Acne

Acne vulgaris 

Acne vulgaris (cystic acne or simply acne) is a common human skin disease, characterized by areas of skin with seborrhea (scaly red skin), comedones (blackheads and whiteheads), papules (pinheads), pustules (pimples), nodules (large papules) and possibly scarring.Acne affects mostly skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in noninflammatory forms. The lesions are caused by changes in pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland, changes that require androgen stimulation.
Acne occurs most commonly during adolescence, and often continues into adulthood. In adolescence, acne is usually caused by an increase in testosterone, which accrues during puberty, regardless of sex. For most people, acne diminishes over time and tends to disappear — or at the very least decreases — by age 25. There is, however, no way to predict how long it will take to disappear entirely, and some individuals will carry this condition well into their thirties, forties, and beyond.
Some of the large nodules were previously called "cysts" and the term nodulocystic has been used to describe severe cases of inflammatory acne. The "cysts", or boils that accompany cystic acne, can appear on the buttocks, groin, and armpit area, and anywhere else where sweat collects in hair follicles and perspiration ducts. Cystic acne affects deeper skin tissue than does common acne.
Aside from scarring, its main effects are psychological, such as reduced self-esteem and in very extreme cases, depression or suicide.Acne usually appears during adolescence, when people already tend to be most socially insecure. Early and aggressive treatment is therefore advocated by some to lessen the overall long-term impact to individuals.

Most people develop acne-- the most common skin condition -- to some degree, but it primarily affects teenagers undergoing hormonal changes.
Acne may be mild (few, occasional pimples), moderate (inflammatory papules), or severe (nodules and cysts). Treatment depends on the severity of the condition.

What Causes Acne?

Acne is primarily a hormonal condition driven by male or ‘androgenic’ hormones, which typically become active during the teenage years. Sensitivity to such hormones, combined with bacteria on the skin, and fatty acids within oil glands, cause acne. Common sites for acne are the face, chest, shoulders, and back -- the sites of oil glands.
Acne lesions include whiteheads, blackheads, small bumps, and nodules and cysts.
Though acne is essentially a normal physiologic occurrence, certain conditions may aggravate the condition, including:

• Fluctuating hormone levels around the time of menses (women)
• Manipulating (picking/prodding) acne lesions
• Clothing (for example, hats and sports helmets) and headgear

How Is Acne Treated?

Only three types of drugs have proven to be effective for the treatment of acne -- benzoyl peroxide, retinoids, and antibiotics. Most people require at least one or two agents, depending on the severity of their acne.

• Benzoyl peroxide, available as an over-the-counter product (for example, Clearasil, Stridex) and by prescription (for example, Benoxyl, PanOxyl, Persagel), targets surface bacteria, which often aggravate acne. Irritation (dryness) is a common side effect.
• Retinoids (vitamin A derivatives), for example, Retin-A, Differin, Tazorac, treat blackheads and whiteheads, the first lesions of acne. The most common side effect is irritation.
• Antibiotics, either topically applied to the skin (clindamycin, erythromycin), or taken orally (tetracycline and its derivatives) control surface bacteria and reduce inflammation in the skin. Antibiotics are more effective when combined with benzoyl peroxide or retinoids. The oral retinoid isotretinoin is reserved for people with severe (nodular or cystic) disease. Isotretinoin shrinks the size of oil glands, the anatomic origin of acne. Without active, plump oil glands, acne actively diminishes. Side effects can include dry skin, elevated cholesterol and triglycerides, and birth defects. Women of childbearing age must practice birth control before, during, and after treatment (often a year) with isotretinoin. The use of isotretinoin requires rigorous testing (cholesterol, pregnancy) and follow-up for the prescribed period (5 months). It is reserved for the most severe types of acne that do not respond to other treatments.
• Hormone therapy may be helpful for some women with acne, especially for those with signs and symptoms (irregular periods, thinning hair) of androgen (male hormone) excess. The hormone therapy consists of low-dose estrogen and progesterone (birth control pills).

How Can Acne Be Prevented?

To prevent acne and reduce its damage to your skin, follow these tips.

• Choose a cleanser specially formulated for acne. These products often contain salicylic acid or benzoyl peroxide, which help to clear acne sores.
• Clean your face gently, as trauma to the acne breakouts may worsen the acne or cause scarring. When washing your face, use your hands, as any terrycloth or other scrubbing material may cause acne sores to rupture.
• If you need to use a moisturizer, use only light, noncomedogenic moisturizers, which do not aggravate acne. This type of product may be your best option.
• If you are a woman, use an oil-free foundation. Heavy makeup or other cosmetic products that block pores may cause a flare-up of acne.

Acid Reflux Disease (GERD)

Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD), gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease is a chronic symptom of mucosal damage caused by stomach acid coming up from the stomach into the esophagus.^[
GERD is usually caused by changes in the barrier between the stomach and the esophagus, including abnormal relaxation of the lower esophageal sphincter, which normally holds the top of the stomach closed, impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia. These changes may be permanent or temporary.
Treatment is typically via lifestyle changes and medications such as proton pump inhibitors, H₂ receptor blockers or antacids with or without alginic acid.Surgery may be an option in those who do not improve. In the Western world between 10 and 20% of the population is affected.

Signs and symptoms

Adults

The most-common symptoms of GERD are:

• Heartburn
• Regurgitation
• Difficulty in swallowing (dysphagia)

Less-common symptoms include:

• Pain with swallowing/sore throat (odynophagia)
• Increased salivation (also known as water brash)
• Nausea
• Chest pain

GERD sometimes causes injury of the esophagus. These injuries may include:

• Reflux esophagitis – necrosis of esophageal epithelium causing ulcers near the junction of the stomach and esophagus
• Esophageal strictures – the persistent narrowing of the esophagus caused by reflux-induced inflammation
• Barrett's esophagus – intestinal metaplasia (changes of the epithelial cells from squamous to intestinal columnar epithelium) of the distal esophagus
• Esophageal adenocarcinoma – a rare form of cancer

Some people have proposed that symptoms such as sinusitis, recurrent ear infections, and idiopathic pulmonary fibrosis are due to GERD; however, a causative role has not been established.

Children

GERD may be difficult to detect in infants and children, since they cannot describe what they are feeling and indicators must be observed. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems, such as wheezing. Inconsolable crying, refusing food, crying for food and then pulling off the bottle or breast only to cry for it again, failure to gain adequate weight, bad breath, and belching or burping are also common. Children may have one symptom or many; no single symptom is universal in all children with GERD.
Of the estimated 4 million babies born in the US each year, up to 35% of them may have difficulties with reflux in the first few months of their lives, known as 'spitting up'.One theory for this is the "fourth trimester theory" which notes most animals are born with significant mobility, but humans are relatively helpless at birth, and suggests there may have once been a fourth trimester, but children began to be born earlier, evolutionarily, to accommodate the development of larger heads and brains and allow them to pass through the birth canal and this leaves them with partially undeveloped digestive systems.
Most children will outgrow their reflux by their first birthday. However, a small but significant number of them will not outgrow the condition. This is particularly true when a family history of GERD is present.

Barrett's esophagus

Main article: Barrett's esophagus

GERD may lead to Barrett's esophagus, a type of intestinal metaplasia, which is in turn a precursor condition for carcinoma. The risk of progression from Barrett's to dysplasia is uncertain, but is estimated at about 20% of cases. Due to the risk of chronic heartburn progressing to Barrett's, EGD every five years is recommended for patients with chronic heartburn, or who take drugs for chronic GERD.

Causes

GERD is caused by a failure of the lower esophageal sphincter. In healthy patients, the "Angle of His"—the angle at which the esophagus enters the stomach—creates a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the esophagus where they can cause burning and inflammation of sensitive esophageal tissue.
Factors that can contribute to GERD:

• Hiatal hernia, which increases the likelihood of GERD due to mechanical and motility factors.
• Obesity: increasing body mass index is associated with more severe GERD. In a large series of 2000 patients with symptomatic reflux disease, it has been shown that 13% of changes in esophageal acid exposure is attributable to changes in body mass index.
• Zollinger-Ellison syndrome, which can be present with increased gastric acidity due to gastrin production.
• Hypercalcemia, which can increase gastrin production, leading to increased acidity.
• Scleroderma and systemic sclerosis, which can feature esophageal dysmotility.
• The use of medicines such as prednisolone.
• Visceroptosis or Glénard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach.

GERD has been linked to a variety of respiratory and laryngeal complaints such as laryngitis, chronic cough, pulmonary fibrosis, earache, and asthma, even when not clinically apparent. These atypical manifestations of GERD is commonly referred to as laryngopharyngeal reflux or as extraesophageal reflux disease (EERD).
Factors that have been linked with GERD, but not conclusively:

• Obstructive sleep apnea
• Gallstones, which can impede the flow of bile into the Duodenum, which can affect the ability to neutralize gastric acid

In 1999, a review of existing studies found that, on average, 40% of GERD patients also had H. pylori infection.The eradication of H. pylori can lead to an increase in acid secretion, leading to the question of whether H. pylori-infected GERD patients are any different than non-infected GERD patients. A double-blind study, reported in 2004, found no clinically significant difference between these two types of patients with regard to the subjective or objective measures of disease severity.

Diagnosis

 

 

Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach: This is a complication of chronic gastroesophageal reflux disease and can be a cause of dysphagia or difficulty swallowing.

The diagnosis of GERD is usually made when typical symptoms are present. Reflux can be present in people without symptoms and the diagnosis requires both symptoms or complications and reflux of stomach content.
Other investigations may include esophagogastroduodenoscopy (EGD). Barium swallow X-rays should not be used for diagnosis. Esophageal manometry is not recommended for use in diagnosis being recommended only prior to surgery.Ambulatory esophageal pH monitoring may be useful in those who do not improve after PPIs and is not needed in those in whom Barrett's esophagus is seen. Investigations for H. pylori is not usually needed.
The current gold standard for diagnosis of GERD is esophageal pH monitoring. It is the most objective test to diagnose the reflux disease and allows monitoring GERD patients in their response to medical or surgical treatment. One practice for diagnosis of GERD is a short-term treatment with proton-pump inhibitors, with improvement in symptoms suggesting a positive diagnosis. Short-term treatment with proton-pump inhibitors may help predict abnormal 24-hr pH monitoring results among patients with symptoms suggestive of GERD.

Endoscopy

Endoscopy, the looking down at the stomach with a fiber-optic scope, is not routinely needed if the case is typical and responds to treatment.It is recommended when people either do not respond well to treatment or have alarm symptoms, including dysphagia, anemia, blood in the stool (detected chemically), wheezing, weight loss, or voice changes.Some physicians advocate either once-in-a-lifetime or 5- to 10-yearly endoscopy for patients with longstanding GERD, to evaluate the possible presence of dysplasia or Barrett's esophagus.
Biopsies performed during gastroscopy may show:

• Edema and basal hyperplasia (nonspecific inflammatory changes)
• Lymphocytic inflammation (nonspecific)
• Neutrophilic inflammation (usually due to reflux or Helicobacter gastritis)
• Eosinophilic inflammation (usually due to reflux): The presence of intraepithelial eosinophils may suggest a diagnosis of eosinophilic esophagitis (EE) if eosinophils are present in high enough numbers. Less than 20 eosinophils per high-power microscopic field in the distal esophagus, in the presence of other histologic features of GERD, is more consistent with GERD than EE.
• Goblet cell intestinal metaplasia or Barrett's esophagus
• Elongation of the papillae
• Thinning of the squamous cell layer
• Dysplasia
• Carcinoma

Reflux changes may not be erosive in nature, leading to "nonerosive reflux disease".

Differential diagnosis

Other causes of chest pain such as heart disease should be ruled out before making the diagnosis. Another kind of acid reflux, which causes respiratory and laryngeal signs and symptoms, is called laryngopharyngeal reflux (LPR) or "extraesophageal reflux disease" (EERD). Unlike GERD, LPR rarely produces heartburn, and is sometimes called silent reflux.

Treatment

The treatments for GERD include lifestyle modifications, medications, and possibly surgery. Initial treatment is frequently with a proton-pump inhibitor such as omeprazole.

Lifestyle

Certain foods and lifestyle are considered to promote gastroesophageal reflux, however most dietary interventions have little supporting evidence. Weight loss and elevating the head of the bed are generally useful. Moderate exercise improves symptoms however in those with GERD vigorous exercise may worsen them.Stopping smoking and not drinking alcohol do not appear to result in significant improvement in symptoms. Avoidance of specific foods and eating before lying down should only be recommended to those in which they are associated with the symptoms. Foods that have been implicated include: coffee, alcohol, chocolate, fatty foods, acidic foods, and spicy foods.

Medications

Main article: Drugs for acid-related disorders

The primary medications used for GERD are proton-pump inhibitors, H₂ receptor blockers and antacids with or without alginic acid.^[2]
Proton-pump inhibitors (PPIs) (such as omeprazole) are the most effective followed by H₂ receptor blockers (such as ranitidine). If a once daily PPI is only partially effective they may be used twice a day.^[ They should be taken a half to one hour before a meal.There is no significant difference between agents in this class. When these medications are used long term, the lowest effective dose should be taken.They may also be taken only when symptoms occur in those with frequent problems. H₂ receptor blockers lead to roughly a 40% improvement.
The evidence for antacids is weaker with a benefit of about 10% (NNT=13) while a combination of an antacid and alginic acid (such as Gaviscon) may improve symptoms 60% (NNT=4).Metoclopramide (a prokinetic) is not recommended either alone or in combination with other treatments due to concerns around adverse effects. The benefit of the prokinetic mosapride is modest.
Sucralfate has a similar effectiveness to H₂ receptor blockers; however, sucralfate needs to be taken multiple times a day thus limiting it use. Baclofen, an agonist of the GABA_B receptor, while effective, has similar issues of needing frequent dosing in addition to greater adverse effects compared to other medications.

Surgery

The standard surgical treatment for severe GERD is the Nissen fundoplication. In this procedure, the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia. It is only recommended in those who improve with PPIs. Benefits are equal to medical treatment in those with chronic symptoms.In addition, in the short and medium term, laparoscopic fundoplication improves quality of life compared to medical management.When comparing different fundoplication techniques, partial posterior fundoplication surgery is more effective than partial anterior fundoplication surgery.

Pregnancy

In pregnancy, dietary modifications and lifestyle changes may be attempted, but often have little effect. Calcium-based antacids are recommended if these changes are not effective. Aluminum- and magnesium-based antacids are also safe, as is ranitidine and PPIs.

Infants

Infants may see relief with changes in feeding techniques, such as smaller, more frequent feedings, changes in position during feedings, or more frequent burping during feedings. They may also be treated with medicines such as ranitidine or proton pump inhibitors. Proton pump inhibitors however have not been found to be effective in this population and there is a lack of evidence for safety.

Overtreatment

The use of acid suppression therapy is a common response to GERD symptoms and many patients get more of this kind of treatment than their individual case merits.The overuse of this treatment is a problem because of the side effects and costs which the patient will have from undergoing unnecessary therapy, and patients should not take more treatment than they need.
In some cases, a person with GERD symptoms can manage them by taking over-the-counter drugs and making lifestyle changes. This is often safer and less expensive than taking prescription drugs. Some guidelines recommend trying to treat symptoms with an H₂ antagonist before using a proton-pump inhibitor because of cost and safety concerns.

Epidemiology

In Western populations GERD affects approximately 10% to 20% of the population and 0.4% newly develop the condition.For instance, an estimated 3.4 million to 6.8 million Canadians are GERD sufferers. The prevalence rate of GERD in developed nations is also tightly linked with age, with adults aged 60 to 70 being the most commonly affected. In the United States 20% of people have symptoms in a given week and 7% everyday. No data support sex predominance with regard to GERD.

History

An obsolete treatment is vagotomy ("highly selective vagotomy"), the surgical removal of vagus nerve branches that innervate the stomach lining. This treatment has been largely replaced by medication.

Research

A number of endoscopic devices have been tested to treat chronic heartburn. One system, Endocinch, puts stitches in the lower esophogeal sphincter to create small pleats to help strengthen the muscle. However, long-term results were disappointing, and the device is no longer sold by Bard.Another, the Stretta procedure, uses electrodes to apply radio-frequency energy to the LES. The long-term outcomes of both procedures compared to a Nissen fundoplication are still being determined.
The NDO Surgical Plicator creates a plication, or fold, of tissue near the gastroesophageal junction, and fixates the plication with a suture-based implant. The company ceased operations in mid-2008, and the device is no longer on the market.
Another treatment, transoral incisionless fundoplication, which uses a device called Esophyx, may be effective. 

List of all the diseases in the world

A 

Acid Reflux Disease (GERD)
Acne
Allergies
Antisocial Personality Disorder
Attention Deficit Disorder (ADHD/ADD)
Altitude Sickness
Alzheimer's Disease
Andropause
Anorexia Nervosa
Arthritis
Aspergers Syndrome
Asthma
Autism


B


Back Pain
Bad Breath (Halitosis)
Baldness
Bedwetting
Bipolar Disorder (BD)
Bladder Cancer
Body Dysmorphic Disorder (BDD)
Bone Cancer
Brain Cancer
Breast Cancer
Brain Tumors
Brain Injury
Bronchitis
Burns
Bursitis


C
Cancer
Canker Sores (Cold Sores)
Carpal Tunnel Syndrome (CTS)
Celiac Disease
Cervical Cancer
Cholesterol
Chronic Obstructive Pulmonary Disease (COPD)
Colon Cancer
Congestive Heart Failure (CHF)
Cradle Cap
Crohn's Disease


D


Dandruff
Deep Vein Thrombosis (DVT)
Dehydration
Depression
Diabetes
Diaper Rash
Diarrhea
Disabilities
Diverticulitis
Down Syndrome
Drug Abuse
Dysfunctional Uterine Bleeding (DUB)
Dyslexia


E


Ear Infections
Ear Problems
Eating Disorders
Eczema
Endometriosis
Enlarged Prostate
Epilepsy (Seizure)
Erectile Dysfunction (ED)
Eye Problems


F


Fibromyalgia
Fracture


G


Gallbladder Disease
Gallstones
Generalized Anxiety Disorder (GAD)
Genital Herpes
Genital Warts
Glomerulonephritis (Nephritis)
Gonorrhea
Gout
Gum Diseases
Gynecomastia


H


Head Lice
Headache
Hearing Loss
Heart Attacks
Heart Disease
Heartburn
Heat Stroke
Heel Pain
Hemorrhage
Hemorrhoids
Hepatitis
Herniated Discs
Hiatal Hernia (Hiatus Hernia)
HIV/AIDS
Hives
Hyperglycemia (High Blood Sugar)
Hyperkalemia (High Potassium)
Hypertension (High Blood Pressure)
Hyperthyroidism
Hypothyroidism


I


Infectious Diseases
Infectious Mononucleosis (Glandular Fever)
Influenza
Infertility
Insulin Dependent Diabetes Mellitus (IDDM)
Iron Deficiency Anemia
Irritable Bowel Syndrome (IBS)
Irritable Male Syndrome (IMS)
Itching


J


Joint Pain
Juvenile Diabetes
Juvenile Rheumatoid Arthritis (JRA)


K


Kidney Diseases
Kidney Stones (Renal Calculi)


L


Leukemia
Liver Cancer - Hepatocellular carcinoma (HCC)
Lung Cancer


M


Mad Cow Disease
Malaria
Melena (Blood in Stool)
Memory Loss
Menopause
Mesothelioma
Migraine
Miscarriages
Mucus In Stool
Multiple Personality Disorder
Multiple Sclerosis (MS)
Muscle Cramps
Muscle Fatigue
Muscle Pain



N


Nail Biting
Narcissistic Personality Disorder
Neck Pain


O


Obesity
Obsessive Compulsive Disorder (OCD)
Osteoarthritis (OA)
Osteomyelitis
Osteoporosis
Ovarian Cancer
Ovarian Cyst


P


Pain
Panic Attack
Parkinson's Disease (PD)
Peripheral Artery Disease (PAD)
Personality Disorders
Pervasive Developmental Disorder (PDD)
Peyronie's Disease
Phobias
Pink Eye (Conjunctivitis)
Polio
Pneumonia
Post Nasal Drip
Post Traumatic Stress Disorder (PTSD)
Premature Baby
Premenstrual Syndrome (PMS)
Prostate Cancer
Psoriasis


R


Reactive Attachment Disorder (RAD)
Renal Failure
Restless Legs Syndrome (RLS)
Rheumatoid Arthritis (RA)
Rheumatic Fever
Ringworm
Rosacea
Rotator Cuff


S


Scabies
Scars
Sciatica
Schizophrenia
Sexually Transmitted Disease (STD)
Sinus Infections
Skin Cancer
Skin Rash
Sleep Apnea
Sleep Disorders
Smallpox
Snoring
Social Anxiety
Staph Infection (MRSA)
Stomach Cancer
Strep Throat (Sore Throat)
Sudden Infant Death Syndrome (SIDS)
Sunburn
Syphilis
Systemic Lupus Erythematosus (SLE)


T


Tennis Elbow
Termination of Pregnancy (Abortion)
Testicular Cancer
Tooth Decay
Tuberculosis (TB)


U


Ulcers
Urinary Tract Infection (UTI)


V


Varicose Veins
Vertigo


W


Warts
Williams Syndrome


Y


Yeast Infection (Candidiasis)
Yellow Fever