pain may also be felt along the spine, neck or hips. Common types of back pain include: Neck pain Ankylosing spondylosis Whiplash injury Sprains and injuries Frozen shoulder Slipped or bulging disc (this lies like a cushion between two vertebrae) Sciatica Arthritis Osteoporosis and vertebral fractures Skeletal irregularities (e.g., scoliosis, kyphosis, lordosis, back extension, back flexion) Other conditions include fibromyalgia, stress, pregnancy, kidney stones or infections, endometriosis etc. More serious causes include cauda equine syndrome, bone cancers, spine infections Causes of back pain Risk factors for back pain: Age – Back pain typically occurs between the ages of 30 and 40. It becomes more common with age. Being overweight or obese – These individuals have too much stress on their spine that may lead to pain. Level of fitness - Back pain is more common among people who are not physically fit, these individuals have weak back muscles. Occupation – Persons who need to lift, push or pull and twist their backs at work, they may be at risk of back pain. Those working for long hours at their desks are also at risk of back pain. Inherited - Some causes of back pain, such as disc disease may be inherited. Ethnicity - African American women are found to be two to three times more likely than white women to develop spondylolisthesis. Caucasian women of northern European heritage, on the other hand, are at the highest risk of developing osteoporosis. Smoking - Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate. Other diseases – Those with arthritis and cancers with spread to bones may also experience back pain. Warning signs of back pain Related StoriesStudy suggests there are health benefits for the ‘tummy tuck’Back pain being mismanaged globallyNew essential oil inhaler facilitates pain management In most cases a few days of rest and adequate mobility may help in recovery from back pain. However, some symptoms may indicate a deeper problem and mandates a visit to the doctor. These symptoms include: Weight loss that is unexplained Swelling and immobility of the back Fever Pain in the limbs Numbness of the lower limbs or other parts of the body including genitals Loss of bladder or bowel control Worsening pain at night Treatment of back pain The primary modality of treatment is by remaining mobile and active. Earlier bed rest was advised for back pain. These days it is known that being inactive for long periods is actually bad for the back. Patient is advised moderate activities such as walking and doing their own daily tasks. Pain relievers like Acetaminophen (Paracetamol) is commonly advised. Hot or cold compression packs may also help reduce the pain. There are other manual therapies including physiotherapy and osteopathy. These may also help relieve pain. For back pain lasting for more than six weeks exercise classes or manual therapy along with pain relievers are advised. Acupuncture may provide relief in some individuals. Spinal surgery is usually only considered when all else has failed. Prevention of back pain Maintenance of good posture while sitting, standing, lifting, lying down. Getting up from sitting or lying position is another important factor that needs to be improved to prevent strain to the back. Individuals are advised not to place too much pressure on the back and ensure their back is strong and supple. Regular exercise, such as walking and swimming, is an excellent way of preventing back pain. Yoga and pilates also improve the flexibility and strength of the back muscles. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://www.nhs.uk/Conditions/Back-pain/Pages/Introduction.aspx www.patient.co.uk/.../Assessment-and-Management-of-Low-Back-Pain.htm www.bbc.co.uk/.../index.shtml http://fcs.tamu.edu/health/healthhints/2009/jul/back-pain.pdf http://www.who.int/bulletin/volumes/81/9/Ehrlich.pdf http://www.sportspinerehab.com/Back%20Pain.pdf http://www.niams.nih.gov/health_info/back_pain/back_pain_ff.pdf Further Reading What Causes Back Pain? Back Pain in Pregnancy Back Pain Research Back Pain Treatment Last Updated: Jan 1, 2014","{
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16,"2018-04-20 02:29:43","Back Pain in Pregnancy","By Dr Ananya Mandal, MD Back pain may affect pregnant women especially during later stages of their pregnancy. The prevalence of back pain during pregnancy is 48 - 56%. In fact it is so common that in most cases this symptom is looked upon as a normal part of pregnancy. Around a third of all pregnant women may get severe back pain that compromises their ability to work in gainful employment during pregnancy and also interferes with their activities of daily living. Furthermore, back pain occurs at night in over one-third of pregnant women, contributing significantly to insomnia. Pregnancy related back pain and risk factors Pregnancy-related back pain is commonly seen in women who have a history of previous episodes of back pain. The pain is usually most intense from the 12th week of pregnancy till 28th week and usually declines in intensity after that. Women with twin pregnancies or in later pregnancies (after the first pregnancy) may be more at risk of back pain. Pregnancy related back pain may also be related to long hours of work and bad posture. Even bad shoes and heels and long hours of standing can contribute to back pain in a pregnant women. Furthermore Hispanic women have a proportionally lower instance of back pain in pregnancy than Caucasian women. Younger age is also a risk factor, possibly due to higher sensitivity to hormonal changes induced by relaxin and estrogens, or to more pronounced collagen laxity Higher weight (obesity and overweight mothers) and those with a short stature are at higher risk of back pain Women who have had pain during pregnancy are also more likely to suffer from back pain after childbirth. Mechanism of back pain during pregnancy Related StoriesBack pain being mismanaged globallyStudy identifies two genes associated with extreme nausea and vomiting during pregnancyPainkiller use during pregnancy could affect unborn child's fertility in later life A normal pregnancy brings about several physiological changes in the body. These include mechanical and structural changes to the spine and hips to facilitate pregnancy and childbirth. Changes also include posture, gait (the nature of walk) and total body water content. There are hormonal changes and engorgement of blood vessels around the spine (epidural blood vessels). The main change in posture is increased forward convexity of the spine (called lumbar lordosis). Most of the weight is thus concentrated low in the pelvis with a protruding abdomen. This leads to low back pain. This also causes a tendency to fall forwards. Increased total body water means there is collection of fluids in the connective tissues around the vertebral column and pelvis. This increases the laxity around these joints. This fluid retention is also aggravated by hormonal changes of pregnancy. There is a hormone relaxin released during pregnancy. It softens the ligaments around the pelvic joints and cervix, possibly by enhancing fluid retention in these tissues and this helps in easy childbirth. Treatment and prevention of back pain during pregnancy Patient education – This is vital. Maintenance of good posture, good methods of rising from sitting or lying position, prevention of awkward lifting etc. should be emphasized. Patient is advised to stop smoking as this aggravates back pain. Physiotherapy – Physiotherapy in the third trimester may help ease back pain. Other physical treatments include mechanical support for the back for example a wedge shaped pillow for support (Ozzlo pillow), a belt or pelvic girdle etc. Labor pain can be managed appropriately to prevent back pain after childbirth. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources www.uws.edu.au/.../...ated_Pelvic_Girdle_Pain_how_can_we_help_0809.pdf http://members.multimania.co.uk/shiryu01/Pdf/MacEvilly%201996.pdf http://www.bioline.org.br/pdf?md06026 http://www.biomedcentral.com/content/pdf/1471-2393-12-30.pdf http://www.nct.org.uk/pregnancy/back-pain-pregnancy Further Reading What is Back Pain? What Causes Back Pain? Back Pain Research Back Pain Treatment Last Updated: Dec 3, 2012","{
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17,"2018-04-20 02:29:48","Back Pain Research","By Dr Ananya Mandal, MD Back pain affects a significant population worldwide and has a severe impact on a nation’s productivity. Workers worldwide lose a large number of work-days to back pain. Despite this wide prevalence, there are very few sure-fire cures for back pain. Research is constantly taking place worldwide to understand the aetiologies and find therapies to ease back pain. The National Institute of Neurological Disorders and Stroke (NINDS) and the National Institutes of Health (NIH) The National Institute of Neurological Disorders and Stroke (NINDS) and other institutes of the National Institutes of Health (NIH) have several pain research studies in their laboratories. The researchers are looking at use of different drugs to effectively treat back pain, in particular, chronic pain that has lasted at least 6 months. There are yet other studies that compare the different approaches to acute back pain and attempt to find the best approach. These studies in addition compare standard care with pain relievers and hot or cold compresses and physiotherapy with complementary therapies like chiropractic, acupuncture, or massage therapy. There are studies that compare various surgical approaches to back pain as well. Related StoriesJury’s in: Opioids are not better than other medicines for chronic painYoung athletes commonly have bone marrow edema in lower spine, study showsChronic opioid users at increased risk of complications after spinal fusion surgery The studies on back pain look at various factors like symptom relief, restoration of function, and patient satisfaction. Arthritis Research UK Primary Care Centre at Keele University Arthritis Research UK Primary Care Centre at Keele University is also conducting research on back pain. They have found that a new model of primary care management called stratified primary care management can have significant benefits for patients seeking help from their GP for back pain. For their approach they group patients into different levels of treatment depending on their level of risk (low, medium or high) for persistent or chronic back pain problems. This stratification helps in more effective treatment of patients. This also reduced healthcare costs because fewer patients ended up coming back through the healthcare system at a later date after being managed effectively at first contact. Vertebroplasty Vertebroplasty is a new approach that has been studied extensively. It involves injection of surgical cement into vertebral bodies that have collapsed due to compression fractures to immobilize the spine. Severe biological response modifier drugs Like for treatment of arthritis, severe biological response modifier drugs are being tried in chronic back pain. These may provide rapid pain relief and prevent disease progression in back pain. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://www.ninds.nih.gov/disorders/backpain/backpain.htm www.arthritisresearchuk.org/.../research-and-new-developments.aspx www.spineuniverse.com/.../back-pain-research-treatment-updates www.pottsmerc.com/.../why-does-low-back-pain-recur-new-research-findings-and-treatment-considerations Further Reading What is Back Pain? What Causes Back Pain? Back Pain in Pregnancy Back Pain Treatment Last Updated: Dec 3, 2012","{
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18,"2018-04-20 02:29:53","Back Pain Treatment","By Dr Ananya Mandal, MD Back pain treatment varies with the severity, cause and associated factors. Some of the treatments and therapies that may be tried for back pain may be outlined as follows. Management of acute or short term back pain This is commonly seen in most individuals with back pain. The pain lasts no longer than six weeks and can be treated with pain relievers that are available over-the-counter or without prescription at a pharmacy and home treatments. Of the pain relievers Paracetamol (Acetaminophen) is commonly used successfully. Some people find anti-inflammatory drugs such as ibuprofen more effective. Stronger pain killers like codeine may be taken for more severe pain along with paracetamol. Those with muscle spasms may be prescribed a muscle relaxant like diazepam along with a pain reliever. Pain relievers may also be applied as creams, ointments or sprays over the affected area. Hot and cold compresses Heat with the use of a hot bath, hot water bottle or heated pad may provide relief from back pain in some individuals. In yet others application of ice packs or a bag of frozen vegetables over the pain may ease the pain. Ice packs, however, should not be applied directly over the back as this may cause cold burns. Some persons also benefit by alternating hot and cold using ice packs and hot compression packs. Lifestyle changes Sleeping posture – Sleeping posture and mattress may be contributing to the back pain. By changing the sleeping position and/or mattress the pain may be eased or prevented. Patient is advised to sleep on their side and draw their legs up slightly towards their chest and pillow is put between their legs. For those who sleep on their backs, a pillow may be placed under the knees to maintain the normal curve of the lower back. Relaxing muscle tensions – this can be achieved by deep breathing and conscious relaxation of back muscles before retiring to bed each day. Maintaining regular physical activity – Long periods of inactivity is bad for the back. People who remain active are likely to recover more quickly. Earlier those with back pain were advised bed rest. These days they are advised to walk or perform their daily activities to prevent immobility of the back. Weight loss – Being overweight and obese is a risk factor for back pain. Having a healthy and balanced diet along with regular exercise helps in keeping excess weight in check. Reduction of stress Regular exercise and being active and physically fit – This may be achieved by walking, swimming, yoga and pilates. These help in maintaining the flexibility and strength of the back muscles and prevent recurrence of back pain Management of long term or chronic back pain Related StoriesBack pain being mismanaged globallyBack pain affects nearly half of well-functioning, highly active older adultsModifying Oncolytic Adenoviruses to Target Pancreatic Cancer Back pain lasting over six weeks is called chronic back pain A more intensive exercise programme is prescribed. This is usually up to eight sessions over a period of up to 12 weeks. It will usually be a group class supervised by a qualified instructor. These exercises help to strengthen the muscles and improve posture. There are aerobic and stretching exercises as well. Manual therapy is prescribed and this includes manipulation, mobilisation and massage. This is performed by chiropractors, osteopaths or physiotherapists. These are usually for up to nine sessions over a period of up to 12 weeks. Acupuncture may be tried as a treatment modality as well. These may include up to 10 sessions over a period of up to 12 weeks. Some patients may suffer from concurrent depression due to their back pain. These patients require antidepressant medications, counselling and cognitive behavioral therapy as well. Surgery is usually only recommended as a treatment option when all else has failed. A common procedure is spinal fusion surgery. This involves fusion or joining up of the joint that is causing pain to prevent it moving. Other therapies include low level laser therapy. In this low energy lasers are focused on the back to reduce the inflammation. Ultrasound waves may also be used to accelerate healing and encourage tissue repair Interferential therapy (IFT) is performed by a device that passes an electrical current through the back to improve healing. Transcutaneous electrical nerve stimulation (TENS) – This is delivered by a machine that provides small electrical pulses to the back through electrodes that are placed on the skin. This helps to reduce the pain signals from the back. Mechanical measures – This includes lumbar supports like cushions, pillows and braces, traction devices for the spine. Drugs – Pain killers and steroids may be directly injected into the affected joints to reduce inflammation and pain. Warning signs of back pain and when to see the physician In most cases a few days of rest and adequate mobility may help in recovery from back pain. However, some symptoms may indicate a deeper problem and mandates a visit to the doctor. These symptoms include: Weight loss that is unexplained Fever Swelling and immobility of the back Pain in the limbs Worsening pain at night Numbness of the lower limbs or other parts of the body including genitals Loss of bladder or bowel control Unsteadiness when standing Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://www.nhs.uk/Conditions/Back-pain/Pages/Treatment.aspx http://www.knowyourback.org/documents/back_pain_basics_web.pdf www.patient.co.uk/.../Assessment-and-Management-of-Low-Back-Pain.htm www.bupa.co.uk/individuals/health-information/directory/b/backpain www.bbc.co.uk/.../prevention_back_pain.shtml Further Reading What is Back Pain? What Causes Back Pain? Back Pain in Pregnancy Back Pain Research Last Updated: Dec 3, 2012","{
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19,"2018-04-20 02:29:55","Lower Back Pain Management","By Yolanda Smith, BPharm The management of lower back pain typically depends on the nature and cause of the pain. In most cases, management involves a combination of physical therapy and drug treatments. Surgical procedures are reserved for refractory cases, or when there is significant and worsening nerve damage. Physical therapy Hot or cold packs are often recommended for the relief of pain and to reduce inflammation, particularly for individuals who have suffered an injury to the lower back. There is currently no research-backed evidence to prove that this is effective. However, many individuals find it helpful, and it does not appear to have adverse effects. People with lower back pain should be encouraged to continue with their normal daily activities, as long as it is not heavy manual labor, and resist the urge to stay in bed for more than the acute phase. Inactivity can worsen the pain and increase the risk of depression and blood clots. Instead, physical therapy with light stretching exercises can help to enable the area to heal more efficiently. Strengthening exercises are also recommended for people with chronic (but not acute) low back pain, and is particularly important for pain caused by irregularities of the spine. Medications There are many different medications that may be used in the management and relief of lower back pain. These include: Simple analgesics: acetaminophen and aspirin Opioids: codeine, oxycodone, hydrocodone, morphine Non-steroidal anti-inflammatory drugs (NSAIDS): ibuprofen, ketoprofen, naproxen Anticonvulsants Tricyclic antidepressants: amitriptyline Selective serotonin-receptor inhibitors (SSRIs) or serotonin–norepinephrine reuptake inhibitors (SNRIs) Each of these medications has its own specific risks and benefits, and the best treatment will depend on the individual factors of the patient. Points to consider may include: The cause of pain Duration of treatment Safety in pregnancy Side effects Availability Cost Other non-pharmacological treatments There are also various other non-pharmacological treatments that may be used in the management of lower back pain. These include: Spinal manipulation or mobilization: Chiropractors are practitioners who practice spinal mobilization, adjustment, massage, or stimulation, to improve the alignment and strength of the spine and connective tissues in the lower back. Traction: Weights or pulleys are used to gradually reposition the spine and improve alignment so as to relieve pressure on the spinal cord and nerves. Acupuncture: This technique involves the insertion of needles into so-called pressure points of the body. It is not known precisely how this works but it appears to be effective in some patients at least. Acupuncturists explain the effect as being linked to clearing blockages in Qi or stimulating neurotransmitters. Related StoriesCorin introduces new Unity Knee with EquiBalance at AAOS 2018 Annual MeetingEnvironmental pollutants found to worsen rheumatoid arthritisHottest pepper gives man “thunderclap” Biofeedback: This involves the attachment of electrodes to the skin and the use of electromyography to increase awareness of breathing, heart rate, temperature and muscle tension. Nerve block therapies: This treatment involves the inhibition of nerve conduction in specific areas with the use of local anesthetics, botulinum toxin or steroid injections. Transcutaneous electrical nerve stimulation (TENS): Placement of an electrode on the skin of the affected area to create electrical impulses and block pain signals from nerves. Surgery Surgical techniques are usually reserved as a last-line option when other techniques have failed to provide adequate relief of lower back pain. This is because it is associated with a risk of nerve compression and worsening pain. Surgery is most often needed in cases with musculoskeletal injuries or compression of the nerves that causes neuropathic pain. Procedures that may be used include: Vertebroplasty Kyphoplasty Spinal laminectomy Discectomy Microdiscectomy Foraminotomy Intradiscal electrothermal therapy (IDET) Nucleoplasty (plasma disc decompression, PDD) Radiofrequency denervation Spinal fusion Artificial disc replacement The treatment decision about whether to use surgery for low back pain, and, if so, which procedure to use, will vary from case to case of lower back pain. Each procedure has unique risks and benefits that promote its use over others in certain situations. Reviewed by Liji Thomas, MD References http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm#3102_3 http://patient.info/health/nonspecific-lower-back-pain-in-adults http://emedicine.medscape.com/article/310353-treatment#showall http://orthoinfo.aaos.org/topic.cfm?topic=a00311 Further ReadingWhat Causes Back Pain?What is Back Pain?Back Pain in PregnancyBack Pain ResearchBack Pain TreatmentMore... // Last Updated: Aug 3, 2017","{
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20,"2018-04-20 02:29:57","What is Degenerative Disc Disease?","By Joseph Constance BA, MA Degenerative disc disease and the soreness in the back that it causes are a significant socioeconomic burden on the health care system. Studies have shown that back pain racks up costs greater than $100 billion annually in the U.S., including lost wages and reduced productivity. More than 75 percent of those costs are generated by fewer than five percent of patients. As they age, almost everyone will experience some wear on their spinal discs. But not everyone will have the symptoms of what is known as degenerative disc disease. The pain caused by degenerative disc disease arises when a disc loses its integrity. Most people older than 60 years of age have some disc degeneration, but they do not all experience discomfort. When a disc fails, the vertebral facet joints grind against each other, and cause pain. If there is no other cause found for the pain, the patient is diagnosed with degenerative disc disease. Spinal discs The vertebral discs in the spine act as shock absorbers for the bones. The discs enable the spine to remain elastic, flexible, and strong. A disc is composed of: The anulus fibrosus, which is a strong outer wrapping, on the outside of which are nerves. If this area is damaged, the pain can become extensive. The nucleus pulposus, the soft inner core of the spinal disc. It holds proteins that can cause swelling, tenderness, and an extensive amount of pain, if they leak into the outer layers of the disc. Causes of degenerative disc disease Loss of fluid due to aging can cause the intervertebral discs to compress. . When this occurs, the discs do not handle shocks to the system well. Daily activities cantear the disc components, resulting in swollen and sore tissues. A disc receives little blood flow. Unable to repair itself, it begins to deteriorate. Symptoms of degenerative disc disease Related StoriesStudy identifies exercises to help prevent chronic back pain in runnersBack pain affects nearly half of well-functioning, highly active older adultsThe Importance of Fetal Fibronectin Testing for Women with Symptomatic Preterm LaborThere are a variety of symptoms of degenerative disc disease: Pain exacerbated by movement or standing Muscle spasms Sciatic nerve pain Leg muscle weakness Numbness of the leg or foot Reduced reflexes in the ankle or knee Problems with bowel or bladder function Diagnosing and treating degenerative disc disease Diagnostic imaging, such as an MRI scan, can reveal damage to discs, but alone it cannot confirm degenerative disc disease. To make a diagnosis, a physician will review a patient’s history and carry out a physicalexam. The patient’s symptoms will be reviewed, a diagnosis made, and treatment plan determined. Controlling back pain, and degenerative disc disease, requires exercise that will improve the flexibility and strength of the muscles of the spine.. Exercise boosts the amount of blood circulation, . bringingnutrients to the area while reducing inflammation. In addition to physical activity, additional treatment may be necessary. Physical therapy Massage Pain relievers Non-steroidal anti-inflammatory drugs Disc replacement or spinal fusion surgery Applying heat or cold to the affected area. . Mobilization of the spinal joint Degenerative disc disease can also be managed by nutrition, weight loss, and healthy lifestyle. Reviewed by Catherine Shaffer, M.Sc. Sources: http://www.ncbi.nlm.nih.gov/pubmed/16595438 www.cedars-sinai.edu/.../Degenerative-Disc-Disease.aspx www.arthritis.org/about-arthritis/types/degenerative-disc-disease/ www.beaumont.edu/.../ www.cedars-sinai.edu/.../index.aspx Further ReadingWhat Causes Back Pain?What is Back Pain?Back Pain in PregnancyBack Pain ResearchBack Pain TreatmentMore... // Last Updated: Jan 11, 2017","{
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21,"2018-04-20 02:30:00","Bacterial Vaginosis","Bacterial vaginosis, also called BV is the most common vaginal infection in women of childbearing age. It happens when the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria. The vagina normally contains mostly ""good"" bacteria, and fewer ""harmful"" bacteria. BV develops when there is an increase in ""harmful"" bacteria and fewer ""good"" bacteria. What causes Bacterial vaginosis? The cause of BV is not understood. It can develop when something, like sexual contact, disrupts the balance between the good bacteria that protect the vagina from infection and the harmful bacteria that don't. It is not clear what role sexual activity plays in the development of BV, but BV is more common among women who have had vaginal sex. But BV is not always from sexual contact. We do know that certain things can upset the normal balance of bacteria in the vagina and put you more at risk for BV: Having a new sex partner or multiple sex partners Douching Using an intrauterine device (IUD) for birth control Not using a condom We also know that you do not get BV from toilet seats, bedding, swimming pools, or from touching objects around you. What are the signs of Bacterial vaginosis? Women with BV may have an abnormal vaginal discharge with an unpleasant odor. Some women report a strong fish-like odor, especially after sexual intercourse. The discharge can be white (milky) or gray and thin. Other symptoms may include burning when urinating, itching around the outside of the vagina, and irritation. However, these could be symptoms of another infection too. Some women with BV have no symptoms at all. How can I find out if I have Bacterial vaginosis? There is a test to find out if you have BV. Your doctor takes a sample of fluid from your vagina and has it tested. Your doctor may also be able to see signs of BV, like a grayish-white discharge, during an examination of the vagina. How is Bacterial vaginosis treated? BV is treated with antibiotics, which are medicines prescribed by your doctor. Your doctor may give you either metronidazole or clindamycin. Generally, male sex partners of women with BV do not need to be treated. You can get BV again even after being treated. Is it safe to treat pregnant women who have Bacterial vaginosis? All pregnant women with symptoms of BV or who have had a premature delivery or low birth weight baby in the past should be tested for BV and treated if they have it. The same antibiotics that are used to treat non-pregnant women can be used safely during pregnancy. However, the amount of antibiotic a woman takes during pregnancy may be different from the amount taken if not pregnant. Can Bacterial vaginosis cause medical problems? In most cases, BV doesn't cause any problems. But some problems can happen if BV is untreated. Pregnancy problems. BV can cause premature delivery and low birth weight babies (less than five pounds). PID. Pelvic inflammatory disease or PID is an infection that can affect a woman's uterus, ovaries, and fallopian tubes, which carry eggs from the ovaries to the uterus. Having BV increases the risk of getting PID after a surgical procedure, such as a hysterectomy or an abortion. Higher risk of getting other STDs. Having BV can increase the chances of getting other STDs, such as chlamydia, gonorrhea, and HIV. Women with HIV who get BV increase the chances of passing HIV to a sexual partner. How can I prevent Bacterial vaginosis? BV is not well understood by scientists, and the best ways to prevent it are unknown. What is known is that BV is associated with having a new sex partner or having multiple sex partners. Follow these tips to lower your risk for getting BV: Don't have sex. The best way to prevent any STD is to practice abstinence, or not having vaginal, oral, or anal sex. Be faithful. Have a sexual relationship with one partner is another way to reduce your chances of getting infected. Be faithful to each other, meaning that you only have sex with each other and no one else. Use condoms. Protect yourself with a condom EVERY time you have vaginal, anal, or oral sex. Condoms should be used for any type of sex with every partner. For vaginal sex, use a latex male condom or a female polyurethane condom. For anal sex, use a latex male condom. For oral sex, use a dental dam. A dental dam is a rubbery material that can be placed over the anus or the vagina before sexual contact. Don't douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your chances of getting BV. It may also increase the chances of BV coming back after treatment. Talk with your sex partner(s) about STDs and using condoms. It's up to you to make sure you are protected. Talk frankly with your doctor or nurse and your sex partner(s) about any STDs you or your partner have or had. Talk about any discharge in the genital area. Try not to be embarrassed. Have regular pelvic exams. Talk with your doctor about how often you need them. Many tests for STDs can be done during an exam. If you are pregnant and have symptoms of BV or had a premature delivery or low birth weight baby in the past, get tested for BV. Get tested as soon as you think you may be pregnant. Finish your medicine. If you have BV, finish all the medicine that you are given to treat it. Even if the symptoms go away, you still need to finish all of the medicine. Last Updated: Sep 14, 2013","{
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