A brief insight on meningitis

A deadly and devastating disease, meningitis could result in a fatality in a matter of hours. What’s more, bacterial meningitis fatality rates remain high even though there has been the discovery of many new antibacterial agents. In fact, around 1,000 individuals every day are killed around the world as a result of meningitis, with many of them being young adults, children, and small kids.
Infectious meningitis is categorized based on several markers. These include the age of the host (adult, young, or neonatal), parasitic, viral, fungal, bacterial. Another important marker is the health status of the individual which includes the duration of symptoms:

Children lesser than the age of 4 years are the most commonly affected in bacterial meningitis in the pediatric population, with those between the ages of 3 and 8 years showing the highest occurrences. The commonest acute meningitis bacteria in young kids are Escherichia coli and Streptococcus agalactia. These bacteria usually infect infants up to the ages of 3 months. The bacteria are said to have been acquired by the infant at birth itself when the baby was delivered through the vaginal canal.

Listeria monocytogenes is said to be foodborne (uncooked vegetables, processed meat, and dairy products), and affects patients with compromised immunities. The Streptococcus pneumonia sometimes infects children and increases in frequency with age. The Neisseria meningitides affects young adults and children and is the only bacteria which causes a meningitis epidemic. Unvaccinated children between the ages of 6 years and 3-6 months on the other side are the most affected by the Haemophilus influenzae.

The early meningitis symptoms are altered mental status, seizures, neck stiffness, chills, fever, and headache, fever, and chills. The most common bacterial meningitis complications include prolonged fever, pyogenic arthritis, coagulation disorders, endocarditis, and shock. Other serious complications and shock result in fatality within a few hours of the appearance of meningitis symptoms. Amongst the survivors, the outcomes of meningitis seizure disorder, paresis/spasticity, mental retardation, and deafness. The clinical signs and symptoms of meningitis in children differ according to the duration of the disease and the age of the children.



Prevention of meningitis with vaccines

Acute meningitis is life-threatening and presents with increased morbidity and mortality. A distinguishing characteristic exists between bacterial meningitis and the more common viral meningitis. With the increased use of the said conjugate vaccines, the annual occurrences of bacterial meningitis in the US decreased from the earlier 1.9 down to1.5 cases per 100,000 persons between the years 1998 and 2003, with a total mortality rate of 15.6%. The frequency rates in developing countries, however, continue to hover around the higher numbers.

In the year 2009, around 88,000-odd cases of meningococcal disease (assumed) were reported in the countries in the “meningitis belt,” which resulted in close to 5,000-5,500 deaths. The worst hit regions and countries were Niger and Nigeria where the combined fatalities and cases were close to 3,000 deaths and 69,500 cases. Between the year 2003 and 2007, 10% of the epidemic cases were due to W135 and 87.8% were due to serogroup A.

Prevention with meningitis vaccines
Conjugate vaccines administered in early childhood for the following – H. influenzae types S and B pneumonia have effectively decreased the occurrence of bacterial meningitis in both children and adults. While, the overall occurrences of pneumococcal meningitis have reduced with the administration of the said conjugate vaccine, the fraction of cases of meningitis caused due to the nonvaccine serotypes has gone up. Also, the number of isolates that were insusceptible to cefotaxime and penicillin has also gone up. The newer form of conjugate vaccine against Neisseria meningitides is suggested to be administered to all persons with complement component deficiencies, travelers to meningococcal disease endemic regions, and children between the ages of 11 and 18 years.

This vaccine is active against serogroups A, C, W135, and Y, but not serogroup B. Patients with asplenia (anatomic or functional) should be vaccinated against H. influenzae, pneumococcal and meningitis vaccine. Patients who are in the hospital suffering from meningitis of an uncertain etiology or with the N. meningitides infection will need droplet precautions for the first one day of the treatment, or until the latter can be eliminated.

Currently available meningitis vaccines
Meningococcal bacteria can cause meningitis and septicemia (meningococcal disease). Vaccines are now available for all the five groups – A, B, C, W, and Y, which are the common disease causing agents. These include Men B, Men C, Men ACWY, Hib, Pneumococcal conjugate vaccine (PCV), Pneumococcal polysaccharide vaccine (PPV), MMR, BCG and MenACWY for travel. It is always beneficial to consult the doctor before you take any vaccinations.



Cerebral edema and its management

Cerebral edema is the increase in the content of brain water, that is when the brain water content rises above the normal levels of 8/10ths. This disorder is usually a result of and response to a primary brain insult. Cerebral edemas are observed in a large number of cases related to brain injuries, including but not limited to toxic–metabolic derangements, inflammatory diseases, primary and metastatic neoplasms, ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage or traumatic brain injury.

Medical treatment

Osmotic therapy: The most effective and quick method of reducing brain bulk and tissue water is Osmotherapy. Osmotic therapy is designed to decrease blood viscosity by sucking the water and fluids out of the brain using an osmotic gradient. These changes trigger a reduction in the ICP (intracranial pressure) and result in an increase of the CBF (cerebral blood flow, i.e., blood to the brain). The most-employed and popular osmotic agent are Mannitol, while another popular one is Glycerol. The latter is a beneficial agent which is employed to patients orally as a 2.5% saline solution in the form of 50g in 500 ml in the daily IV or amounts of 30 ml and given every 4-6 hours.

Diuretics: As is with osmotic therapy, the osmotic effect can be extended and lengthened using loop diuretics (Furosemide) after the infusion of an osmotic agent. The loop diuretics can be used as aides.

Corticosteroids: Corticosteroids are responsible for lowering the ICP (intracranial pressure) chiefly in the vasogenic edema, especially because of its positive effects and consequences on the blood vessel. The edema around the brain tumors, especially the metastatic brain tumors, responds excellently if the treatment is done with a high dosage of Dexamethasone.

Hyperventilation: Raised ICP can be reduced in a helpful way using controlled hyperventilation. The cerebral vascular system is susceptible to changes in arterial pCO2, especially when they waver from their usual levels of 40 mm Hg. While the ICP falls as soon as the commencement of hyperventilation happens, the extracellular fluid and the CSF have safeguarding mechanisms which quickly restore the pH level to normal, and the effects of which could last for a long time.

Surgical treatment: Sometimes, surgical treatment is suggested for life-threatening shifts in the brain and large hemispherical infarcts with edema. Temporary craniectomy or ventriculostomy could prevent the worsening and could even end up being a lifesaver. In severe cases of hydrocephalus, the VP shunt proves to be a boon.



Frequency of bone-density testing in older women

Osteoporosis is a condition that leads to the bones being weakened and a heightened likelihood of fractures. Millions of people across the US are already suffering from osteoporosis or are now exposed to greater risk for fractures because of their BMD (bone mineral density) being much less than usual, which means they are suffering from osteopenia.

Osteoporosis usually progresses silently and slowly with no symptoms until one sees a fracture happen. However, early screening can identify if the bone density is low, following which therapies and lifestyle changes can help lessen the fractures risk and even remove any issues related to bone density. Therefore, current osteoporosis management guidelines recommend routine bone mineral density (BMD) test for women 65 years of age or older. But there is no enough data to specify how often to undergo the test.

To help clinicians decide on the intervals for BMD testing in women in whose initial assessment osteoporosis doesn’t show up, Dr. Gourlay and his research team at the University of NC analyzed data on a total of 4957 women, 67 years of age or older, and followed prospectively for up to 15 years.

Based on their original bone density test, the study subjects were divided into four groups – advanced, moderate or normal or mild osteopenia. The women were given two to five BMD tests at varying intervals during the study period.

The study report published in the New England Journal of Medicine on 19th January 2012, showed results that are suggestive that are less than 1% of women with regular bone mineral density progressed to developing osteoporosis during the study period. Only 5% who had somewhat low bone density initially went on to have osteoporosis. This suggests that women from these two categories need not be rescreened for around 15 years as they are likely to be safe until then. That’s great news for this category of women.

However, the data shows that 10% (that’s 1 out of 10 women) with moderate osteopenia during their initial assessment made the transition to osteoporosis in 5 years. And for women with advanced osteopenia initially, close to 10% got osteoporosis in a matter of a year, indicating that this group needed the 1-year screening intervals.

Of note, the study report also suggests that frequency of screening may also be influenced by other risk factors, including age, specific diseases or medications.



Things you should know about percutaneous lumbar laser disc decompression

Spinal stenosis is usually categorized as either a postnatal developmental disorder or one that is caused by congenital abnormalities, that is a primary one. It can also be acquired as a result of deteriorating changes or as outcomes of surgery, trauma or even a local infection. Degenerative lumbar spinal stenosis can happen anywhere – the foramina, lateral recess, the central canal or even every and any combination of these locations. Hence spinal stenosis treatment is important.

In 1934, Barr and Mixter described the clinical treatment for rupturing the intervertebral disc. Ever since that time, the surgical procedures becoming open have become quite common in practice. Disc herniations are usually categorized as either being non-contained or contained.

As for contained disc herniation, the consequences of open surgical discectomy for the same have not been favorable. Keeping this in view, several minimally invasive techniques were developed, one of which is percutaneous lumbar laser disc decompression.

The idea of using lasers for the treatment of herniations of the lumbar disc was conceived in the early 1980’s. After a series of laboratory experiments, Choy and colleagues carried out the first percutaneous lumbar laser disc decompression on a patient in February 1986. This procedure, fortunately, received FDA approval in 1991. Since then, many laser spine institutes locations have been performing percutaneous lumbar laser disc decompressions as well as laser surgery spinal stenosis worldwide.

Clinical evidences
A prospective uncontrolled study by Duarte and Costa published in 2000 evaluated the efficacy of percutaneous lumbar laser disc decompression performed under CT guidance and local anesthetic. An appropriate selection criterion was employed. Utilizing MacNab criteria to include functional recovery, pain reduction and absence of drug dependency, the study results showed that 67% of patients experienced good results and 9% acceptable outcomes.

Laser decompression technology has shown a relatively stable success rate over time. In another observational study report by Knight and Goswami in 2002, the authors reported good or satisfactory results in 80% of patients with lumbar disc herniations.

In a case-control study report by Zhao and coworkers, published in 2005, the authors found that 82% of patients with a “good” indication experienced either a good or excellent treatment response, which favorably compared to 56% of patients who had less than a good indication.
Based on the evidence from a large number of similar observational studies, laser disc decompression appears to provide considerable relief in properly selected patients with lumbar disc herniation.



Check out early signs of multiple sclerosis

Multiple sclerosis is a progressive disorder which is immune mediated. Immune mediated is when that system in your body that is supposed to keep your body healthy ends up attacking parts of the body that essential for everyday functioning. This happens as nerve cells progressively wear out their protective covering which in turn reduces the efficiency with which the brain and the spinal cord function. It has unpredictable symptoms each of which vary in intensity from person to person. Some people experience tingling sensations while others have paralysis, for instance.

Early signs of multiple sclerosis include a variety of visual, neurological, muscular, sexual and cognitive issues, to name a few:
One of the early and more common symptoms of multiple sclerosis is visual problems caused by inflammation of the optic nerve. It leads to loss of vision in extreme cases, blurred vision or double vision. The degeneration of vision is not immediately apparent as it is always a gradual process. Loss of vision can also be accompanied by pain. The body’s message center is also affected thanks to nerve damage in the brain and spinal cord resulting in scrambled messages to and fro the brain and the target nerve. These result in tingling sensations. When messages cannot be sent at all, it results in numbness. Muscle spasms and chronic pain are another early warning sign of multiple sclerosis, affecting almost half of those with the disorder. Stiff muscles and joints and painful jerks affect the back and the legs especially. When the nerves begin to degenerate, it causes chronic fatigue. Unexplained fatigue is an early warning sign affecting about 80 percent of those with the disorder, most obvious in the legs.

Another early warning sign of multiple sclerosis is problems with coordination, maintaining balance and dizziness. Bladder and bowel issues are also common, with incontinence, frequent urination, constipation being the most frequent signs. Fifty percent of those with multiple sclerosis have cognitive problems that include short attention spans, memory problems, and language problems. Other early warning signs include, commonly, sexual dysfunction, depression, and, more rarely, hearing loss, seizures, slurred speech, trouble swallowing and breathing problems.



The five most common migraine causes

It is true that there isn’t any substantial reason identified for the cause of a migraine. The best way to get rid of migraines is to keep away from what starts them in the starting place. Migraine symptoms are peculiar to each person, and it is not out of the ordinary for a person to have different migraine triggers. Anyone who has experience of a migraine knows they’re painful. The most common migraine causes include:

It can be a one-time occurrence related to something that does not settle right in the stomach.  Vomiting happening at intervals may be caused by due to the underlying medical conditions.

Sensitivity to Sounds or Noise sensitivity
The spectrum of sound we can hear is phenomenal; some people can hear a pin drop, and yet most peoples can still be subjected to loud sounds such as heavy machinery and sound like the same. Hyperacusis is an uncommon low acceptance to ordinary sounds from the environment, which is acceptable to those who listened with normal hearing.

Sensitivity to Smells or smell sensitivity
Hyperosmia is heightened olfactory acuity (increased and sharpened sense of smell), usually reason for this is a lower threshold for odor. This emotional disorder or discomfort starts when there is a situation of abnormally increased signal at any stage between the olfactory cortex and the olfactory receptors. The underlying cause of Hyperosmia may be environmental, generic or the after effect of benzodiazepine withdrawal syndrome.

Sensitivity to Light
Photophobia is not an abnormal fear or phobia, but a sense of discomfort or pain to the eyes due to the exposure to light. The term is sometimes additionally used to abnormal or irrational fear of light such as heliophobia.

Changes in vision
The real causes of Migraine headaches are a bit of a riddle. Researchers have recognized possible reasons, but they don’t have a clear explanation. Potential studies include: A disorder of an underlying central nervous may set a migraine episode when it triggered.



Vitamin D – A possible treatment option of Multiple Sclerosis

Diet for Multiple Sclerosis should contain some dietary options, and vitamin D is one of the essential add-ons. It is seen that vitamin D is an effective treatment for prevention of multiple sclerosis in young adults, women, obese individuals, etc.

Vitamin D is a fat-soluble, vital vitamin that one can get from various dietary sources such as cereal products, fortified dairy, fish liver oil, animal protein as well as via sunlight exposure directly absorbed by the skin. It is suggested that grown adults should ingest 600 international units of vitamin D daily to sustain a suitable vitamin D status.

Vitamin D has an important immune-modulating role and is not only the most promising but also the most important dietary molecule for treating chronic inflammatory disorders such as multiple sclerosis. It is widely believed that the unique geographical distribution that multiple sclerosis has across the globe can be credited to the fact that vitamin D3 has reduced availability. This is because not all countries are sufficiently exposed to sunlight, so the absence of active vitamin D is a good reason for the geographical origins and distributions of the disease of multiple sclerosis.

However, one needs to remember that the lesser levels of active vitamin D could also not be there in the body due to the altered function or metabolism, and not just because of lack of sunlight exposure. In fact, the failure of supplementation of vitamin D3 to demonstrate significant effects on inflammatory diseases or body weight could be due to the tenacity of its deficiency despite its administration.

When one evaluates the efficacy of vitamin D supplementation in multiple sclerosis, one should consider the ensuing and subsequent polymorphisms affecting the vitamin D receptor (VDR), which has been associated recently with changes to gut permeability, inflammation, and obesity.

Moreover, the revelation that VDR-D triggers and stimulates the Sirtuin SIRT-1 to lead to suggest that vitamin D has a considerable effect on cell metabolism. Thus, it could be similar to other natural dietary supplements regarding its properties.



Avail the Best Treatment Option for Dry Eye Syndrome

Dry eye syndrome is a chronic condition of the eye wherein the amount of tears produced is insufficient. Since the tears are essential for the proper lubrication and health of the eyes, production of an insufficient amount results in the chronic condition of dry eyes also known as dry eye syndrome.

The latest addition- Xiidra
Restasis had been the most effective treatment of the dry eye syndrome over the past decade. One of the most recent additions to the treatment of dry eye syndrome is the Xiidra dry eyes and is approved by the US Food and Drug Administration (US FDA). The eye drop is not available for sale in the market yet, but it is being claimed as the best treatment option for the dry eye syndrome.

Why is Xiidra the best?
There are many treatment options available for dry eye syndrome, but Xiidra dry eyes claim to be the best in treating the patients affected with dry eye syndrome. Xiidra dry eyes are used for the treatment of both the signs and symptoms of the overall dry eye syndrome. Xiidra does not have any side effects and is one of the eye medications that do not have any effect on the immune system of the person who uses it.

Other eye medications-
Some of the other useful options for treatment are as mentioned below:

  • Many eye medications help in the reduction of the inflammation of the eyelid which plays an effective role in treating dry eye syndrome along with some side effects.
  • Use of different types of drugs that help in the stimulation of tears is one of the most effective treatments for the disease. This option is good when the amount of tears produced is less.
  • Several eye drops can be used for controlling the inflammation of the cornea of the eye, but it suppresses the immune system of the body to some extent.

Thus, several treatment options are available for treating the dry eye syndrome, however, among them all, Xiidra eye medications seems to be the best treatment option available due to its efficiency and minimal side effects.



The role of Xiidra for dry eye relief

Day by day, the number of people who suffer from dry eye syndrome is increasing. And the reasons behind this can be various. Be it due to the constant exposure to computer screens or the certain old age; dry eyes are common. There are effective eye medications available that can help in curing the symptoms. One of such medications is the Xiidra, an eyedrop that offers relief from the dry eye.

What is Xiidra?
Xiidra is the latest addition to the list of eye medications for treating dry eyes. It is a new class of drugs approved by the FDA. With almost 30 million people suffering from dry eyes in the USA alone, the introduction of Xiidra is surely a relief. A completely preservative-free eye drop solution, made with lif-teg Rast 5% ophthalmic, Xiidra comes in dosed BID and individual vials.

How Xiidra works?
The Xiidra dry eyes medication works by influencing the T cells of the body’s immune system. It blocks a certain kind of protein on the cells’ surface in the human body, which can be responsible for preventing your eyes from producing enough and quality tears for necessary lubrication of the eyes. Thus, Xiidra helps in reducing the inflammation in the eyes, caused by dry eyes syndrome.

Why choose Xiidra?
Among the various reasons behind choosing Xiidra, the primary one is the fact that it works perfectly on the dry eyes, better than the traditional eye medications. It also works fine for treating both the signs as well as the symptoms of dry eyes. However, one must consult with the doctor regarding the dosage and the eye condition, before applying this medication. Despite being an effective eye drop, it may have a few side effects. Hence, one must use it under medical supervision.

Dry eyes not only can become a serious threat to the vision if left untreated for long, but also make one’s life miserable, no matter how mild it is. Though latest medications like Xiidra may seem expensive compared to other traditional eye drops, it might well be considering the results of such eye medications.