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Medicine is to heal from the inside

Understanding Fibromyalgia

Introduction
Fibromyalgia syndrome (FMS), a well known disease of human population, that cause the chronic widespread pain. The prevalence of fibromyalgia only surpassed by osteoarthritis as the most common diagnosis among patients seen in rheumatology offices. This problems often found in women than men, about 4 times more frequently.

Recently, there is less known about fibomyalgia, some say it as "unexplained clinical conditions" or "functional somatic syndromes" that are characterized more by symptoms, suffering, and disability than by consistent tissue abnormality. Therefore, there have been suggestions that fibromyalgia may represent a form of somatization disorder.


Fibromyalgia patients usually comes to clinics with a number of symptoms beyond pain. Fatigue is cited as a significant cause of morbidity for the vast majority of the patients. Subjective sleep disturbances, particularly in the form of non restorative sleep, are reported to occur in over three-quarters of patients. A majority of patients complain of difficulties with concentration and memory, a situation that has been termed "fibro fog." Approximately 20-40% of fibromyalgia patients also have an identifiable current mood disorder such as depression or anxiety disorder at the time of diagnosis, with a lifetime incidence as high as 70%.
Fibromyalgia Tender Points

When The Symptoms Occurs
Fibromyalgia usually causes symptoms that begin between ages 25 and 45, but children can also have fibromyalgia. In fact, physicians have identified fibromyalgia developing in toddlers, and some researchers believe that the first trigger points of myofascial pain syndrome, a disorder commonly coexisting with fibromyalgia, may cause severe colic symptoms in some infants.


In addition, a traumatic physical injury, such as an automobile accident, or an extremely traumatic emotional event, has been known to cause the onset of fibromyalgia. However, the vast majority of fibromyalgia patients, around 80%, are unable to identify a trigger event that initiated the first obvious “flare” of the syndrome. In addition, there may be a genetic tendency in some individuals to develop the syndrome; fibromyalgia tends to run in families.

Beyond Fibromyalgia Pain
Fibromyalgia patients display quantitative abnormalities in pain perception, in the form of both allodynia-perceiving pain even from a non-painful stimulus, such as light touch-and hyperalgesia-an augmentation of pain processing in which a painful stimulus is magnified and perceived with higher intensity than it would be by a normal volunteer.

In theory, such a state can conceptually result from widespread changes within the target organs (i.e., skin, muscles, etc.), from alterations in pain processing within the central nervous system, or some combination of both processes. Another explanation about fibromyalgia that Fibromyalgia pain was a result of peripheral abnormalities, particularly alterations in skeletal muscle. However, more recent studies have generally failed to confirm the presence of such alterations, though it is recognized that peripheral insults may play a role in instigating or maintaining fibromyalgia. On the other hand, supporting evidences posited the role of altered central pain processing (ie, "central sensitization") as underlying the pain of fibromyalgia.

How is Fibromyalgia Diagnose
Doctors diagnose fibromyalgia based on a patient's symptoms and physical exam. Patients experience pain and stiffness in the muscles, but there are no measurable findings on X-rays or lab tests. While fibromyalgia does not damage the joints or organs, the constant aches and fatigue can have a significant impact on daily life.

One of the unique aspects of fibromyalgia is the presence of tender points in specific locations on the body. When these points are pressed, people with fibromyalgia feel pain, while people without the condition only feel pressure.

Management of Fibromyalgia
The goal of fibromyalgia treatment is to minimize pain, sleep disturbances, and mood disorders. Doctors may recommend medications that help ease your symptoms -- ranging from familiar over-the-counter pain relievers to prescription drugs.
Exercise for Fibromyalgia

Besides drugs, an exercise can relieve several fibromyalgia symptoms. Physical activity can reduce pain and improve fitness. Exercising just three times a week has also been shown to relieve fatigue and depression. Walking, stretching, and water aerobics are good forms of exercise to start with for people with fibromyalgia.

Acupunture - Formal studies have produced mixed results on the use of acupuncture for fibromyalgia, but some patients say it eases their symptoms. This traditional Chinese practice involves inserting thin needles at key points on the body. Acupressure stimulates the same pressure points and may be a good alternative for people who want to avoid needles.

Many people with fibromyalgia have trouble concentrating, a phenomenon known as fibro fog. Treatment for pain and insomnia may help patients, there are other steps you can take to improve concentration. Write notes about things you need to remember, keep your mind active by reading or doing puzzles, and break tasks up into small, manageable steps.
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Understanding Diabetic Retinopathy

Introduction
Diabetic retinopathy is a disease that affect retina that occurs in patients with long-standing diabetes mellitus, and develops to some degree from mild to severe.

Burden of Disease
According to recent statistics, about 19 million Americans aged 20 years or older have either diagnosed or undiagnosed diabetes mellitus; about one-third are not aware that they have the disease. An additional 26% of adults (54 million persons) have impaired fasting blood glucose levels. In the United States, an estimated three out of five people with diabetes have one or more of the complications associated with the disease.

With the increasing population with diabetes, surely will increase the health complications related to diabetes. One of them is diabetic retinopathy.
Recently, Diabetic retinopathy is a leading cause of new cases of legal blindness among working-age in developed nations. The prevalence rate for retinopathy for adults aged 40 years and older in the United States is 3.4% (4.1 million persons); the prevalence rate for vision-threatening retinopathy is 0.75% (899,000 persons). Assuming a similar prevalence of diabetes mellitus, the projected numbers in 2020 would be 6 million persons with diabetic retinopathy and 1.34 million persons with vision-threatening diabetic retinopathy.

Risk Factors
The important risk factor of having diabetic retinopathy is having a diabetes, whether it types I or II, it doesn't matter. Since this disease only occurs in person who has diabetes.

Another risk factor is Duration of diabetes, this factor is highly associated with the development of diabetic retinopathy. After 5 years, approximately 25% of type 1 patients have retinopathy. After 10 years, almost 60% have retinopathy, and after 15 years, 80% have retinopathy. And for type 2 patients who have a known duration of diabetes of less than 5 years, 40% of those patients taking insulin and 24% of those not taking insulin have retinopathy. These rates increase to 84% and 53%, respectively, when the duration of diabetes has been documented for up to 19 years. Proliferative diabetic retinopathy develops in 2% of type 2 patients who have diabetes for less than 5 years and in 25% of patients who have diabetes for 25 years or more. These percentages are based on data from the 1980s before there was closer monitoring and tighter glycemic control, and they may have improved.
Well, in conclusion we can say that the longer a person has diabetes the higher risk for diabetic retinopathy.

The severity of hyperglycemia is the key alterable risk factor associated with the development of diabetic retinopathy. There is general agreement that duration of diabetes and severity of hyperglycemia are the major risk factors for developing retinopathy.

Anyway, once retinopathy is present, duration of diabetes appears to be a less important factor than hyperglycemia for progression from earlier to later stages of retinopathy.

Others risk factors such as Intensive management of hypertension has been demonstrated to slow retinopathy progression, and elevated serum lipid levels are associated with the development of retinopathy.

There is less agreement among studies concerning the importance of other factors such as age, type of diabetes, clotting factors, renal disease, physical inactivity, and use of angiotensin-converting enzyme inhibitors. Many of these factors are associated with the substantial cardiovascular morbidity and mortality and other complications associated with diabetes. Thus, it is reasonable to encourage patients with diabetes to be as compliant as possible with therapy of all medical aspects of their disease.

Disease Progression
The progression of Diabetic retinopathy can be predicted in an orderly fashion from minimal changes to more severe stages if there is no intervention. It is important to recognize the stages in which treatment may be beneficial. Several decades of clinical research have provided excellent data on the natural course of the disease and on treatment strategies that are 90% effective in preventing the occurrence of severe vision loss.
Diabetic Retinopathy

The earliest clinically apparent stages is called nonproliferative diabetic retinopathy (NPDR) and is characterized by retinal vascular abnormalities including microaneurysms, intraretinal hemorrhages, and cotton-wool spots. Increased retinal vascular permeability that occurs at this or later stages of retinopathy may result in retinal thickening (edema) and lipid deposits (hard exudates). Clinically significant macular edema (CSME) is a term commonly used to describe retinal thickening and/or adjacent hard exudates that either involve the center of the macula or threaten to spread into it. Patients with macular edema, will experience a blurred vision, color disturbances, distorted images, etc. since macula is the center of vision. These patients should be considered for focal laser photocoagulation, particularly if the center of the macula is already involved or if retinal thickening/adjacent hard exudates are very close to it.

As diabetic retinopathy progresses, there is a gradual closure of retinal vessels, which results in impaired perfusion and retinal ischemia. Signs of increasing ischemia include venous abnormalities (e.g., beading, loops), microaneurysms, and more severe and extensive vascular leakage characterized by increasing retinal hemorrhages and exudation. When these signs progress beyond certain defined thresholds, severe NPDR is diagnosed. Patients with this degree of retinopathy should be considered for possible treatment with panretinal (scatter) laser photocoagulation.

The more advanced stage, proliferative diabetic retinopathy (PDR), is characterized by the onset of neovascularization of the inner surface of the retina induced by the retinal ischemia. New vessels at the optic disc (NVD) and new vessels elsewhere in the retina (NVE) are prone to bleed, resulting in vitreous hemorrhage. These new vessels may undergo fibrosis and contraction; this and other fibrous proliferation may result in epiretinal membrane formation, vitreoretinal traction bands, retinal tears, and traction or rhegmatogenous retinal detachments.
When new vessels are accompanied by vitreous hemorrhage, or when new vessels at the optic disc occupy greater than or equal to about one-quarter to one-third disc area, even in the absence of vitreous hemorrhage, PDR is said to be in the high-risk stage.
Neovascular glaucoma can result from new vessels growing on the iris and anterior chamber angle structures. Patients with neovascular glaucoma or high-risk PDR should receive prompt panretinal photocoagulation.
Vision of Diabetic Retinopathy

Prevention and Early Detection
Primary prevention of diabetic retinopathy is by not having diabetes, do a healthy lifestyle with exercise and weight control may decrease the risk of developing diabetes in some patients. With the prevention of diabetes surely will prevent the occurance of diabetic retinopathy.

In many cases the blinding complications of diabetes mellitus can be prevented or moderated. Recent innovations in treatment can yield substantial cost savings compared with the direct costs for those disabled by vision loss.

The early detection is need to emphasize in order to identify earliest stages of diabetic retinopathy thus can properly treated. They are several forms of retinal screening with standard fundus photography or digital imaging, with and without dilation, are being investigated as a means of detecting retinopathy.

Appropriately validated digital imaging technology can be a sensitive and effective screening tool to identify patients with diabetic retinopathy for referral for ophthalmic evaluation and management. Digital cameras with stereoscopic capabilities are useful for identifying subtle neovascularization and macular edema. At this time, it is not clear that photographic screening programs achieve a greater reduction in vision loss than does routine community care in areas where access to ophthalmologists is straightforward.

At this time, these technologies are not considered a replacement for a comprehensive eye evaluation by an ophthalmologist experienced in managing diabetic retinopathy. Furthermore, an ophthalmologists, also can play an important role in the total care of the patient with diabetes. For example, at the time of the eye examination, patients can be counseled about the importance of blood glucose and blood pressure control.
But, the problems most of diabetic patients doesn't know when to find an opthalmologist since they doesn't any changes in visions. Current recommendation stated that annual eye examination is needed for the patients that having diabetes at least 5 years.

The development and progression of diabetic retinopathy in patients with type 1 diabetes can be delayed if glucose concentrations are maintained in the near-normal range. Strict glucose control also resulted in a 50% reduction in the rate of progression of retinopathy in patients with existing retinopathy. At the 6- and 12-month visits, a small number of patients had a transient early worsening of the retinopathy in the intensive treatment group, but there was no effect on visual acuity.

In patients with newly diagnosed type 2 diabetes. Intensive blood glucose control by either the sulfonylureas or insulin decreased the risk of microvascular complications but not the risk of macrovascular disease. There were no adverse effects of the individual drugs on the cardiovascular outcome. In this study, there was a 29% reduction in the need for retinal photocoagulation surgery in the group with intensive glucose therapy compared with those receiving conventional treatment.

Conclusion
It is important to educate all patients who have diabetes about the disease and to emphasize the value of maintaining blood glucose (as monitored by hemoglobin A1c) as near normal as is safely possible. The studies have shown that lowering blood glucose reduces other end-organ complications as well, including nephropathy and neuropathy and cardiovascular disease.
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Brief about Cataract

Introduction
Before talking about cataract, we should look at eye problems first. Talking about eye problems, we should look at eye main function that is for vision.
Decreasing of visual acuity is main concern of eye function, Blindness is form ocular mortality since the eye is non-functioning.

Blindness is the inability to see. Blindness not only causes the problems for the person himself/herself but also family, and society. Blindness makes a person lost his/her capabilities and chances to work. Thus makes them become more dependent to the others.

Cataract is the world leading cause of blindness, thus the concern about proper cataract management is being emphasized.

Cataract
Cataract is opacity of the crystalline lens of the eye. Cataract has become common eye problem that affects millions of people, thus it has the potential to cause decreased vision as aging process. Most cataracts occurs in patient are related to aging process. Therefore, cataracts are very common in elderly. Approximately 75 percent of population over 75 suffer from lens opacity or cataract, which is the major cause of poor vision and blindness in the world.
The commonest form of cataract that is mainly found in ages more than 45 is named age-related or senile cataract. It should be mentioned that cataract surgery is the commonest case of surgery in the field of ophthalmology.

Around 50 millions people in the world suffer from age-related cataract and its prevalence in developing countries is much more than the developed ones. Annual new cases of cataract in India is 4 millions, and more than one million cataract surgeries are done annually in United States of America, although the accurate number of those suffering from cataract might be unknown. Much cost is spent on cataract surgery each year to prevent disabilities and improve quality of life, making it difficult for the health system to carry on.

There are many types of Cataracts. They may be characterized by their severity (i.e. partial or total, incipient, mature, hypermature), tendency to progress ( i.e. progressive or stationary) and location (i.e. anterior, posterior, cortical, nuclear).

Aging Crystalline Lens
One of the often seen consequences of the aging process is the development of senile cataract, a disease that affects one of our most precious gifts, that of sight.

For the importance of cataract, research for clarifying its etiology is a necessity, so that many future disabilities can be prevented, surgical costs reduced and quality of life improved. Multiple mechanisms such as osmotic graduation, protein aggregates, oxidative stress, post translational protein changes, phase separation are proposed for cataract formation, though the exact mechanism is not known yet. Combined factors of heritage, UV light exposure, diet, some metabolic disorders, quality of life, cationic pump malfunction and lens metabolism disorder are believed to have a role in cataract formation.
Cataract Eyes
Cataract Eyes

In simple explaination, as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.

Cataracts Risk Factors
Age
By far the greatest risk factor for developing a Cataract is age. It is estimated that by age 65, approximately 50% of our United States population has developed some degree of clouding of the Crystalline Lens of their eye. The degree of clouding can be minimal and not really disturb vision or it can be significant and require treatment.

Diabetes
Researchers believe that since Diabetes is associated with an elevation of sugar in the blood, or hyperglycemia, and impaired glucose metabolism, it is possible that the byproducts of the faulty glucose metabolism may accumulate within the eye and cause the Crystalline Lens to become cloudy and form a Cataract.

Eye Injury and Inflammation
An eye injury or eye trauma give a greater risk of developing a Cataract. Both a blunt trauma to the eye and a penetrating trauma to the eye can cause the formation of Cataracts. Inflammation inside the eye, called Iritis, that can be caused by trauma as well some type of systemic disease such as Rheumatoid Arthritis, Disease or Herpes Zoster (Shingles), also increases the risk of Cataract development.

Steroid Usage
Steroid use is well documented to increase the risk of forming a Cataract. For many years it was believed that the main culprit in steroids causing Cataract development were the prolonged use of a high dose of oral steroid medication.

Excessive Sunlight Exposure
It has been well documented that excessive exposure to sunlight can increase your risk of developing Cataracts. This is particularly true if you have daily repeated exposure as a result of your work or recreational activities.

Smoking
Smoking is believed to cause the formation of free radicals throughout the body and it is these free radicals that are potentially linked to Cataract formation. In addition, smoking may deprive the Crystalline Lens on the necessary nutrients, minerals and vitamins required for the proteins in the Crystalline Lens to maintain their integrity and thus their clarity.

Well, those are several risk factors of developing cataracts, thus by identifying those risk factors, you could do cataract prevention and be more aware of cataract. Eventhough cataracts doesn't kill us, but cataracts do impair our quality of life.

The most common symptoms of a cataract are:
- Cloudy or blurry vision.
- Colors seem faded.
- Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
- Poor night vision.
- Double vision or multiple images in one eye.
- Frequent prescription changes in your eyeglasses or contact lenses.
Cataracts Vision
Vision in Cataract Patients

Cataracts Diagnosis
Cataracts are diagnosed by first listening to the patient’s symptoms and then through careful examination. Examination for Cataracts most commonly includes the testing of visual acuity, refraction, dilating the pupils and observation with the slit lamp biomicroscope. In some cases glare testing may be used to help understand the degree of visual disability that a Cataract is actually causing the patient to experience.

About cataract treatment modalities especially surgical procedure, i'm gonna discuss it in my next article.
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Beware of Lung Cancer

Introduction
Lung cancer is a Cancer that forms in tissues of the lung, usually in the cells lining air passages or epithelial cells. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.

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Recent Evidence about Coronary Stent Technology

Introduction
Coronary Heart Disease is still leading cause of death in developed nations, and also causing lot of morbidity and long term complications such as heart failure, impaired daily activity, etc. Because of that, cardiovascular disease is one of the major concern of the modern medicine. Many technology and knowledge have been developed recently about cardiovascular.
Heart Disease

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Non-smoking Has Different Type of Lung Cancer

Introduction
Cancer is disease that characterized by uncontrolled growth of cell grow and multiplication, and malfunction. Cancer is malignant, because its invasive behaviour. Cancer tissues are dangerous for host because they take oxygen, nutrients, and space from healthy cells and they invade and destroy or reduce the ability of normal tissues to function.

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Childhood obesity as a Risk factor for Cardiovascular disease

How big is the problem?
Obesity itself is a medical condition in which excess body fat accumulated to the extent and it may have effect to the heart. Early obesity alone, is linked to certain abnormalities in the blood that can predispose individuals to developing cardiovascular disease early in adulthood.

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When to Drink Blood Pressure Drugs?

High Blood Pressure
Hypertension has been increasing in incidence, recently. About one in every four adults, around 50 million people in the USA alone have high blood pressure. But many people are unaware that they have the condition. Because it doesn't cause significant symptoms.

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Hypertension. How Bad Can It Be?

Definition
Hypertension is a high blood pressure.
hmm, What is that


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A Lizard can cure HIV/AIDS? Hoax or not?

Recently, there is a rumor in Indonesia that a lizard can cure HIV/AIDS. This rumor is spread from mouth to mouth. Is this just a hoax or not?
AIDS

AIDS (Acquired Immune Deficiency Syndrome is caused by HIV (Human Immunodeficiency Virus), this virus will infect our immune system thus make our immunity become weaken, can't encounter infectious agents. Until now, scientists especially in developed countries haven't discovered the cure for AIDS. The Latest invention is Anti Retro Viral (ARV) to limit virus spread or replication in our body, but can't eradicate the virus. Also until know, there is no vaccine for HIV, because the virus is highly mutability


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Swine Flu, The next pandemic?

Introduction
Many resources and scientist warn us about next flu pandemic, possible cause by swine flu. World have ever had three previous influenza-pandemics — A/H1N1 from 1918 through 1919 also known as Spanish Flu, A/H2N2 from 1957 through 1963 also known as Asian Flu, and A/H3N2 from 1968 through 1970 also known as Hongkong Flu. And Spanish Flu become the worst ever flu pandemic, caused nearly 50-100 millions people death, worldwide. And from that pandemic, we learn about prevention, preparedness, management, and policies should be made to reduce the impact of the pandemic. It can be saw from total case and death of next pandemic was less than Spanish flu.
Spanish Flu

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Swine Flu, New Hazards

About Influenza Virus
Actually, many kinds of influenza virus around the world. And not all strain can infect human. Because of mismatch antigen. Influenza virus also responsible for millions death worldwide. High mutability and high frequency of genetic reassortment and resultant antigenic changes in the viral surface glycoproteins make influenza viruses formidable challenges for control efforts.

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