Diseases / Sexually Transmitted Infections

Sexually transmitted diseases (STDs / STIs) are infections that are transmitted from person to person through sexual contact, including oral and anal sex and sharing sex toys. These infections can be transmitted through any contact between the genitals of one person and the genitals, anus, mouth, or eyes of another person.

There are many different STDs, including some of the most common infections by herpes simplex virus type II (genital herpes), human papillomavirus, and Chlamydia by HIV (Human Immunodeficiency Virus dictates AIDS), gonorrhea, syphilis and genital warts . Some infections that can be transmitted by sexual intercourse, such as hepatitis B virus, are not traditionally regarded as STIs due to the fact that they are mainly transmitted by other means, but must also be included.

Prevention

A person can help prevent STDs:

• Not having sex

• Having sex with only one person (who is not infected and who has no other partners)

• Always using condoms during sexual activity

It is important to note that although condoms can help reduce exposure to STDs / STIs, are not infallible.

Most doctors advise people who are diagnosed with an STD to report this situation to their sexual partners. This is important, first, because some STDs are infections fairly quiet and can pass unnoticed between sexual partners. For example, infection by Chlamydia may not cause symptoms in those infected and, nevertheless, the scars arising as a consequence of infection can lead to infertility, particularly in women. Second, STDs are considered a threat to public health by the transmission cascade that can be originated. With identification and treatment, infection rates can be reduced.

If a person developing frequent outbreaks of genital ulcers due to herpes virus may take a daily low dose of an anti-viral drug to reduce the risk of developing recurrent episodes as well as the risk of transmitting the infection to partners. However, the person can still transmit the infection, so practice safe sex using condoms remain the best way to avoid a potential herpes infection.

Treatment

The treatment of the infection depends STDs:

• In case of gonorrhea and chlamydia infection, the physician will give an injection to the patient to treat the first and second oral antibiotics to treat.

• Genital herpes is an infection for life that has no cure. However, vesicular cutaneous ulcerations do not persist as long as genital herpes is treated with an oral antiviral medication as soon as symptoms appear in a crisis. If a person has frequent episodes, one must ask the physician prescribing a drug antiviral such as acyclovir, famciclovir, or valacyclovir, so that the medication has available when needed. A daily dose of an anti-viral medication can reduce the frequency of attacks by 80% in people who have severe and frequent episodes of genital herpes.

• Syphilis is usually treated with penicillin injections.

• Genital warts can be removed by freezing using Liquid Nitrogen (Cryosurgery) for CO2 Laser Surgical via application threads as a cytostatic called Podofilino, all this to be done by the doctor.

• HIV infection can not be cured, but it can now be controlled with a combination of chronic drugs (anti retroviral). In cases where there is an indication to start therapy, these drugs should be taken daily for the rest of their lives.

Annals Diseases

The anal canal is the area of ​​the digestive canal running through the pelvic muscles of the anal sphincters and with 4 to 5 cm in length in adults, being the end anus orifice through which the feces out of the body. The lower half of the anal canal has sensory nerve endings. There blood vessels under the coating and its middle portion there are numerous small anal glands. This article describes four disorders that cause anal pain and irritation:

• anal fissure - An anal fissure is a tear or fissure in the lining of the lower anal canal. Most anal fissures occur when faeces excessively bulky and hard distend the anal opening and anal tear the coating. Less often, anal fissures develop due to a prolonged diarrhea an inflammatory bowel disease or sexually transmitted disease involving the anorectal area. Anal fissures acute (short-term) are usually superficial, while chronic anal fissures (long-term) can be deeper, exposing the surface of the underlying muscle.

• Anal Abscess - An anal abscess is a painful collection of pus, followed by edema, located near the anus. Most anal abscesses are not related to other health problems arise spontaneously and, for unclear reasons, resulting in a small anal gland which increases in volume to create a loca infected under the skin. Anal abscesses occur most frequently in young adults between 20 and 40 years, being more common in males. Most anal abscesses are located near the opening of the anus but rarely occur in an area deeper or higher anal canal, near the lower portion of the colon or pelvic organs.

• Anal fistula - An anal fistula is an abnormal path, resembling a tunnel establishing a connection between the middle portion of the anal canal and the surface of the skin near the anus. The fistula is often a structure reminiscent of an old anal abscess after having been drained (either spontaneously or after being lanced by a physician), a complication that occurs in at least half of cases of anal abscesses. Sometimes the fistula opening on the skin surface constantly drain pus or bloody fluid. In other cases, the fistula opening is closed temporarily, causing the former to reappear anal abscess, forming a painful pus-filled bag.

• Hemorrhoids - Hemorrhoids are enlarged, bulging blood vessels in the anal canal, around the anus (external hemorrhoids) or inside the anus and the lower portion of the rectum (internal hemorrhoids). Hemorrhoids usually do not cause pain. However, sometimes blood vessels of a hemorrhoid small located at the edge of the anal orifice can become blocked by a blood clot ("thrombosis") which can be triggered by a period of constipation or diarrhea. When thrombosis occurs, the external hemorrhoid becomes swollen, hard and painful, sometimes with a bloody exudate.

Prevention

It is possible to reduce the risk of anal fissure by preventing constipation, making it softer stools. For this, the patient should gradually increase the amount of fiber in your diet, drink 6-8 glasses of water a day and exercise tolerance. Fiber supplements currently marketed are effective.

Although not always possible to prevent other types of anal disease, may decrease the risk of these diseases through the following measures:

• using gentle techniques to clean the anal area

• keeping the area dry, changing underwear frequently and using powder to absorb moisture

• always using a condom in the case of the practice of anal intercourse

• never entering any foreign body in the anus.

Treatment

Once performed the diagnosis, the treatment of anal diseases can involve or not to carry out an operation, depending on the specific disease. If surgery is necessary, the doctor will use an appropriate anesthesia to help prevent the pain in this very sensitive area.

• Anal fissure - In acute fissure, the doctor may recommend that the patient fulfills the measures to prevent constipation described above (in the section on Prevention) and can advise you to immerse the anal area in warm water for 10 to 15 minutes several times per day (sitz bath) and apply an ointment in anal fissure (topical anesthetics and / or ointments that reduce the spasm of the anal sphincter). In chronic fissures, surgery can correct the problem in 90% of cases.

• Anal abscess - An anal abscess should be opened or lanced by a doctor to drain the pus. This procedure (incision and drainage) can generally be performed on an outpatient basis, especially in case the person is young and healthy abscess is close to the anal orifice.

• Anal Fistula - surgery to open the fistulous track ("fistulotomy") is the most effective therapy. The doctor opens the route and scrape any remaining infected abscess anal old. The wound is left open to heal by secondary intention. If the fistula is associated with Crohn's disease, the treatment is directed to this disease, comprising the administration of anti-inflammatory drugs in combination with an antibiotic.

• Hemorrhoids - General treatment of hemorrhoids consisting of fiber supplements to decrease stool consistency, often by immersion in lukewarm water ("sitz baths") and the use of locally applied drugs. The symptomatic hemorrhoids that do not advance the implementation of these measures may require other interventions such as elastic ligation, sclerosis or surgical removal of hemorrhoids. The thrombosed external hemorrhoid usually regress spontaneously but the process could be accelerated if the physician to perform a small incision in the haemorrhoid so as to leave the clot under local anesthesia.

Pelvic Inflammatory Disease

Pelvic inflammatory disease is an infection of the uterus, fallopian tubes or ovaries and is probably the most common serious infection in young women, although its incidence and prevalence are unknown in Portugal. This disease usually affects sexually active women during childbearing years.

Pelvic inflammatory disease is a common cause of infertility able to be prevented. Infection can cause the tissue within the fallopian tube scarring form, which can damage these structures or block them completely. The more times a woman has this type of infection, the greater the risk becomes infertile. The risk doubles every episode of the disease.

The researchers believe that most cases it develops from diseases / sexually transmitted infections. The two situations are more likely to lead to pelvic inflammatory disease is gonorrhea and chlamydia. Without treatment, the bacteria that cause these diseases can ascend the genital tract and cause pelvic inflammatory disease.

Pelvic inflammatory disease usually develops in a process with two stages. At first, the microorganisms affect the cervix (the opening of the uterus). Then, in approximately 10% of women, bacteria migrate to the uterus, fallopian tubes to or at the ovaries. More rarely, pelvic inflammatory disease may develop if the bacteria reach the upper parts of the reproductive tract after childbirth, inserting an intrauterine device (IUD) or an induced abortion. All this entails some risk of infection, especially if the patient is also a disease / sexually transmitted infection (STD / STI).

Pelvic inflammatory disease is more common in women under the age of 25 who have more than one sexual partner. Women who had a disease / sexually transmitted infection have a higher risk of having pelvic inflammatory disease, as do those that have had a prior pelvic infection. Any woman whose sexual partner has more than one partner also has an increased risk of pelvic infection.

Prevention

Besides avoiding sexual intercourse, there is no sure way to prevent pelvic inflammatory disease. However, women who have sex with only one stable partner have a very small risk if any of the people have been infected with a disease / sexually transmitted infection from a previous partner. Condoms provide protection against sexually transmitted infections. Although oral contraceptives can prevent pregnancy, women with more than one sexual partner must make sure that their partners use condoms whenever they have sex vaginally.

Since most cases of pelvic inflammatory disease is associated diseases / sexually transmitted infections, the treatment of sexual partners of a woman is essential to prevent repeated infections. All recent sex partners a woman with pelvic inflammatory disease should be examined by a doctor and treated as if they had either gonorrhea or chlamydia. A woman with pelvic inflammatory disease should not go back to having sex while their sex partners have not been treated.

Treatment

The main treatment for pelvic inflammatory disease is the administration of antibiotics which, in most cases, by itself, can cure the infection. Once the pelvic inflammatory disease is often caused by more than one type of organism, can take two or more antibiotics, which may be taken orally or intravenously. If oral antibiotics are used, it is important that the patient take treatment until the end, even if symptoms disappear, given that the infection may still be present after the symptoms have subsided. In most cases, the antibiotic must be taken for 10 to 14 days.

If a woman is being treated for pelvic inflammatory disease, you should contact your doctor if after two or three days of treatment is not improving, it may be necessary to be re-examined.

Some women with severe infection need to be hospitalized to be treated with intravenous antibiotics. If the fever and the pain does not improve after a few days, it may be necessary to perform an ultrasound or computed tomography (CT) to determine if an abscess has formed. If so, the patient will probably need to undergo a surgical intervention, and treatment with antibiotics to cure the infection.

As with any significant infection, bed rest or reduced activity are important to promote recovery. The pain and discomfort can be relieved with analgesics, with hot baths and hot water bottles applied lombossagrada in the region (the lower back) and abdomen.

Fungal disease of toenails (onychomycosis)

The nail fungal disease of the feet is a situation which disfigures and sometimes destroys the nail is known as onychomycosis also.

The fungal disease toenails can be caused by several different kinds of fungi. Fungi are microscopic organisms related to mold and mildew or mold.

These fungi grow well in the environment dark, damp and poorly ventilated environment inside the shoes. As they grow, fungi feed on keratin, the protein that forms the hard surface of the toenails.

Factors that increase the risk of developing fungal toenails include:

• Use of tight shoes or tight socks

• Poor hygiene of the feet

• Use of varnish on her toenails, which does not allow the nail aired

• Being military, athlete or mining, once the toenail fungus can spread from foot to foot on the floors of showers and locker rooms.

• Having a chronic illness, such as a diabetes or HIV-AIDS.

• Having a circulatory problem that decreases blood flow to the toes However, many people with fungal infections of the toenails have no obvious risk factors.

The nails of the big toe and pinky toes (first and fifth finger, respectively) are those with a greater likelihood of developing fungi. This may partly be due to the fact that the nails of the first and fifth toe of the foot are constantly exposed to the friction of the sides of the shoes.

Prevention

To help prevent fungal infections of toenails:

• Wear comfortable shoes and socks that allow your feet to air space.

• Wear shoes, sandals or flip flops in the showers in the locker rooms or community.

• Wash your feet daily, dry them thoroughly and use a powder to the feet of good quality.

• Put on clean socks every day.

• Keep toenails trimmed.

• Disinfect pedicure tools before using them.

Treatment

This can be done as follows:

• Cut the nail with pliers nail

• Limhah it

• Dissolving the nail with a topical containing urea and an antifungal such as amorolfine or a derivative of imidazole.

If the infection is mild and limited to a small area of ​​the nail, the doctor may prescribe an anti-fungal cream or medicinal nail lacquer.

If the infection reaches a wider area of ​​the nail or several nails, your doctor may prescribe an anti-fungal medication orally. Examples include itraconazole and terbinafine. Both drugs occasionally cause unpleasant side effects. Itraconazole can produce drug interactions.

In very severe cases, when the fungus toenails are resistant to treatment, it may be necessary to surgically remove the entire nail.

Sick sinus syndrome

The sinus node disease is a generic term that encompasses three heart rhythm disorders:

• Bradycardia, frequency (or beat) slow heart

• tachycardia, rapid heart rates. The types of abnormal tachycardia include atrial fibrillation, atrial flutter / atrial tachycardia and supraventricular tachycardia

• The bradycardia-tachycardia, alternating slow and fast heart rhythms

These arrhythmias (or dysrhythmias) are caused by changes in an area called the sinus node of the heart. This group of specialized cells in the upper right chamber of the heart (right atrium) monitors the heart's rhythm, creating electrical pulses which are conducted to the rest of the heart, so that this contract, pumping blood. In a person with sinus node disease, there is a change in the functioning of this structure, so these signals will not be issued with a stable frequency.

The sick sinus syndrome is a relatively rare problem. It is difficult to tell the number of people who suffer from this problem since this can often be asymptomatic. Thus, many people can suffer from this problem without knowing it. One study estimates that the sick sinus syndrome occurs in about one in 600 people with cardiovascular disease over the age of 65 and is even less common in younger people. The average age of patients with sick sinus syndrome is about 68 years. These three arrhythmias that are covered by the term sick sinus syndrome, bradycardia is the most common.

The causes of this disease are not fully understood, although it is known that diseases that cause heart lesions, with subsequent degeneration or scarring can cause sick sinus syndrome, including:

• Degenerative disease idiopathic (changes in heart area surrounding the sinus node and that occur with aging)

• Cardiovascular Disease

• Heart attack

• Hypertension

• Structural defects of the heart.

Some drugs may also cause changes in heart rate, many prescribed for the treatment of cardiac problems such as:

• digitalis (also known as digoxin)

• Calcium channel blockers

• beta-blockers

• antiarrhythmic drugs.

Prevention

In many cases it is not possible to prevent the sick sinus syndrome. However, the prevention of diseases that lead to sick sinus syndrome (see above) may lead to a better overall cardiovascular health and will probably decrease the likelihood of developing sick sinus syndrome. A proper diet, engaging in physical exercise, maintaining a healthy weight and smoking cessation can prevent many heart problems. Medicines may also be necessary for the prevention of heart disease.

Treatment

If a person has no symptoms, it may not be necessary to institute treatment. If the patient is taking a medication that may be causing the problem, your doctor will probably advise the suspension of this drug.

People who are diagnosed symptomatic sinus bradycardia usually require the implantation of a pacemaker permanent. This small device is placed under the skin of the chest during a minor surgical procedure. Pacemakers generate electrical impulses to cause the heart to beat at a normal pace.

People with sinus node disease and rapid heart rates often can not tolerate the usual medicines to reduce heart rate. There is a risk that these medications can cause the heart ceases to beat. These people also require permanent pacemakers.

If the patient requires medication to control sinus node disease, the type of medication prescribed depends on the specific problem of the heart rhythm the patient presents. Medications that may be prescribed include:

• anticoagulant medications - such as warfarin (Varfine) - that help prevent blood clot

• medications that decrease the heart rate and prevent tachycardias, such as a beta-blocker, or a blocker of calcium channels.

Tay-Sachs

Tay-Sachs disease is a hereditary disease caused by a gene mutation. People with this defective gene does not have an enzyme (i.e., a "throttle" of a chemical reaction in the body) important designated by hexosaminidase A (HEXA), which allows combat the formation of a type of fat called GM2 ganglioside. As a result, it accumulates in the brain, eventually damaging nerve cells and cause neurological disorders.

Children with Tay-Sachs disease usually manifests the earliest signs of disease between 3 and 6 months of age. These children may be deaf, blind and with cerebral, ending in most cases die around the age of five.

Tay-Sachs disease is an autosomal recessive inherited disease, meaning that the newborn inherited from each of his parents copy of the defective gene. The child's parents do not actually suffer from the disease but are carriers of the gene for Tay-Sachs and transmit it to the baby. If both parents are carriers of the mutated gene, there is one chance in four of his son inherit this gene from both and will develop Tay-Sachs.

Tay-Sachs disease has a higher incidence in Ashkenazi Jews, and about one in 30 individuals in this ethnic group has the gene. Some non-Jewish ethnic groups also have a higher probability of being carriers of the disease, including groups of French-Canadian descent, mangrove inhabitants of Louisiana, or belonging to the Amish communities of Pennsylvania.

In addition to the classical form of the disease cited above, which usually leads to death in children, there are two types which are usually included in the definition of Tay-Sachs since they affect the same gene:

• a juvenile form of the disease which is manifested normally between two and five years old and whose symptoms are similar to those of Tay-Sachs classical, with the patient's death occurs between 15 and 20 years. If symptoms arise after the fifth year of life may be more mild.

• An adult form, very rare, called Tay-Sachs late, which resembles the chronic form of the disease but that comes later in life, between adolescence and "thirties".

Tay-Sachs disease may also be called Type 1 GM2 gangliosidosis.

Prevention

The advice from a geneticist before attempting a pregnancy help both parents understand the chances that they will generate a child suffering from Tay-Sachs. If both prospective parents are carriers of the gene and if a woman is pregnant, an amniocentesis or chorionic villus biopsy can determine whether the fetus has the disease or not.

Treatment

There is no effective treatment for Tay-Sachs. As with other fatal diseases, treatment aims to relieve symptoms and provide comfort to the child and family.

Disease Gastro-Esophageal Reflux

Gastroesophageal reflux disease (GERD) is a disorder of the digestive tract involving the esophagus, the tube that carries food from the mouth to the stomach.

In GERD, acid and digestive enzymes of the stomach flow back into the esophagus, which is the retrograde flow of gastric juice referred to as "reflux". Inflamed gastric juices coat the esophagus causing heartburn and other symptoms. If GERD is not treated can permanently damage the esophagus.

A muscular ring called the "lower esophageal sphincter" separates the stomach and esophagus normally only opens when swallowed, allowing the entry of food into the stomach. During the rest time, the sphincter remains contracted to prevent food and stomach acid into the esophagus retreat.

In most people with GERD, the lower esophageal sphincter does not close tightly and remains relaxed between swallows, allowing the digestive juices from the esophagus and irritates the lining of the organ.

There are many factors that can weaken or relax the lower esophageal sphincter, including:

• Tobacco

• Alcohol

• Pregnancy

• obesity (by increasing the pressure inside the abdomen)

• Certain foods

• Many medications

• Hiatus hernia (sliding part of the stomach to the region above the diaphragm, the muscle that separates the chest from the abdomen)

Prolonged exposure to acid can cause the esophagus:

• to become inflamed

• decrease in size (be narrowed)

• develop an ulcer.

This acid exposure can lead to long-term disease called "Barrett's esophagus", which increases the risk of esophageal cancer.

Prevention

There are several measures that can be taken to prevent the symptoms of GERD. Some simple changes in lifestyle include:

• Elevation of the head of the bed at least 7.5 cm, if possible, be placed wooden blocks under the legs of the bed on the side of the head or use a foam wedge under the mattress of the compact's bedside, using simple additional pads may not provide relief

• Avoid foods that cause sphincter relaxation during digestion, including:

coffee

Chocolate

the fatty foods

fat milk

the mint or peppermint (Mentha piperita and Mentha spicata)

• Limit your intake of acidic foods that aggravate the irritation when regurgitated, including citrus and tomatoes

• Avoid carbonated beverages because the belching gas force the opening of the esophageal sphincter and promote reflux

• Eat smaller meals and more frequently

• Do not go to bed immediately after eating. Should not eat for three to four hours before bedtime

• If you smoke, stop doing

• Avoid drinking alcohol as this causes relaxation of the lower esophageal sphincter

• Lose weight if you are overweight, and obesity can hinder the maintenance of the esophageal sphincter closed

• Avoid wearing tight clothing; increased pressure in the abdomen can open the lower esophageal sphincter

• Using pills or chewing gum to produce saliva

People with GERD for more than five years should be tested to identify the presence of Barrett's esophagus. If this situation is encountered, it is advisable to carry out endoscopies at regular intervals, so that any cancerous changes may be identified and treated when the cancer is in its early stages.

Treatment

The treatment for most people with GERD includes lifestyle changes described in the previous section, as well as drug if necessary. If symptoms persist, surgical or endoscopic provide additional options.

Medicines

There are many drugs that can be used to treat GERD, including:

• proton pump inhibitors - The proton pump inhibitors disrupt the production of acid by the stomach and are very effective in relieving symptoms. These drugs block the production of acid more powerful than the H2 blockers, but take longer to start its effect.

• H2 blockers - These drugs, which include famotidine, cimetidine and ranitidine, cause stomach produces less acid. The dose of medicine to be taken depends on the severity of symptoms.

• Protective mucosal - These drugs coat, protect and soothe irritated esophageal lining, sucralfate is an example.

• Antacids free sale - These substances neutralize the acid buffer. The liquid forms of these drugs act most quickly, but the tablets are more comfortable. Antacids that contain magnesium can cause diarrhea and those that contain aluminum can cause constipation. The doctor may advise the patient to switch antacids to avoid these problems. These drugs results in symptomatic relief for short periods and do not heal inflammation of the esophagus.

• Medications that increase the motility - These medicines may help lower esophageal reflux, since they help to empty the stomach more rapidly and, therefore, reduce the time during which may occur reflux. However, they are not very effective by itself and are generally used in combination with other classes of drugs.

Surgery

Surgery is an option for people with GERD symptoms severe and difficult to control and may also be considered for people who have complications, such as asthma or pneumonia, or scar tissue in the esophagus. Some people do not want to take drugs for long periods can also opt for surgery.

The anti-reflux surgery can be performed using instruments guided by a camera (laparoscopic surgery), which requires smaller incisions than conventional surgery.

In a procedure called Nissen fundoplication, excess stomach tissue is wrapped around the esophagus and then sutured in position so as to increase pressure around the lower esophageal sphincter weakened. It appears to relieve symptoms almost as effective as gastric acid-blocking medicines subject to prescription. The success rates of surgery may be lower in people whose symptoms are not relieved by antacids. After surgery, some people experience unpleasant side effects and prolonged (such as difficulty swallowing, diarrhea and inability to burp - "burp" - or vomit to relieve bloating or nausea), but most people are very satisfied with the results .

Endoscopic treatments

Three new treatments have been developed to strengthen the lower esophageal sphincter using an endoscope:

• suturing (plication)

• heating (Stretta procedure)

• injection sphincter with a material that promotes an increase in volume (procedure Enteryx)

As these treatments have been developed recently, their success rates in the long term are still unknown and little is known about their potential complications.

Parkinson's disease

Parkinson's disease is a disease of the central nervous system disorder that causes the body movements, including:

• tremors

• Muscle stiffness (increase in muscle contraction)

• slow body movements

• unstable posture

• difficulty in walking

Parkinson's disease develops when certain nerve cells (neurons) die brain. These neurons produce a chemical known as dopamine helps to transmit messages between areas of the brain that control movement of the body. When these dying neurons are produced abnormally low levels of dopamine, which complicates the control of muscle tension and movement.

Parkinson's disease can manifest itself from the age of 40, being more frequent after 60 years. A small number of patients have Parkinson's disease with early onset, which is characterized by onset of symptoms before age 40. This disease can affect more than 12,000 patients in Portugal and is more frequent in males.

Having a close relative who has been diagnosed with Parkinson's disease at an early age increases the risk of suffering from this disease. The risk is less if the family is affected older at diagnosis.

Prevention

There is still much to discover about the cause of Parkinson's disease and there is no known way to prevent this disease.

Treatment

There is no cure for Parkinson's disease but its symptoms can be treated with various types of drugs.

When the forms are not very disturbing medication may not be required. Early treatment can increase the likelihood of side effects and other late complications of medication but on the other hand, it is known that some patients treated early outperform later.

Treatment usually starts when:

• manifestations interfere with work, carrying out household chores and other activities

• difficulty in walking and loss of balance are significant.

Medicines

The medications used to treat Parkinson's disease:

• increase levels of dopamine in the brain

or

• mimic the effects of dopamine.

The most effective drug for Parkinson's disease is levodopa, which is converted to dopamine in the brain. In general, levodopa is prescribed in combination with another drug that increases the amount of levodopa reaches the brain and which decreases the side effects of levodopa: carbidopa or benzerazida. There are combinations of levodopa + carbidopa and levodopa + benserazide in a single tablet.

Virtually all individuals with Parkinson's disease improve after they started taking levodopa. However, long term use may eventually have side effects and complications, particularly loose effectiveness and cause involuntary movements that can be debilitating and painful (dyskinesias). Often, doctors need to adjust the frequency and dose of levodopa for the patient to continue taking this medicine.

Different drugs may be used alone or in combination with levodopa to treat the symptoms of the disease.

For minor manifestations of Parkinson's disease, amantadine may be useful by blocking glutamate receptors, which is a neurotransmitter that can contribute to motor dysfunction that occurs in this disease.

Anticholinergic medicines (tri-hexifenidilo and biperiden) also help relieve mild manifestations of Parkinson's disease at an early stage. The anticholinergic drugs are particularly effective against tremor but may cause side effects, including confusion and hallucinations, particularly in elderly patients.

Another option for treating Parkinson's disease at an early stage is a monoamine oxidase B (MAO-B) such as selegiline and rasagiline. The MAO-B inhibitors potentiate the efficacy of the dopamine that is still produced by the brain and may delay the need to administer more potent drugs. Finally, people being treated with an inhibitor of MAO-B will eventually need a drug containing levodopa.

The drugs called protease inhibitors of catechol-O-methyltransferase (COMT) inhibitor may be used in combination with levodopa. The COMT inhibitors such as entacapone, prolong the action of dopamine in the brain and also increase the effectiveness of levodopa. When it is assigned a COMT inhibitor, the physician generally reduces levodopa.

Dopamine agonists stimulate dopamine receptors, increasing its ability to capture this neurotransmitter. Some of the commonly prescribed dopamine agonists are bromocriptine, ropinirole, piribedil the, pramipexole and dihydroergocryptine? may be used alone to delay or need to administer levodopa may be administered concomitantly with levodopa to improve their efficiency and reduce their dose. Elderly patients are particularly sensitive to these drugs, which can cause confusion, hallucinations and weakness due to a decrease in blood pressure.

Depression is a common problem in Parkinson's disease, many patients may benefit from treatment with antidepressant drugs.

Regular exercise and a balanced diet can help improve the overall feeling of well-being and control the patient's body.

Surgery

Surgery is considered when patients fail to respond well to medications. Surgical options include:

• Deep brain stimulation, electrodes are placed (a kind of pacemaker) in the basal ganglia of the brain (which is the origin of Parkinson's Disease). It is possible to activate the system according to the manifestations of the patient. If surgery does not work and does not improve the complaints, it is possible to remove the electrodes.

• destruction needs certain area of ​​the basal ganglia of the brain: the nucleus pallidus (pallidotomy) or the thalamus (thalamotomy). Allows generally reduce motor dysfunction.

Paget's Disease

The bones in our body are continually being reabsorbed and form up again through a natural process called bone remodeling closely balanced. This bone remodeling also occurs in response to stress or injury experienced by the bone. For example, the exercise load leads to an increase in bone formation.

In Paget's disease, bone resorption is greater than usual and the formation of new bone is also higher than normal.

These changes in the bone can lead to an increase of the volume and the appearance of deformities. The new bone growing tends to be softer and more fragile than normal bone and can develop a disorganized pattern. Due to this, the bone may fracture. The long bones, especially of the lower limbs tend to curl up and the skull may enlarge, particularly at the level of the frontal region.

Paget's disease is the second most common bone disease in people over 50 years, then to osteoporosis is rarely diagnosed in young adults.

Although the cause is unknown, genetics may play a role, because, sometimes, there is a familial tendency. Research suggests that a virus slow growth may trigger the disease, some cells with the people bone Paget's disease appear to be infected by a virus. However, so far not identified any viruses.

This disease is rare in certain parts of the world, such as Japan, being more common in the United States and Australia. In about 20% of patients with Paget's disease, only one area of ​​the body? the spine, pelvis, thighs, legs and skull? is affected. The remaining patients have involvement of multiple areas. In serious cases, complications may include deafness, congestive heart failure (caused by excessive blood flow at diseased bone), a rise in blood calcium and bone cancer.

Prevention

There is no way to prevent Paget's disease.

Treatment

The treatment is usually reserved for people with symptoms. In some cases, the physician may recommend treatment even if the patient does not have symptoms X-ray and blood tests to detect location or extensive disease risk (for example, near a joint).

Medications such as aspirin, mild analgesics and anti-inflammatory medications can help treat the pain and inflammation. In advanced cases, the doctor may recommend medications such as alendronate, risedronate, pamidronate or zoledronate to reduce the activity of the cells that remodel bone.

Surgery to correct the deformity is rarely necessary. If Paget's disease cause significant injuries in a hip joint, can weigh up to hold a surgery for placement of prosthetic joint (arthroplasty). The hearing aids can be useful if Paget's disease affects the bones inside the ear.

A person with Paget's disease should be carefully monitored with regard to complications such as heart failure or an elevation in serum calcium and, if necessary, these situations must be handled.

Huntington's disease

Huntington's disease is a relatively rare neurodegenerative condition in which change occurs in the normal functioning of the brain cells, leading to mental deterioration, altered behavior and loss of control over the major muscle movements. It is called Huntington's chorea because its most important feature is chorea, or involuntary body movements, rapid and unpredictable, that may affect the face, limbs and torso.

Huntington's disease is a hereditary (genetic) that each child of an individual with the disease has a 50% chance of inheriting. It affects people of all ethnic groups and affects both sexes equally.

Prevention

There is no way to prevent this disease when a person inherits the genetic abnormality.

If a person has a family history of Huntington's disease, can perform a genetic test that will determine whether you have the disease gene and, consequently, whether the risk of transmitting to their children.

Treatment

There is currently no treatment that allows Huntington's disease cure or slow the progression.

Some therapies can lessen the severity of clinical manifestations, including speech therapy and physiotherapy.

Some medications can help control mood and involuntary movements. These include the use of neuroleptics and tetrabenazine for severe cases of chorea and antidepressants, neuroleptics and anti-epileptic drugs for psychiatric manifestations.

Besides pharmacological treatment, it is essential to the support of a multidisciplinary team of health professionals, including psychological and genetic counseling.

Graves' disease

Graves' disease is a disease of the immune system that causes overactive thyroid gland becomes. It is an autoimmune disease, which means that the immune system attacks the body's own cells rather than protect them against foreign invaders. In Graves' disease, the immune system produces chemicals, called immunoglobulins that stimulate the thyroid gland to produce excessive amounts of thyroid hormone. This state of overactive thyroid gland is referred to as hyperthyroidism.

Doctors do not yet know what causes Graves' disease, but the fact that it tends to affect multiple people from the same family indicates that this may have a genetic component (hereditary). It is possible that abnormal production of immunoglobulins are triggered by an unknown factor in the environment and the immune system is unable to interrupt this overproduction due to a hereditary defect.

Graves' disease affects more women than men and is most common between 20 and 40 years, although it can occur at any age.

Prevention

There is no way to prevent Graves' disease.

Treatment

Treatment focuses on two objectives: to improve quickly the signs / symptoms of hyperthyroidism and slow the production of thyroid hormone by the gland.

The symptoms of palpitations, increased heart rate, tremor and nervousness are treated with a drug beta-blocker, such as propranolol. For anxiety and for insomnia, your doctor may prescribe diazepam, lorazepam or similar medication.

To prevent excessive quantities of thyroid hormone, there are three possible treatments: The anti-thyroid antibodies, radioactive iodine and surgery.

Graves' disease is often treated with anti-thyroid drug, methimazole which blocks the formation of thyroid hormones. It is also available another anti-thyroid, called propylthiouracil, but this drug should only be used in patients who can not tolerate methimazole or in women just before and during the first trimester of pregnancy. From the moment in which the thyroid hormone levels reached normal values, the patient may decide, together with their doctor if the medication should continue daily anti-thyroid or will choose a treatment with radioactive iodine.

Radioactive iodine is a treatment administered orally at a dose large enough, totally preventing the thyroid gland to produce the hormone. Once the person receiving therapy with radioactive iodine store a small amount of radiation in the thyroid gland, they should avoid prolonged contact with children and pregnant women for several days after treatment. Radioactive iodine is concentrated in breast milk, so women should stop breastfeeding if they choose this therapy. After performing this treatment is that the patient must take thyroid hormone medication daily for the rest of his life.

Surgery for Graves disease is rarely performed. However, people with very bulky goiter are less likely to respond well to anti-thyroid drugs or radioactive iodine, and may provide better results if most of the thyroid gland is surgically removed (called subtotal thyroidectomy).

Patients with eye signs of Graves' disease can be treated with ophthalmic eye drops to keep the eyes moist and sunglasses to protect your eyes from sun, wind and dust. In people with severe ocular symptoms, medications may be needed corticosteroids, administered either alone or in combination with radiotherapy treatments directed to the muscles that control eye movements. Skin manifestations of Graves' disease can be treated with corticosteroid creams and ointments.

Gaucher's disease

Gaucher disease is a disease inherited (genetic) that can damage many different parts of the body. The damage occurs when a type of fat? the glucocerebroside? accumulates in certain organs. Normally, we have an enzyme? glucocerebrosidase? eliminating this harmful fat, but people with Gaucher disease do not produce enough of this enzyme. Gaucher disease usually causes a volume increase of the liver and spleen (splenomegaly and hepatomegaly, respectively), a low red blood cell count (anemia) and platelets (thrombocytopenia), lung disease, bone disease and sometimes disease brain.

There are three basic types of Gaucher disease. The type 1 causes virtually all of the symptoms listed above with the exception of brain disease. The type 2 and 3 cause all symptoms reported, including the effects on the brain. The disease type 2 is the most serious, with symptoms that start before the age of two. In type 3 Gaucher disease, symptoms may begin before age two, but they are lighter and worsen slowly. In type 1 disease, symptoms usually appear in adulthood.

Gaucher disease is rare, affecting about one person in 100,000. In certain ethnic groups such as Ashkenazi Jews, Gaucher disease type 1 may affect up to one in every 1,000 people. About 90% of patients with Gaucher disease have type 1, which means that this is the most common form.

The three types of Gaucher disease is caused by an alteration or mutation in a gene called ABM, which is responsible for the production of the enzyme glucocerebrosidase. Gaucher disease is an autosomal recessive genetic disorder, meaning that people with the disease inherit two mutations of the gene, one from the mother and one from the father. If no GBA gene normal person can not produce sufficient amounts of glucocerebrosidase to prevent the accumulation of abnormal fat. In cases where the person has only one mutation (inherited from the father or the mother, the other copy of the normal gene) did not develop disease and is called "bearer".

If both parents are carriers of a mutation causing Gaucher disease, each of their children has a 25% probability (ie, 1 in 4) of inheriting the disease. Generally, parents do not know they are carriers of the gene. In some ethnic groups? as Ashkenazi Jews? people are often tested before having children to determine if they are carriers.

Prevention

Gaucher disease occurs when a baby inherit two copies of the gene with the mutation causing this disease, one from each parent. Each country typically has one copy of the mutated gene and thus does not have Gaucher disease. If both parents know they are carriers of a mutation, having been identified genetic change because they belong to an ethnic group in which the disease is frequent or are parents of a child with Gaucher disease, it is possible to detect the disease earlier in the offspring. Genetic testing may be done on the fetus during pregnancy, or in an embryo prior to being deployed. In the latter case, it is necessary to use assisted reproductive techniques. All couples wishing to undergo genetic testing to determine if they are carriers of a genetic mutation causing Gaucher disease should be sent to a query Genetic Counseling.

The care a person with Gaucher disease are the prevention of disease complications.

Treatment

Gaucher disease is caused by low levels of the enzyme glucocerebrosidase, so that the best treatment for preventing the accumulation of glucocerebroside is the enzyme replacement therapy with synthetic enzyme called imiglucerase. The synthetic enzyme is administered intravenously, the intravenous infusion with regular imiglucerase shown to be safe and effective with regard to reversal of low blood cell counts and the increase of liver and spleen. Approximately 10 to 15% of people develop antibodies to enzyme replacement although in most cases remain asymptomatic.

It is available as a new treatment for people who fail to respond to enzyme replacement therapy. This drug, which prevents the formation of glucocerebroside is administered orally (i.e., swallowed) and helps reduce the swelling of the liver and spleen, strengthens the bone and can also improve other symptoms.

People with Gaucher disease type 1 and type 3 live longer than people with type 2 disease. Over time, people with type 1 and 3 may become resistant to the effect of drugs, in which case it can be recommended in bone marrow transplantation.

Other treatments may help relieve the symptoms of Gaucher disease, but will not act on the cause. For example, surgery to remove the spleen (splenectomy) is useful in some patients, once an enlarged spleen may destroy the platelets. Blood transfusions can treat severe anemia and bone pain can be treated with painkillers. Sometimes you need a joint replacement surgery. Medicines that can help increase bone density, the most frequently used are the bisphosphonates, such as alendronate, ibandronate and risedronate.

Crohn's

Crohn's disease is a disease in which inflammation damages the intestines (inflammatory bowel disease). This disease typically begins between 15 and 30 years old.

Nobody knows for sure what triggers the initial intestinal inflammation of Crohn's disease. It is believed that the disease process might start with a bacterial or viral infection which activates the immune system in a persistent manner, causing inflammation even after the infection has been eliminated.

Certain genes that pass from parents to children can increase the risk of a person developing a Crohn's disease in the presence of the factor triggering appropriate.

Once started, Crohn's disease may cause symptoms for life, evolving through periods of exacerbation and remission. The mucosa or lining and deeper layers of the intestinal wall become inflamed with irritation and increased thickness erosion in some areas. This process leads to the emergence of ulcers, fissures and cracks, and inflammation may also lead to the appearance of abscesses (pus bags) or stenosis (narrowing intestinal areas).

Fistulas, which are a common complication of Crohn's disease are abnormal connections between organs of the digestive system, usually between two parts of the intestine. Fistulas may arise after the inflammation has become very sharp and penetrating deep, reaching to the wall of adjacent organs.

The terminal region of the small intestine, called the ileum, is particularly prone to be damaged by Crohn's disease. The ileum is located in the right lower quadrant of the abdomen. However, ulcers and inflammation can occur in all areas of the digestive tract, from the mouth to the anus.

Some other areas of the body such as eyes and joints may also be affected by Crohn's disease.

Prevention

There is no way to prevent Crohn's disease.

Nevertheless, the patient can prevent the disease causes substantial damage to his body. Maintain a nutritious and balanced diet for storing vitamins and nutrients between episodes or exacerbations. Thus, they can be reduced to malnutrition associated complications, such as loss of weight and anemia.

The patient should also quit smoking.

When in the context of Crohn's disease inflamed area is the large intestine may be increased risk of colon cancer and the patient should be regularly monitored in order to identify the presence of abnormal precancerous or cancerous. If Crohn's disease has affected the entire colon eight years or longer (or, where more localized disease, twelve to fifteen years or more), the patient should start to perform colonoscopy regular intervals of one to two years.

Treatment

The drugs, most of which acts to reduce intestinal inflammation are very effective in improving the symptoms of Crohn's disease.

One group of anti-inflammatory aminosalicylates is usually experienced called first. Aminosalicylates are chemically related to aspirin and suppress inflammation in the gut and joints. These drugs are administered in the form of tablets (oral) or enemas (rectal).

Certain antibiotics help to kill bacteria irritated areas of the colon and may also decrease inflammation.

Antidiarrheal medications such as loperamide, may be useful if the patient has diarrhea but not infection.

Other anti-inflammatory drugs more potent as corticosteroids may be useful, but can also depress the immune system, increasing the risk of infections. For this reason, these drugs are frequently not used in the long term.

The drugs most recently approved for the treatment of Crohn's disease are inhibitors of tumor necrosis factor (TNF) such as infliximab and adalimumab. These drugs block the effect of TNF, a substance produced by cells of the immune system that causes inflammation. The TNF inhibitors can have potentially serious side effects so that, in general, these drugs are prescribed only for the condition of moderate to severe Crohn which is not responding to other treatments.

Surgery to remove a segment of intestine is another possible treatment. In general, surgery is only recommended if there is:

• Obstruction of the bowel

• Symptomatology persistent despite medical therapy

• A fistula that does not heal.