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High cholesterol (Hypercholesterolemia)

Thursday, 30 September 2010

High cholesterol level is becoming an increasing threat to many people. This is because many changes have involved our daily lifestyle that had lead to a partial sedentary life. Exercising, which is an important factor in preventing high cholesterol level, is being practiced by less individuals. All of these events had caused an increase in the incidence of hypercholesterolemia.

Hypercholesterolemia refers to a blood cholesterol measurement > 200 mg/dl. The normal total cholesterol level is 150-199 mg/dl. Cholesterol is not a harmful substance. It is only harmful when it's level is higher than normal. Cholesterol has the following functions in the human body:
1. It enters in the structure of many important body hormones as sex hormones.

2. It is important for production of bile acids, which digests fats.

3. It is an important constituent of the cell membrane of each cell.

4.  Cholesterol is a part of the myelin sheath which covers the nerves. This sheath insulates the axon, which helps transmission of nerve impulses efficiently.
Now let's talk about hypercholesterolemia.
The problem of high cholesterol lies in increased risk for arteriosclerosis and heart disease.

What causes hypercholesterolemia ?
It can be primary due to: 1.Hereditary
                                        2. Obesity
                                        3. Dietary intake
Or it can occur secondarily due to:
1. Diabetes mellitus (if poorly controlled)
2. Hypothyroidism
3. Renal impairment
4. Drugs as oral contraceptive pills and steroids

Hypercholesterolemia is asymptomatic and is only detected by a blood test.

Is there a good cholesterol and a bad one ?

Yes there is. HDL cholesterol is the good one because it removes excess cholesterol from the blood vessels and carries it to the liver where it is broken down. Thus high level of HDL reduces the risk of atherosclerosis and heart disease.
VLDL, LDL and IDL are called bad cholesterol because they can deposit on the walls of blood vessels and form a plaque which can block arteries.

What can we do to prevent high cholesterol ?
A well-balanced low-fat diet and maintenance of healthy body weight are the best ways to prevent high cholesterol. Saturated (animal) fats, including egg yolks and whole-milk dairy products, increase LDL. Monounsaturated fats—such as olive, canola, or peanut oils—and fiber can lower cholesterol levels. Besides exercising daily for 30 minutes will increase the level of HDL and lower LDL and triglycerides.

What is the treatment of hypercholesterolemia ?
Lines of management includes the change of lifestyle and diet (as explained above). Drugs used are:
1. Statins (most common)
2. Bile acid sequestering resins
3. Cholesterol absorption inhibitors
4. Fibrates
5. Niacin

Important values: 
Total cholesterol (normal): 150-199 mg/dl
Total cholesterol (borderline elevated): 200- 239 mg/dl
Total cholesterol (elevated): > 240 mg/dl

HDL (normal): > 40 mg/dl
HDL (borderline depressed): 35- 39 mg/dl
HDL (depressed): < 35 mg/dl

LDL (normal): <130 mg/dl
LDL (borderline elevated): 131- 159 mg/dl
LDL (elevated): > 160 mg/dl

Triglycerides (normal): < 160 mg/dl

Bottomline, a fasting lipoprotein profile is recommended every five years. 
I hope this article was beneficial and that it included the enough information to get the best awareness to you. 

Chemotherapy , its benefits and harms

Monday, 27 September 2010

Is chemotherapy the cure ? 
A question that is asked frequently to health professionals concerning the management of cancer. In fact, chemotherapy has its advantages and its disadvantages. And this is our topic today.

Benefits of chemotherapy:
Chemotherapy kills the primary malignant tumour. It limits the spread of cancer cells to other parts of the body. Radiation which is localized to a single site of the body, cannot kill distant malignant cells. Therefore chemotherapy prolongs the life span of the patient. Besides chemotherapy can reduce the size of the tumour so that surgery would be much easier for the surgeon and the patient. 
Chemotherapy can help relief the symptoms of an advanced cancer, as pain. This is called palliative chemotherapy.

But there are harms due to the use of chemotherapy too.

Harms of chemotherapy:
There are acute and long-term toxicity. 

Acute toxicity includes:
1. Bone marrow suppression. 
It is the most common and most serious acute toxicity. (Bone marrow is the industry that produces all blood cells: red blood cells, white blood cells and platelets). With a low white blood count, the patient is liable to infections. If fever occurs, it is considered as a medical emergency. 
With a low platelets count, the patient is liable to bleeding tendency. 
That's why it is crucial to check the blood counts frequently when undergoing a chemotherapeutic treatment.

2. Gastrointestinal toxicity:
It can occur in the form of nausea, vomiting, stomatitis and diarrhea. The management will include analgesics and maintaining an adequate hydration level.

3. Neurological toxicity:
Paclitaxel, a chemotherapeutic agent, causes sensory peripheral neuropathy

4. Skin toxicity:
Rashes, photosensitivity and hair loss can occur.

5. Genitourinary toxicity:
Renal damage can occur. Cyclophosphamide (in high doses) can cause hemorrhagic cystitis.

6. Hypersensitivity:
Among the agents used in management of breast cancer, taxanes have the highest incidence. Taxanes include paclitaxel (Taxol) and docetaxel (Taxotere). To reduce hypersensitivity, a premedication with corticosteroids, diphenhydramine and histamine antagonists are used.

Long-term toxicity includes:
1.Premature menopause:
Chemotherapy causes ovarian ablation. Therefore it leads to premature menopause.

2. Cardiomyopathy

3. Secondary malignancy:
The risk was particularly high for patients treated with melphalan ( a drug no longer used in treatment of breast cancer). 

Owing to the above numerous side effects, there must be a safer option in treatment of cancer. i believe researches will be our way to get it.
At last, i want to encourage each and every cancer patient that there is always hope and that the psychological factor plays a great role in reaching cure.

Thyroid nodule

Saturday, 25 September 2010

Today's topic will be about "Thyroid nodule". First let me give a brief introduction about the thyroid gland. 
The thyroid gland is the biggest gland in the neck. It's function is to secrete hormones responsible for regulating the body's metabolism. It is situated in the front of the neck, below the larynx. The gland consists of two lobes (right and left) connected by a tissue called "isthmus".

The thyroid problems are common including goiters, thyroiditis, hyperthyroidism, hypothyroidism and solitary thyroid nodules. 

Solitary thyroid nodule is a solid or fluid-filled nodule present in the thyroid gland. It is present in about four percent of the population of the United States. The vast majority of thyroid nodules are benign and do not require removal. A small percentage are cancerous and should be removed surgically. There are two high-risk groups for cancer: 

1. The first group of those with a family history of thyroid cancer
2. The second group consists of those who have been exposed to low-dose irradiation to the head and neck. 

Most nodules are asymptomatic but can be visible when you feel them or look at it. Some nodules can produce extra thyroid hormones which gives a picture similar to hyperthyroidism:
weight loss - palpitations - nervousness - insomnia.

There are types of thyroid nodules, which are:
1. Colloid nodule (commonest)
2. Follicular adenoma (benign)
3. Simple cyst (fluid-filled)
4. Toxic adenoma (produces more thyroid hormones --> Hyperthyroidism)
5. Thyroid cancer (malignant)

In order to know the exact type of the thyroid nodule present, an investigation called "Fine needle aspiration for cytology" is done. Other investigations include:
1. Ultrasound: differentiates between solid and cystic nodules and to detect nonpalpable nodules.
2. MRI and CT scan: unnecessary except for very large and substernal lesions.
3. Thyroid isotope scanning: indicates functional activity.

When the type of the nodule is identified, the managment can be discussed with the doctor. 
If it is a colloid nodule, then no surgery is indicated unless there is cosmetic disturbance or presence of symptoms as dyspnea.
Lobectomy is indicated for follicular adenoma and for nodules that enlarge on suppressive doses of thyroxine or cysts that enlarge after 3 aspirations or complex on ultrasound.

If you feel any thyroid nodule, get it examined by a doctor.
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