General Topics

Uses and Precautions of Genomic Medicine | Endocrinology

What is genomic medicine?

Genomic medicine is the study of our genes (DNA) and their communication with our health. Genomics investigates how a person’s biological info can be used to improve their clinical care and health outcomes (for example, through real diagnosis and personalized treatment.

While genetics looks at exact genes or groups of ‘letters’ along the DNA chain, genomics refers to the study of a person’s whole genetic makeup. It is about how they tell and react to each other and is associated with conditions that have a wider variety of triggers, such as diabetes, heart disease, cancer, and asthma.

How is genomics used in medicine?

Diagnosis: For example, when the cause of a variety of symptoms cannot be identified by any other means. Prenatal tests are done during pregnancy, either for screening (in case something is wrong with the baby) or when there is already a family history. Helps parents make informed decisions and plans for the future.

When there is a family history of serious genetic disorders, you can tell prospective parents whether they are carriers or not and if they can pass it on to their children. You can also tell someone if you are likely to develop the inherited condition later in life, even if you don’t have any symptoms yet.

To assess risk: A person’s genetic makeup can show their susceptibility to certain diseases, such as heart disease, stroke, and cancer. Maybe they have high cholesterol levels or have vein problems. Possessing this knowledge means that they can achieve risk through medication, medical intervention, or by making positive existence changes.

Advances in genomic medicine

Several notable advances or achievements in genomic medicine are described below. However, further study of these issues beyond that provided in these summaries is warranted.

Precision medicine: The ultimate goal of precision medicine is that instead of a “one size fits all” approach by disease type, medicine will be based on a genetic understanding of the disease. Precision medicine not only involves studying the genome, but it also considers factors such as where a person lives, what they do, and what their family health history is.

The goal is to develop specific prevention or treatment approaches to help specific people stay healthy or get better rather than relying on approaches that are the same for everyone.

Precautions of genomic medicine

There are many aspects of genomic medicine that society must consider. For example, if a genomic medicine causes a disease with no known treatment, does it make sense to test people for that mutation before they develop symptoms? Also, some mutations cause an increased risk of disease, but that increased risk is very small compared to the risks of other factors such as diet and exercise.

Does it make sense to screen people for these kinds of changes when the change may not cause harm? How should this information be used? It is illegal for health insurance companies and employers to use genetic information to limit eligibility, set premiums, or discriminate against people without symptoms.

What is genetic counselling?

There are several types of service providers. In the UK, for example, the National Health Service employs 90 consultant clinical geneticists in 25 centres. They are supported by hundreds of specifically trained staff.5 Referral is usually done through a general practitioner (GP or family doctor) and is available to those concerned about a serious genetic family condition or a family tendency to develop cancer, or for parents of a child with learning disabilities and other developmental problems seeking expert evaluation.

In places where a public service is not available, or for those who choose to seek private healthcare treatment, check that the clinic you are using has the necessary registration (for example in the UK this is through the Care Commission for Quality, also known as CQC6) and the laboratory is also duly accredited.

Whatever the setting, the appointment may take some time and you may need to bring other members of your family with you. Your medical and family history will be mapped and explored, and you will likely have a medical exam as well. Finding out that there may be a life-changing or limiting condition in your future is a serious and, for some, traumatic experience.

Along with counselling, you may be offered tests (including blood tests), with the option to have them done the same day or, if you need time to think about the possible implications, come back at a later date. Results can take weeks or even months to recover (depending on the rarity of the genetic abnormality and how easy it is to find), but the results of prenatal tests will be returned much sooner.

Aftercare depends on the results and the nature of the test. Some people will be referred back to their family doctor along with all the details, or they can continue to receive treatment in a specialized unit. Those without symptoms will receive support and advice on lifestyle changes to minimize their risk, and advice on how to manage their possible condition in the future.

Several private companies offer genetic testing by mail. It involves taking a cheek swab or a blood sample at a local clinic. Then it is sent to the laboratory. The types of things that are tested include genetic risk for diabetes and heart conditions, as well as information about ancestry. Some companies provide more services than others, with counsellors or other healthcare professionals available to help. Convenient (but not necessarily cheap), it should be remembered that this is genetic testing without the usual level of holistic support found in established clinics.

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Overview of Diabetic Microvascular Complications | Endocrinology

Diabetic microvascular complications

Diabetic microvascular disease

The 3 main manifestations of diabetic microvascular disease, retinopathy, nephropathy, and neuropathy are reviewed.

Retinopathy: Diabetic microvascular disease is strongly associated with hyperglycemia. In the range of chronic hyperglycemia commonly seen in practice, there is an 11-fold increase in retinopathy compared to a 2-fold increase in coronary artery disease. Despite the importance of hyperglycemia, some patients may develop early evidence of retinopathy up to 7 years before the development of Frank’s type 2 diabetes mellitus, indicating the contribution of insulin resistance.

In addition to the severity of hyperglycemia and the duration of diabetes mellitus, other factors associated with retinopathy include hypertension, smoking, and dyslipidemia. These and other pathophysiological mechanisms, including insulin resistance and inflammation, contribute to the diabetic microvascular disease process.

The early histopathological sign of retinopathy related to diabetes mellitus is the loss of pericytes. Pericytes surround arterial and capillary endothelial cells and participate in the maintenance of capillary tone, growth, and resistance to damage from oxidative stress. Then the disease is characterized by hardening of the basement membrane, permeability of endothelial cells, and the formation of microaneurysms.

Broadly speaking, there are 2 types of retinopathy, non-proliferative (background), and diffuse. In nonproliferative retinopathy, patients may develop point bleeds, which are small hemorrhages in the middle of the retina surrounded by tight lipid exudates. Retinal edema can also be seen. Proliferative retinopathy is the development of neovascularization in the retina, which is complicated by vitreous hemorrhage. These later changes, without treatment, can lead to vision problems.

According to an analysis of the National Health and Nutrition Survey, the prevalence of retinopathy in the diabetic population is 28.5% and the general risk of vision loss is 4.4%. Male gender, high levels of glycated hemoglobin, long duration of diabetes mellitus, high blood pressure, and insulin use are associated with the development of retinopathy. In a group of 35 studies of people with diabetes from around the world from 1980 to 2008, retinopathy was 35% prevalent in people aged 20 to 79 years, 7% for proliferative retinopathy, and 10% for vision threat.

Rates of retinopathy are higher for patients of African or Caribbean descent compared to Caucasians or South Asians. The presence of the diabetic microvascular disease is also a sign of contagious vascular disease. Diabetic patients with retinopathy have a higher rate of atherosclerosis than diabetic patients without retinopathy.

Diabetic retinopathy is the leading cause of blindness in the United States. It is responsible for 8% of the cases of legal blindness and 12% of the cases of blindness in the United States each year during the last decade of the 20th century. However, newer therapies have improved outcomes with a significantly reduced rate of acute visual impairment. Although the number of patients with diabetes mellitus and diabetic retinopathy has increased from 4 million to మి 5 million in the United States over the past few decades, the number of visually impaired diabetes mellitus patients decreased from 26% in 1997 to ≈19% in 2011, while the general visual disability in the civilian population was 9.3%. It is constant.

Systemic medical treatment plays an important role in diabetic microvascular disease and will be discussed later. 2 specific eye treatments slow the progression to blindness. Two clinical trials, the Diabetic Retinopathy Early Treatment Study and the Diabetic Retinopathy Study established macular and pan-retinal photocoagulation as the main treatment for these two eye problems. Recently, the use of injected vascular endothelial growth factor antagonists has been shown to improve outcomes in proliferative retinopathy and has become fashionable. The timing, use, and role of this treatment about photocoagulation have not been established and depend on the results of clinical studies.

Nephropathy: The pathophysiology of nephropathy in diabetes mellitus has many similarities to retinopathy, including hardening of the basement membrane and the formation of microaneurysms. Furthermore, glomerular hyperfiltration is associated with the proliferation of the extracellular matrix and the progression of tubular and glomerular sclerosis. These changes can cause albuminuria. Nephropathy is defined as a protein loss> 500 mg/day. Previously, microalbuminuria was defined as a loss of 299 mg / d28.

Neuropathy: The development of diabetic neuropathy is associated with vascular and non-vascular abnormalities. In addition to basement membrane hardening and percussion damage, there is evidence that capillary blood flow to C fibers is reduced, resulting in nerve perfusion and consequent endocrine hypoxia. Neuropathy is characterized by axonal hardening and eventual loss of neurons. Although there are 2 main types, the clinical manifestations of diabetic neuropathy can vary widely.

The most common is length-dependent, symmetric, chronic sensorimotor polyneuropathy, which is associated with the severity and duration of hyperglycemia. The pathophysiology of this subtype is similar to other microvascular manifestations of diabetes mellitus. Polyneuropathies that develop at more unpredictable times during diabetes mellitus are less likely to be symmetrical. Polyneuropathy is often accompanied by pain or spontaneous symptoms and can have a fluctuating course.

Medical therapy and diabetic microvascular disease

Clinical trials have shown that diabetic microvascular disease can be prevented or progressed by aggressive treatment of hyperglycemia and cardiovascular risk factors. Seminal trial Diabetes Control and Complications Trial (DCCT) in glycemic control. In DCCT, 1,441 type 1 diabetic patients, 726 without retinopathy, and 715 with mild retinopathy were randomly assigned to routine or intensive glycemic monitoring and followed for more than 6.5 years.

Median hemoglobin A1c as a result of intensive monitoring was ~ 7%, compared with 9% in the general care group. Intensive treatment is associated with a 76% reduction in the development of retinopathy and a 56% reduction in the need for laser therapy in patients with mild retinopathy at baseline. Similarly, intensive therapy reduced the rate of microalbuminuria by 43% and neuropathy by 69%.

The benefits of lowering glucose in patients with type 2 diabetes mellitus have also been demonstrated in the UK Prospective Diabetes Study (UKPDS). Diabetes and Vascular Disease in More Aggressive Glucose Control Action: Action to Control Cardiovascular Risk in Pretrox and Diamicron Modified Release (Advance) and Diabetes (ACCORD) Controlled Evaluation Trials. In both attempts, the intensive glycohemoglobin target gly6.5% arm was treated, some with modest benefits but not all signs of diabetic microvascular disease, which were not sufficient to change glycemic treatment goals.

Controlling blood pressure also reduces the likelihood of diabetic microvascular disease. A recent meta-analysis examined the effect of blood pressure control on diabetic retinopathy. The improved control of blood pressure resulted in an 18% reduction in the incidence of retinopathy in patients with type 1 diabetes mellitus and a 22% reduction in patients with type 2 diabetes mellitus. In contrast, no one has been identified. benefit in preventing the progression of retinopathy.

For nephropathy, some blood pressure agents are more effective. Angiotensin-converting enzyme (ACE) inhibitors reduce the incidence of nephropathy by 30% as determined by albuminuria42. Although there is no significant difference in blood pressure reduction, ACEIs are superior to calcium channel blockers. In contrast, the data supporting the efficacy of angiotensin receptor blockers are conflicting, with recent data being less positive than the initial studies.

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What Are The Childhood Eye Diseases and Conditions? | Ophthalmology

Common eye problems in children

  • Squint
  • Chalazion
  • Amblyopia
  • Refractive error

The most common eye problems include dizzy eyes (strabismus), mild eyelid swelling (chalazion), lazy eye (amblyopia), and the need for strong glasses at a young age (refractive error).

See your family doctor if you are concerned about your baby’s eyes.

Squinting (strabismus)

Strabismus may be known as turned eyes, crossed eyes, squint, or lazy eyes. Strabismus happens when the eyes point in different directions. When one eye is straight the other may point in, out, up or down. This may be noticeable all the time, or it may come and go. It may be present at birth or appear later. In babies and children with strabismus, the vision in the turned eye will not develop normally. Children do not outgrow strabismus. Treatment is most effective when started at an early age and may include glasses, patching, exercises, or surgery and is usually a combination of these.

Treatment is performed by an ophthalmologist and an orthopedist.

The aim of strabismus treatment:

  • Good vision in both eyes
  • Good performance
  • Coordinated eyes (i.e. depth perception)


Amblyopia occurs when one eye is lazy because it does not receive a clear image like the other eye. The most common causes of amblyopia are strabismus, refractive error (misalignment), ptosis (drooping eyelid), and cataracts (cloud or blurring of the lens). If left untreated, it can lead to very low vision. Treatment for amblyopia consists of patches and/or glasses. Vision usually improves when treatment is started at an early age.


Mild inflammation of the eyelid chalazion when there is a blockage in the glands of the upper or lower eyelid. The eyelid may be swollen and red and sometimes have a yellowish discharge. Your baby will have a lot of chalazion on the eyelid at one point and it can occur in one or both eyes.

Take your child to your family doctor, who will prescribe early treatment. If there is no improvement after 3-4 months of treatment, you should see an ophthalmologist.

If the chalazion is too large, it will cover the centre of your child’s pupil (the central black part of the eye), which can affect your child’s vision. Your family doctor will need to refer you to an ophthalmologist.

Blocked tear duct (epiphora)

Epiphora or watering eyes may happen if the duct that drains tears from the eye to the nose becomes blocked. In many cases, blocked tear ducts get better by themselves, but if this doesn’t happen within 12 months, or frequent infection becomes a problem, a small surgical procedure may be necessary. Blocked tear ducts are not the only cause of watering eyes so it’s a good idea to have an eye examination.

Signs to watch in childhood eye diseases

Occasionally, serious conditions have signs and symptoms similar to those described above. For this reason, children suspected of having an eye problem should be examined.

  • one or both pupils have an unusual or white appearance this may be noticed in photographs.
  • There is constant watering or discharge from your child’s eyes.
  • One eye often appears dizzy or the eyes do not seem to move well.
  • You have extreme sensitivity to light or light.
  • Your child’s head will always tilt/turn to one side.

Routine exam for vision problems

Screening for certain vision problems is done immediately after birth and at age 4 as part of a B4 school check. If your child is not screened, he or she must have this test during the first year of school. Please contact your child’s school to make sure the hearing and vision technician has examined your child at your next visit. This exam did not detect all vision problems.

A comprehensive eye exam is recommended for all infants and children:

  • Turned eye (strabismus)
  • Lazy eye (amblyopia)
  • Strong glasses at an early age (refractive error)
  • Premature birth (30 weeks gestation or less)
  • Developmental delay

If none of the above applies to your child, but if you have a family history of dizzy eyes, laziness, or strong glasses at a young age, then the ideal time for your child to have an eye exam is between 2 and a half year or 3 years. At this age, your child is old enough for a very accurate vision test and it is still too early to handle any problems.

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Overview of Endocrine Neoplasia and Cancer | Endocrinology

What are endocrine neoplasia and cancer?

Endocrine neoplasia refers to growths or tumors that affect the hormone-producing endocrine system. Tumors develop in the adrenal glands, pituitary gland, parathyroid glands, or pancreas and can be cancerous or benign. The Nig Comprehensive Cancer Center‌ Endocrine Neoplasia Program is dedicated to the evaluation and treatment of the structural and hormonal symptoms of these disorders.

Our endocrine neoplasia program is the only one in Connecticut, and our dedicated team of experienced multidisciplinary specialists provides clinical services in the following areas:

  • Thyroid cancer and thyroid nodules
  • Fine injection aspiration biopsy: Thyroid and adrenal
  • Thyroid ultrasound
  • Thyroid carcinoma test: Thyrogen stimulated thyroglobulin and thyroid scan
  • Cancer and benign tumors of the adrenal glands.
  • Invasive radiology including petrous sinus sampling, adrenal vein sampling, and selective infusion of pancreatic calcium
  • Hyperparathyroidism and parathyroid tumors
  • Pituitary adenomas
  • Dynamic endocrine examination
  • Nuclear medicine scan

With specialists in a variety of diagnostic and therapeutic approaches, we work with teams of physicians from other disciplines to treat patients with endocrine neoplasia. Our medical professionals have experience in endocrine surgery, urological surgery, neurosurgery, neuro-ophthalmology, pathology, nuclear medicine, invasive radiology, hypertension, genetics, molecular biology, and endocrinology. They provide state-of-the-art patient care while conducting basic and clinical research to advance treatment options.

Types of endocrine neoplasia and cancer

Tumors can appear in any large endocrine gland, including the thyroid, parathyroid, pituitary, and adrenal glands, and the pancreas. The most common sites are:

  • Thyroid gland: Most endocrine cancers develop in the thyroid gland (a butterfly-shaped organ in the lower neck). Thyroid cancer is more common in women than in men. Statistics show that the annual rate of thyroid cancer is increasing in the United States and around the world. The good news is that most thyroid tumors (called nodules) are not cancerous.
  • Pituitary gland: A pea-sized organ connected to the brain, the pituitary gland produces hormones that affect growth and fertility. Pituitary tumors are almost always benign, but they contain more or less than one or more hormones, which can upset the balance of other glands.
  • Adrenal gland: The two adrenal glands that live above the kidneys produce hormones that regulate metabolism (cortisol), stress response (adrenaline), blood pressure (aldosterone), and certain sexual characteristics (androgens).
  • Pancreas: Although the pancreas plays an active role in the digestive system, it is also a source of important hormones, including insulin. Rare tumors produce too much insulin or other related hormones, which can affect blood sugar levels.

Although some cases are inherited, the cause of most endocrine cancers is generally unclear.

Symptoms of endocrine neoplasia and cancer

Some patients with thyroid tumors notice a lump in the neck. For others, and for other endocrine tumors, the general rules do not apply. Some tumors cause severe hormonal changes or discomfort, while other tumors do not have any symptoms.

So when does a tumor have symptoms? You basically have symptoms if it doesn’t work (makes extra hormones) but is active (doesn’t make them). For example, an adrenal tumor that produces excess testosterone can cause a patient to develop certain male characteristics, such as facial hair. Symptoms also appear as the tumor grows.

A large tumor destroys part of the gland, causing a lack of hormones. It also affects nearby structures. For example, a large pituitary tumor can focus on the nerve that runs between the eyes and the brain, causing vision changes. When endocrine tumors have no symptoms, doctors may randomly notice them and evaluate the patient for another reason.

What are the genes associated with multiple endocrine neoplasias?

Mutations in the MEN1, RET, and CDKN1B genes cause multiple endocrine neoplasms. Mutations in the MEN1 gene cause type 1 multiple endocrine neoplasias. This gene provides instructions for the production of a protein called melanin. Menin acts as a tumor suppressor, which means that it generally prevents cells from growing and dividing too quickly or uncontrollably.

Although the exact function of the meninges is unknown, it is involved in cellular functions such as DNA copying and repair and regulation of the activity of other genes. When mutations inactivate two copies of the MEN1 gene, the meninges are no longer available to control cell growth and division. Loss of functional meninges allows cells to divide more frequently, leading to tumor characterization of multiple endocrine neoplasia type 1. It is not clear why these tumors affect endocrine tissues.

Mutations in the RET gene can cause type 2 multiple endocrine neoplasias. This gene provides instructions for the production of a protein involved in cell signaling. The RET protein stimulates chemical reactions that direct cells to respond to their environment, for example by dividing or maturing. Mutations in the RET gene over-activate the protein’s signaling function, which stimulates cell growth and division in the absence of signals external to the cell. This unproven cell division can lead to the formation of tumors in the endocrine glands and other tissues.

Mutations in the CDKN1B gene cause type 4 multiple endocrine neoplasias. This gene provides instructions for the production of a protein called p27. Like the meaning protein, p27 is a tumor suppressor that helps regulate cell growth and division. Mutations in the CDKN1B gene reduce the number of functional p27 that allows cells to grow and divide without being analyzed. This irregular cell division leads to the development of tumors in the endocrine glands and other tissues.

Diagnosis of endocrine neoplasia and cancer

Doctors can perform several tests to check for a suspected endocrine tumor:

  • A medical history and physical exam to assess for physical or behavioral changes related to hormone function
  • Lab tests to check for abnormal hormone levels in the blood or urine
  • Imaging studies (CT scan, MRI, or ultrasound) to look for evidence of abnormal tissue in the gland
  • A biopsy to obtain a sample of abnormal tissue and analyze it for cancer cells

Treatment for endocrine neoplasia and cancer

For any endocrine tumor, treatment involves surgery to remove it. For people with cancer, another approach that is sometimes used is radiation therapy. Patients sometimes receive hormone therapy to balance the level of hormones in the body. Depending on the type of tumor, your doctor may prescribe other specific rules to meet your individual needs.

General Topics

Causes and Types of Thyroid Disorders And Cancer | Endocrinology

Thyroid disorders and cancer

It occurs in thyroid cancer cells – a butterfly-shaped gland at the base of your neck, just below your Adam’s apple. Your thyroid makes hormones that regulate your heart rate, blood pressure, body temperature, and weight. Thyroid cancer may not cause any symptoms at first. But as it grows, it causes pain and swelling in the neck.

There are many types of thyroid cancer. Some grow very slowly and others are very aggressive. Most cases of thyroid cancer can be cured with treatment. Thyroid cancer rates appear to be increasing. Some doctors believe this is because new technology allows them to detect small, previously undeveloped thyroid cancers.

Symptoms of thyroid cancer

It’s common for people with thyroid cancer to have fewer or no symptoms. These are often diagnosed by a routine physical exam of the neck. They can also be detected accidentally by X-rays or other imaging scans done for other reasons. People may experience the following symptoms or signs. Sometimes people do not have any of these changes. Or, the symptom may be caused by a different medical condition that is not cancerous.

In front of the neck, a lump near Adam’s apple.

  • Blunt
  • Swelling of the glands in the neck.
  • Difficulty swallowing
  • Difficulty breathing
  • Throat or neck pain
  • The cough persists and is not caused by a cold.

If you are concerned about any changes you may experience, speak with your doctor. Among other things, your doctor may ask how often and how often you experience symptoms. This helps identify the cause of the problem called a diagnosis. Other thyroid problems such as goiter; Or a condition not related to the thyroid, such as an infection.

If cancer is diagnosed, symptom relief is an important part of cancer care and treatment. This is called palliative or supportive care. It often begins after diagnosis and continues throughout treatment. Be sure to talk to your healthcare team about any symptoms you are experiencing, including new symptoms or changes in symptoms.

How common is thyroid cancer?

This is rare cancer accounting for less than 1% of all cancer cases in the UK. Every year approximately 2,700 people in the UK are diagnosed. It is most common in people 35 to 39 years old and in people 70 and older.

Women are 2 to 3 times more likely to develop, than men. It is not clear why, but it may be the result of hormonal changes associated with the female reproductive system.

Who gets it?

This is more common in women than in men. Women have between the ages of 40 and 50, while men who have it are usually between the ages of 60 and 70. Follicular thyroid cancer is more common in whites than blacks and more women than men. You can still get this if you are young. Papillary thyroid cancer, for example, occurs most often in people between the ages of 30 and 50.

Types of thyroid cancer

Thyroid cancer is classified into types based on the cells found in the tumor. Its type is determined when a sample of tissue from your cancer is examined under a microscope. The type of thyroid cancer is considered to determine its treatment and prognosis.

Types of thyroid cancer:

  • Papillary thyroid cancer: The most common form of thyroid cancer, papillary thyroid cancer, arises from follicular cells that produce and store thyroid hormones. Papillary thyroid cancer can occur at any age, but most often affects people between the ages of 30 and 50. Doctors sometimes refer to papillary thyroid cancer and follicular thyroid cancer together as thyroid cancer.
  • Follicular thyroid cancer: Follicular thyroid cancer also arises from the follicular cells of the thyroid. It usually affects people over 50 years of age. Hartley cell cancer is a rare and more aggressive type of follicular thyroid cancer.
  • Anaplastic thyroid cancer: This is a rare thyroid cancer that begins in follicular cells. It grows quickly and is very difficult to treat. Anaplastic thyroid cancer usually occurs in adults 60 years of age or older.
  • Medullary thyroid cancer: It begins in thyroid cells called C cells, which make a hormone called calcitonin. Calcitonin levels in the blood indicate medullary at a very early stage. Some genetic syndromes increase the risk of medullary thyroid cancer, although this genetic link is unusual.
  • Other rare varieties: Another very rare cancer that begins in the thyroid is thyroid lymphoma, which begins in the cells of the thyroid immune system, and thyroid sarcoma, which begins in the cells of the thyroid connective tissue.

Causes of thyroid cancer

In most cases, the cause is unknown. However, some things increase the chances of developing your condition. The cause is unclear.

It occurs when cells in your thyroid undergo genetic changes (mutations). Mutations allow cells to grow and multiply rapidly. Cells also lose the ability to die, just like normal cells. The abnormal thyroid cells have accumulated from a tumor. The abnormal cells can attack nearby tissues and spread to other parts of the body (metastasize).

Risk factors of thyroid cancer

Factors that increase the risk:

  • The female gender is more common in women than in men
  • Exposure to high levels of radiation. Radiation therapy treatments to the head and neck increase the risk

Some hereditary genetic syndromes. Genetic syndromes that increase the risk, and include familial medullary thyroid cancer, multiple endocrine neoplasms, Cowden’s syndrome, and familial adenomatous polyposis.

Recurrent thyroid cancer: Despite treatment, even if the thyroid is removed, it will return. This happens when microscopic cancer cells cross the thyroid before being removed.

  • Lymph nodes in the neck
  • Small pieces of thyroid tissue remain during surgery
  • Other areas of the body, such as the lungs and bones.
  • Recurrent thyroid cancer can be treated. Your doctor may recommend regular blood tests or thyroid scans to check for recurring signs.

Diagnosis of thyroid cancer

A type of blood test called a thyroid function test measures hormone levels in the blood and can rule out or confirm other thyroid problems. Fine needle aspiration cytology (FNAC) is used if nothing else appears to be causing a thyroid lump. More evidence is needed if the FNAC results are incomplete or if more information is needed to make your treatment more effective.

Treatment for thyroid cancer

Treatment options depend on your type and stage, and your general health, and your preferences. Most of those can be cured with treatment. Treatment may not be needed right away

Very small thyroid cancers that have a low risk of spreading throughout the body do not require immediate treatment. Instead, you can often consider active surveillance with cancer control. Your doctor may recommend blood tests and an ultrasound exam of your neck once or twice a year. In some people, cancer never grows and does not require treatment. In others, the increase can eventually be detected and treatment started.

  • Surgery
  • Parathyroid glands
  • Open the Parathyroid Glands pop-up dialog

Most people have surgery to remove the thyroid. Your doctor may recommend any operations based on the type of thyroid cancer, the size of the cancer, whether the cancer has spread beyond the thyroid, and the results of an ultrasound examination of the entire thyroid gland.

Operations used to treat thyroid cancer:

Remove all or most of the thyroid (thyroidectomy). An operation to remove the thyroid gland involves the removal of thyroid tissue (total thyroidectomy) or thyroid tissue (near the entire thyroidectomy). The surgeon often leaves small borders of thyroid tissue around the parathyroid glands, which can help control calcium levels in the blood.

Removal of a portion of the thyroid (thyroid lobectomy). During a thyroid lobectomy, the surgeon removes half of the thyroid. This may be recommended if you have slow-growing thyroid cancer in one part of the thyroid and there are no suspicious nodules in other areas of the thyroid.

Removal of lymph nodes in the neck (lymph node dissection). By removing the thyroid, the surgeon can also remove nearby lymph nodes in the neck. These can be tested for signs of cancer.

Thyroid surgery can increase the risk of bleeding and infection. Damage to the parathyroid glands can also occur during surgery, which can lead to lower levels of calcium in your body. The nerves connected to the vocal cords may not function normally after surgery, which can lead to laryngeal paralysis, numbness, voice changes, or shortness of breath. Treatment improves or reverses nerve problems.

Thyroid hormone therapy: After a thyroidectomy, you can take the medicine levothyroxine (Levoxyl, Synthroid, others) for life. This action has two benefits: it supplies the missing hormone normally produced by the thyroid, and it suppresses the production of thyroid-stimulating hormone (TSH) from the pituitary gland. High levels of TSH can trigger the growth of the remaining cancer cells.

Radioactive iodine: Radioactive iodine treatment uses large doses of radioactive iodine. Radioactive iodine treatment is often used to destroy healthy thyroid tissue that remains after a thyroidectomy, as well as microscopic areas of thyroid cancer that have not been surgically removed. Radioactive iodine treatment is also helpful, which can come back after treatment or spread to other parts of the body.

Radioactive iodine treatment comes as a capsule or liquid that is swallowed. Radioactive iodine is taken up primarily by thyroid cells so the risk of damaging other cells in your body is low.

Side effects can include:

  • Dry mouth
  • Oral pain
  • Inflammation of the eye
  • Altered sense of taste or smell
  • Fatigue

Most of the radioactive iodine is excreted in the urine during the first days after treatment. You will be told what precautions to take at this time to protect other people from radiation. For example, you may be asked to temporarily avoid close contact with other people, especially children, and pregnant women.

External radiation therapy: Radiation therapy can also be delivered externally to a specific point on your body (external beam radiation therapy) using a machine that targets high-energy rays, such as X-rays and protons. During treatment, you lie on a table while a machine moves around you. External beam radiation therapy may be recommended if surgery is not an option and your cancer is growing after treatment with radioactive iodine. Radiation therapy may also be recommended after surgery if your cancer is at risk of recurrence.

Chemotherapy: Chemotherapy is the treatment of cancer by using chemicals to kill cancer cells. Chemotherapy is usually given through an IV. The chemicals travel throughout the body and destroy rapidly growing cells, including cancer cells. Chemotherapy is not commonly used, but it is sometimes recommended for people with anaplastic. Chemotherapy can be combined with radiation therapy.

Targeted drug treatment: Targeted drug therapies target specific abnormalities in cancer cells. By preventing these abnormalities, targeted therapeutic therapies can cause cancer cells to die. Drug treatment targets the signals that tell cancer cells to grow and divide. It is commonly used in advanced cancer.

Alcohol injection in cancers: Alcohol ablation is the injection with alcohol to ensure accurate injection placement using ultrasound-like imaging. This procedure reduces thyroid cancer. Alcohol ablation may be an option if your cancer is very small and surgery is not an option. It is sometimes used to treat recurrent cancer of the lymph nodes after surgery.

Supportive (palliative) care: Palliative care is specialized medical care that focuses on relieving pain and other symptoms of a serious illness. Hospice professionals will work with you, your family, and your other doctors to provide additional support to complete your ongoing care. Palliative care can be used when other aggressive treatments such as surgery, chemotherapy, or radiation therapy are performed. Most of it is offered at the beginning of cancer treatment. When palliative care is used in conjunction with all other appropriate therapies, people with cancer can feel better and live longer.

Palliative care is provided by a team of specially trained doctors, nurses, and other professionals. Palliative care teams aim to improve the standard of living for people with cancer and their families.

Prevention of thyroid cancer

Doctors do not know the cause, so there is no way to prevent, in those with an average risk of developing the disease.

Prevention for high-risk people: Thyroid surgery to prevent cancer (immune thyroidectomy) may be considered in adults and children with a genetic mutation that increases the risk of medullary thyroid cancer. Discuss your options with a genetic counselor who can explain your thyroid cancer risk and your treatment options.

Prevention for people close to nuclear power plants: Sometimes a drug that blocks the effects of radiation on the thyroid is given to people who live near nuclear power plants. Medicines (potassium iodide) can be used in the event of an accident in a nuclear reactor. If you live within 10 miles of a nuclear power plant and are concerned about safety precautions, contact your local or state emergency management department for more information.

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Diagnosis of Conjunctivitis in Children | Ophthalmology

What is conjunctivitis in children?

Conjunctivitis in children is inflammation of the lining of the eye over the eyeball and inside the eyelids. Infection with bacteria or viruses can cause conjunctivitis. Infection occurs easily, especially if the eye is already irritated. Sometimes children can develop conjunctivitis as part of a cold.

Viral conjunctivitis is very contagious, but bacterial conjunctivitis is not. conjunctivitis in children’s condition is often classified as neonatal conjunctivitis or infantile conjunctivitis. Each group has different causes and treatments.

Types of conjunctivitis in children

  1. Bacterial Conjunctivitis: Bacterial conjunctivitis is another common type of pink eye in which viruses are spread through the air by sneezing and coughing. Bacterial conjunctivitis is a common viral infection of the upper respiratory tract, such as measles, the flu, or the common cold.
  2. Viral Conjunctivitis: Viral conjunctivitis is a common infection in the Western population and is often associated with other infections throughout the body. Due to their correlation with respiratory anatomy, viral upper respiratory infections are a common cause of secondary viral conjunctivitis.
  3. Gonococcal and chlamydial conjunctivitis: It is caused by a bacteria called Neisseria gonorrhea. The newborn passes this type of conjunctivitis through the birth canal of the infected mother. This type of conjunctivitis can be prevented with the use of eye drops at birth in newborns. Newborn eyes are often very red, with thick discharge and swelling of the eyelids. This type usually begins 2 to 4 days after birth. Treatment of gonococcal conjunctivitis usually involves antibiotics through an intravenous (IV) catheter.
  4. Allergic Conjunctivitis: Caused by an allergy, not an infection, not an infection. Antibiotic eye drops may not help, but allergy eye drops can. It usually affects both eyes and the main symptoms in children are watery eyes and itching.
  5. Non-infectious conjunctivitis: Conjunctivitis, which is caused by irritation of the eyes, causes symptoms of conjunctivitis that can occur from a variety of sources, including smoke, diesel exhaust, perfumes, and certain chemicals. Some types of conjunctivitis stem from sensitivity to certain substances ingested, including herbs such as conjunctiva and turmeric.

Causes of conjunctivitis in children

Conjunctivitis in children may be caused by:

  • Bacteria (several different varieties may cause conjunctivitis)
  • Viruses (such as adenovirus or herpes virus)
  • Allergies
  • Exposure to chemicals (rarely, the drops given to newborns for preventing conjunctivitis may have the reverse effect and may irritate the eye)

The causes and treatments of conjunctivitis in children among newborns may differ.

Symptoms of conjunctivitis in children

The following are common symptoms of the condition. However, each child may experience symptoms differently. There may be symptoms:

  • Gritty feeling in one or both eyes
  • Itchy, irritated eyes
  • Clear, thin drainage and increased tearing
  • Sneezing and runny nose
  • Stringy discharge from the eyes
  • Thick, green drainage from the eyes
  • Ear infection
  • A lesion with a crusty appearance
  • Eyes that are matted together in the morning
  • Swelling of the eyelids
  • Pink or red discolouration of the whites of one or both eyes
  • Discomfort when the child looks at a light
  • Burning in the eyes

The symptoms of conjunctivitis in children sometimes resemble other medical problems. Always see your child’s healthcare provider for an examination.

Diagnosis of conjunctivitis in children

Conjunctivitis in children can be diagnosed by its symptoms, and the exact cause can be determined by the paediatrician. Since there are other conditions, such as hay fever, that have similar symptoms, it is important to see a paediatrician as soon as possible.

Common symptoms of infectious conjunctivitis are red, watery, and sticky eyes. However, infectious conjunctivitis is sometimes confused with other types of conjunctivitis, which are treated differently.

Conjunctivitis in children treatment

Treatment depends on your child’s symptoms, age, and general health. It also depends on the cause of the situation, for example:

  • Bacterial infections: It is administered with antibiotic eye drops.
  • Viral infection: Viral conjunctivitis generally does not require treatment. In some cases, antibiotic eye drops can be used to prevent secondary infection.
  • Allergic reaction: Treatment of conjunctivitis caused by allergies generally involves treating the allergies. Your child’s primary care provider may prescribe oral medications or eye drops to help with allergies.
  • Herpes infection: If your child has an eye infection caused by a herpes infection, her paediatrician may refer her to an eye care specialist. You can give your child both oral medications and eye drops.

If the disease is affected by an infection, it is important to know that the disease can spread from one eye to another by touching the affected eye or the fluid that comes out of the eye. The infection can also spread to other people. Fluid from the eye comes out 24 to 48 hours after starting treatment.

To help prevent the spread of infection, you should wash your hands frequently while caring for your baby. Make sure your child does not touch her eyes. Your child should wash her hands often.

Prevention of conjunctivitis in children

Conjunctivitis spreads throughout the nursery or preschool. In some cases, the infection is passed on to the friends of young children, who pass it on to the child.

Common prevention strategies reduce the spread of infections and reduce the risk of recurrent conjunctivitis:

  • Encourage young children to avoid touching or rubbing their eyes.
  • Keep school children away from school with a fever or thick eye discharge.
  • Don’t share eye care products like contact lenses, glasses, or eye makeup. Encourage children not to share these products.
  • Practice washing your hands frequently.
  • Encourage children not to touch their friends’ faces.

Complications of conjunctivitis in children

Pink eye is a depressing condition, especially allergic conjunctivitis, but in most cases, it does not pose a serious health threat.

Complications of conjunctivitis are very rare, but when they do occur they are serious and include:

  • A severe case of allergic conjunctivitis can lead to scarring of the eye
  • In cases of infectious conjunctivitis, the infection can spread to other parts of the body and trigger more serious secondary infections, such as meningitis.

When to contact the doctor

  • Worsening drainage or discharge from the eye
  • Fever in addition to pink eye
  • Blistering or rash on the eyelids
  • Severe light sensation or pain
  • Vision problems
  • Any injury to the eye
  • Symptoms that do not change within a week.

What Is A Pediatric Ophthalmologist? | Ophthalmology

Pediatric ophthalmologist

Pediatric ophthalmology is a subspecialty related to visual improvement, eye diseases, and vision care in children. If your child has an eye problem, has difficulty reading, or needs surgery or medical treatment for a disease that affects the eyes, a pediatric ophthalmologist will have the experience and qualifications to treat your child.

Reasons to visit a pediatric ophthalmologist

Early detection of eye problems can protect your child’s vision. There are warning signs your child may have an eye problem:

  • Persistent watery eyes
  • Frequent eye rubbing
  • Sensitivity to light
  • A white or yellow substance in the pupil (lack of red reflex)
  • Redness that does not go away
  • Pus or crust in the eyes
  • Crossed or wandering eyes
  • Squinting
  • Frequent head tilting or face turning
  • Drooping eyelids or bulging eyes
  • Eyes moving back and forth involuntarily

Conditions pediatric ophthalmologists treat

Pediatric ophthalmologists treat children who have eye diseases such as:

  • Amblyopia (lazy eye)
  • Anisometropia: Unbalanced focus in a person’s eyes.
  • Congenital cataracts: Cataracts that happen in newborns
  • Dissociated vertical deviation: One eye that drifts gently upward
  • Drooping eyelid (ptosis)
  • Esotropia: One or both eyes that change inside, sometimes called crossed eyes
  • Exotropia: One or both eyes that turn outward
  • Ocular infections: Bacterial, viral, or fungal infections in the eye, eyelid, or enclosing areas
  • Ocular trauma: Injury to the eye, eyelid, or enclosing areas
  • Retinopathy of prematurity: Eye disorder of the retina (back layer of the eye) that essentially affects premature babies.
  • Strabismus: Misalignment of the eyes, either higher, downwards, outside, or inside, which can sometimes occur in adults or not be diagnosed until adulthood.
  • Superior oblique palsy: Disorder of the fourth cranial nerve that causes instability in the eye muscle (superior oblique), occurring in misaligned eyes.
  • Uveitis: Group of inflammatory conditions that effects swelling in the middle layer of the eye and can begin vision loss.
  • Refraction (vision) errors such as nearsightedness, farsightedness, and astigmatism

What kind of tests do pediatric ophthalmologists perform?

Vision Assessment: Special skills are required to assess a child’s vision, especially in preschool-age children. Different methods are used for different ages.

Refractive error diagnosis (need and resistance of glasses): This test is performed after an eruption in most pediatric patients to confirm objective measurement.

Mobility tests: Quantitative measurements of ocular misalignment are required to plan the medical and surgical treatment of strabismus.

Biomicroscopy and dilated fundus tests: These are required to investigate the behaviour of eye diseases related to diabetes, juvenile idiopathic arthritis, genetic abnormalities, neurological pathology (increased intracranial pressure), as well as systemic conditions such as cataracts and specific eye conditions and glaucoma.

Testing under anaesthesia (AUS): This may be necessary to diagnose and/or treat conditions in patients who are not allowed to perform proper tests/treatments in the workplace.

Monitor diseases over time and determines if treatment is working properly and make any necessary changes.

What kind of treatments do pediatric ophthalmologists provide?

Pediatric ophthalmologists can diagnose, treat, and control all children’s eye problems. Pediatric ophthalmologists generally provide the following services:

  • Eye exams
  • Perform surgery, microsurgery, and laser surgery (for obstacles like weak eye muscles, crossed eyes, wandering eyes, blocked tear ducts, retinal problems, and diseases)
  • Diagnose problems of the eye affected by diseases of the body such as diabetes or juvenile rheumatoid arthritis (JRA) and other medical and neurological diseases.
  • Diagnose visible processing disorders
  • Care for eye injuries

What kind of procedures done by pediatric ophthalmologists?

Surgical procedures conducted by pediatric ophthalmologists, which include:

  • Strabismus surgery: eye muscle surgery to repair misaligned eyes, crossed eyes, or walleyes.
  • Blocked tear duct surgery: an outpatient procedure performed to address blocked tear ducts in children.
  • Pediatric cataracts (cataract is either congenital/infantile and acquired/juvenile).
  • Glaucoma cataract extraction: pediatric cataract extraction and replacement with intraocular lenses (IOL’s) in patients with glaucoma.
  • Chalazion (eyelid cysts) excision: excision of a chalazion (eyelid cyst) and stye (eyelid margin cyst).
  • Congenital ptosis (drooping eyelids) surgery.
General Topics

About Eye Problems In Children | Ophthalmology

Eye problems in children

There are many types of eye problems and diseases that can affect a child’s vision. If an eye condition is suspected or if the child fails a vision test, he should be referred to a pediatric ophthalmologist for further evaluation and diagnosis. Early detection and treatment are important to prevent lifelong vision defects.

There are some types of eye problems in children:

1. Astigmatism

Astigmatism, a common eye problem in children is a refractive disorder that affects the shape of the cornea or lens. For near and far objects, vision can be blurred because the affected eye does not focus. Astigmatism coexists with both myopia and hyperopia and should be corrected as soon as it is diagnosed.

Diagnosing astigmatism in children is difficult because children with astigmatism sometimes do not recognize the ambiguity they need to see as a notification condition. Comprehensive eye exams are needed to make a proper diagnosis and rule out other eye problems.

Treatment for astigmatism

The goal of astigmatism treatment is to improve visual acuity and eye comfort. Treatments are corrective lenses or refractive surgery.

Eyeglasses: Glasses are made with lenses that help replace the asymmetrical shape of your eye. Lenses allow light to tilt your eye correctly. Glasses can also correct other refractive errors such as myopia or hyperopia.

Contact lenses: Some people have better vision with contact lenses instead of glasses. Contact lenses can provide clear vision and panoramic vision. However, since contact lenses are worn directly on the eyes, regular cleaning and care are required to maintain eye health. Regular soft lenses may not be effective in improving astigmatism.

Special toric soft contact lenses can be adjusted for a wide variety of astigmatism. Because rigid gas permeable contact lenses maintain their regular shape while on the cornea, they can replace the irregular shape of the cornea and improve vision for people with astigmatism.

Orthokeratology: Orthokeratology (ortho-K) involves fitting a series of rigid contact lenses to redesign the cornea. The patient uses contact lenses for a short time, such as at night, and then separates them.

People with moderate astigmatism may temporarily have clear vision without glasses for their daily activities. Orthokeratology does not permanently improve vision. If patients stop wearing retinal lenses, their vision can return to its original state.

Laser and other refractive surgeries: Performed with LASIK laser technology (photorefractive keratectomy) or manual incisions (radial keratotomy), which rescue the cornea by removing small pieces of tissue from the cornea.

2. Cataract

Cataracts are one of the common eye problems in children caused by cloudy spots that develop on the lens of the eye. Children experience cataracts as blurred vision, which affects their development and leads to permanent vision loss. The lens is inside the eye, back the iris. Pediatric cataracts can occur in one or both eyes.

Treatment for cataract

Treatment depends on your child’s symptoms, age, and general health. It also depends on the hardness of the situation. Treatment will be determined by your child’s healthcare provider based on your child’s cataracts.

In some cases, your child may require glasses or contact lenses. This will help your child look better. Most children older than 1 year will need surgery to remove the cataract and a new lens will be inserted.

3. Ptosis

Ptosis, one of the common eye problems in children is a narrowing of the upper eyelid. The eyelid is only slightly lowered or it may completely cover the pupil or eye. Ptosis affects one or both eyelids. In some cases, ptosis can limit and prevent normal vision. Sometimes there is congenital ptosis; In other cases, it occurs later in life due to injury or illness.

Treatment for ptosis

Eyelid lift surgery repairs the upper eyelids.

  • If vision is not affected, surgery can wait for 3 to 4 years for the child to grow a little.
  • In severe cases, immediate surgery is needed to prevent “lazy eye” (amblyopia).

The provider also treats any eye problems caused by ptosis. Your children may need:

  • Wear an eye patch to strengthen vision in the weak eye.
  • Wear special glasses to correct the irregular curve of the cornea that causes blurred vision (astigmatism).

Children with mild ptosis should have regular eye exams to prevent the development of amblyopia.

Surgery works well to improve the appearance and function of the eye. Some children require more than one surgery.

4. Hyperopia

Farsightedness, one of the common eye problems in children appears to be a refractive error, so the image is centered behind the retina, and vision is blurred. The cause may be in the eyeball or the optical power of the cornea and lens may be less than necessary. There is also a specific genealogical component.

Treatment for hyperopia

Hyperopia can be treated with corrective contact lenses or protective glasses. Alternatively, eye surgery can be very effective for the right candidates.

  • Conventional correction: Glasses or contact lenses in the form of positive lenses.
  • Surgical correction: The two surgical procedures available are laser eye surgery and clear lens removal. The latter is similar to cataract surgery but involves the removal of a clear lens (without cataracts).

If your hyperopia treatment is a surgical correction, it is important to speak with your eye surgeon about your choice. Your age, the severity of your hyperopia, the thickness of your corneas, and whether you have other eye conditions are many factors to consider.

5. Glaucoma

Glaucoma, one of the common eye problems in children is a disease that affects the optic nerves of the eye. This usually happens when fluid forms in front of your eye. That excess fluid increases the pressure in the eye and damages the optic nerve.

Symptoms start very slowly, you may not notice them. The only way to know if you have glaucoma is a comprehensive dilated eye exam.

Treatment for glaucoma

Doctors use a variety of glaucoma treatments, including medications (usually eye drops), laser treatment, and surgery.

  • Low pressure by reducing the amount of fluid produced in the eye, in the form of medications, eye drops, or tablets, and increasing drainage. One or more drugs can be used simultaneously.
  • Laser therapy to reduce pressure in the eye is done on a patient basis. A method called laser trabeculoplasty increases fluid drainage in patients with open-angle glaucoma. people with angle-closure glaucoma must be treated with a procedure commonly called laser iridotomy, which creates a small opening (part of the color of the eyes) in the iris that allows the drainage angle to open.
  • Surgery may be necessary to create a second drainage path in the eye to support the natural ones. Glaucoma surgery is usually performed on a patient-by-patient basis under local anesthesia and can allow the patient to reduce or eliminate glaucoma medication.

For more advanced cases, an artificial glaucoma drainage implant can help reduce stress. The implant helps drain excess fluid that builds up in the body.

6. Strabismus

Strabismus, one of the common eye problems in children also known as hypertrophy and crossed eyes, is a misalignment of the eyes, causing one eye to point toward the nose (esotropia) or outward (exotropia), while the other eye is centered.

Misalignment occurs once in newborns, especially if they are tired, they should get over it by the age of three months. In children, uncorrected strabismus can lead to amblyopia, in which case the brain begins to ignore the weak and misaligned signals sent by the eyes, which can lead to vision problems.

Treatment for strabismus

A complete vision evaluation is important to accurately diagnose strabismus (and/or amblyopia). Some types of strabismus are visually recognizable, but the test should include a thorough assessment of the visual system, including a binocular vision assessment to see how the eyes focus and move. Assessing visual acuity alone is not enough. You can expect your ophthalmologists to take a complete history.

It is common to test near and far acuity when evaluating the general health and structure of the eye. The doctor will make a cover to specifically test and diagnose strabismus. Test (also known as the coverage test), as well as the Hirschberg test (also known as Hirschberg corneal reflex test).

7. Amblyopia

Amblyopia, one of the common eye problems in children is when the vision in one or both eyes does not develop properly in childhood. This is sometimes called laziness. Amblyopia is a common problem in infants and young children.

A child’s vision develops during the first years of life. It is necessary to diagnose and treat amblyopia as soon as practicable. Otherwise, a child with amblyopia will not develop a normal, healthy vision.

Treatment for amblyopia

The earlier amblyopia is detected and treated, the better the outcome for the child. Treatment depends on the type of amblyopia the child has and how severe it is.

Glasses / Contact lenses: Corrective glasses or contact lenses are indicated if you have amblyopia because you are nearsighted or farsighted, or astigmatism in one eye.

Eye patch: Wearing a patch over your dominant eye can help strengthen your weak eye. Your doctor may recommend that you wear a patch for 1 to 2 hours a day, depending on the severity of your amblyopia. The patch helps develop the area of the brain that controls vision.

Eye drops: You can use eye drops once or twice a day to cloud your vision in your good eye. Like an eye patch, it encourages your weaker eye to wear more. It is an alternative to the patch.

Surgery: If you cross your eyes or your eyes point in opposite directions, your eye muscles may need surgery.

8. Pink eye

Pinkeye, one of the common eye problems in children is the common name for conjunctivitis, which causes inflammation and redness of the lining of the eye. The pinkeye can be caused by viruses, bacterial infections, allergies, or chemical factors. Sometimes it is the result of a chronic illness. Most commonly, the viral or bacterial infection causes pinkeye.

Treatment for pink eye

Treatment may include antibiotic eye drops or ointments and depending on the type of pinkeye.

Purulent pinkeye with a pink or red eyeball, white or yellow discharge, red or sticky eyelids, and eye discomfort usually caused by bacteria. It can be treated with antibiotics (eye drops or ointments) to prevent the disease from spreading to other people.

Non-purulent pinkeye, where the eyeball is pink or red, but the discharge is clear or watery, with only slight or uncomfortable. It usually causes a virus or other irritation (such as an allergy or exposure to a chemical such as chlorine in a swimming pool). The antibiotic drop does not work for this type of pinkeye.

9. Uveitis

Uveitis, one of the common eye problems in children is an inflammation of the uvea (or uveal membrane), the three middle layers that make up the eye. It can be contagious or contagious. It is a treatable condition; However, without proper treatment, it can lead to other problems such as glaucoma, cataracts, optic nerve damage, retinal detachment, and severe vision loss.

Treatment for uveitis

Steroids are the main treatment for uveitis. This will help reduce the inflammation inside your eye.

Different types of steroid medications are recommended depending on the type of uveitis. For example:

  • Eyedrops are often used for uveitis that hits the front of the eye.
  • Injections, tablets, and capsules are usually used to treat uveitis that affects the middle and back of the eye.

Additional treatment may also be necessary. They can be eye drops to reduce pain or, in some cases, surgery.


Overview of Neuro-ophthalmologist | Ophthalmology

What is a neuro-ophthalmologist?

Neuro-ophthalmologist is a super specialty that integrates the fields of neurology and ophthalmology. Neuro-ophthalmologists are qualified for the diagnosis and control of several systemic diseases of the nervous system that affect vision, eye movements, and alignment, as well as pupillary reflexes.

Neuro-ophthalmologists receive specialized training and experience in eye, brain, nerve, and muscle problems. These physicians complete at least five years of clinical training after medical school and normally receive a board certificate in neurology, ophthalmology, or both.

Neuro-ophthalmologist has unique abilities to diagnose and treat a wide variety of problems in patients from a neurological, ophthalmological, and medical point of view. Expensive medical exams are often avoided by consulting a neuro-ophthalmologist.

What are the conditions treated by neuro-ophthalmologists?

Conditions that are treated by a neuro-ophthalmologist, which include:

  • Blepharospasm: Unlimited blinking, squeezing, or closing of the eyes
  • Brain tumors or strokes that affect vision
  • Defects in the visual field
  • Double vision
  • Droopy eyelids
  • Eyelid or facial spasms
  • Headache and migraines
  • Idiopathic intracranial hypertension
  • Involuntary eye movement, including nystagmus (also known as “dancing eyes”):  Unusual condition in which the eyes move rapidly in a reversible pattern – sideways, up or down, or in a rotating pattern. This can significantly reduce vision, either temporarily or permanently. It can be inherited or caused by metabolic or neurological problems, including multiple sclerosis, and sometimes in people with an inner ear problem.
  • Microcranial nerve palsy
  • Myasthenia gravis
  • Optic neuritis or neuropathy
  • Pseudotumor cerebri
  • Unequal pupils
  • Unexplained vision loss

Neuro-ophthalmologist tests

Neuro-ophthalmology testing starts with a careful review of the patient’s difficulties and related problems, followed by an evaluation of vision and eye movements, usually with visual acuity, color vision, and visual field tests. The eyes are examined under a microscope (slit lamp) with special attention to the optic nerve and the retina. In most cases, dilating drops are given to enhance the testing of these important structures. Eye movements are also evaluated, which may include the use of prismatic lenses and special graphics.

Also, the pressure and size of each eye can be examined. For unequal students, points can be assigned to identify the cause of the problem. Visual field testing is done using a machine that displays lights in different areas, but the patient presses a button to detect each light and assesses patterns of visual field damage leading to diagnosis. Lastly, neuro-ophthalmologists sit down with their patients to discuss their disease and possible treatments or management strategies.

Whats are the treatments done by neuro-ophthalmologists?

Treatment depends on the specific type of disorder being diagnosed but includes vision restoration therapy (VRT). VRT is a non-invasive treatment that helps repair vision loss as an outcome of a traumatic brain injury such as a stroke. Using a specially designed computer device, VRT promotes visual stimulation to increase visual activity in the brain. This has helped some patients to lose their vision.

After making an appointment, you should be ready to see a neuro-ophthalmologist. The test begins with a complete review of your problems. Your vision is then checked, which often includes visual acuity, visual field tests, and color vision. Eye movement is also assessed using prismatic lenses and graphics.

You can also go through a CT scan or MRI to check if the brain is damaged. Some common diseases and their treatments:

Optic neuritis: This is a condition of a sudden loss of vision, which can be due to information from the optic nerve. It is usually caused by an infection and is associated with multiple sclerosis. If you have optic neuritis, your neuro-ophthalmologist will use antibiotics and corticosteroids appropriately, which can help clear the infection and prevent further damage.

Papilloma: Characterized by inflammation of the optic nerve and can be easily detected by a doctor during an evaluation of the retina. It is usually due to increased pressure in the brain and may be due to a tumor or infection.

If it is due to stress, then medications are used to shrink the joint within the skull, but due to this ridiculous enlargement, you may need surgery.

Nutritional optic neuropathy: In this case, the toxins found in tobacco alcohol can damage the optic nerve. It is also caused by a lack of various nutrients and a deficiency of the vitamin B complex. Your neuro-ophthalmologist will prescribe vitamins and lifestyle changes.

Diabetic retinopathy: The cause of this disease is usually diabetes, and if diabetes is not diagnosed, it is advisable to control and treat diabetes before further damage to the blood vessels occurs.

What are the services given by neuro-ophthalmologists?

Your care begins with a detailed evaluation. Our neuro-ophthalmologist takes a close look at the interactions between the eyes and the brain, getting to the root of the problem. We recommend personalized treatments to restore vision. If other treatments are unsuccessful, we will not stop until you have the relief you need.

Your care may include:

  • Special Exam – You have access to the latest imaging technologies, including ocular coherence tomography (OCT). This test uses light waves to examine the layer of tissue in the eye through layers. We are also one of the few multifocal electrocardiogram (ERG) programs offered locally to detect retinal problems.
  • Medications: If you have symptoms due to an infection, you may feel better after taking antibiotics. If you experience inflammation, you may need a stronger dose of steroids.
  • Surgery: If surgery is required, you have access to all available surgical treatments. Our neuro-ophthalmologist will perform some procedures. You may also receive care from other members of the Storm Eyes team, including specialists in reconstructive eye surgery.
  • Low vision therapy: If other treatments don’t relieve symptoms, you have no choice. Our team includes optometrists and therapists who improve the rest of their sight for those with partial but permanent loss of vision (low vision).
General Topics

Overview of Cardiovascular Endocrinology | Endocrinology

What is cardiovascular endocrinology?

Cardiovascular endocrinology and metabolism publish peer-reviewed research on vascular disease, endocrinology, diabetes, and metabolism. Special emphasis will be placed on studies that illuminate the interplay between these disciplines and enhance effective collaboration between cardiologists, endocrinologists, and diabetologists.

The journal serves as a unique resource for the clinical and research communities specializing in cardiology, endocrinology, diabetes, and metabolism. High-quality, cutting-edge reviews, guest editorials, and expert commentary keep original articles relevant in the context of the basic and clinical research interface.

Hormones processed by the endocrine system play an important role in many parts of the cardiovascular system. Some hormone-lapsing properties accelerate high cholesterol and increase circulatory stress. After some time, these problems can be counted as a major risk factor for heart attack and stroke. Research on ways to detect hormones with the heart and veins is known as cardiovascular endocrinology.

Symptomatic patients

Cardiovascular endocrinology disease patients should be evaluated for typical or distinctive cardiac symptoms as predicted by history or for patients with abnormal resting EKG for additional heart disease.

Patients with a normal and achievable resting electrocardiogram should be assigned a stress ECG stress test, but given the wide availability and greater specificity of the ECG stress test when combined with the imaging method, the stress test Exercise ECG should be used primarily to assess exercise response and function as an indicator of general prognosis.

For CAD diagnosis, radionuclide SPECT myocardial perfusion imaging and stress echocardiography have a sensitivity (approximately 90%) and specificity (approximately 50%) similar to coronary artery stenosis (greater than 70% defined as stenosis in one vessel) And you can use the modality according to absolute and relative anti-patient indications and the experience of the local operator.

Exercise should be the preferred stress method in all types of tests because the patient’s response to exercise has prognostic value. Poor diagnostic indicators include the inability to exercise beyond 5 METS, decrease in systolic blood pressure with exercise, development of exercise-induced angina, and chronotropic dysfunction (inability to adequately increase heart rate in response to exercise). If the patient cannot exercise, pharmacological stress should be used.

Diagnosis of cardiovascular endocrinology disease

Asymptomatic patients: CT angiography (CCTA), 2017 ADA standards for patients with diabetes who have asymptomatic CAD and rates of silent ischemia compared to the general population, with routine testing for CAD, either by exercise or drug stress testing or with new methods such as coronary artery calcium score (CACS) or coronary. Not recommended in asymptomatic patients under CARE (Level A recommendation).

This recommendation is mainly based on the results of randomized trials evaluating the role of myocardial perfusion imaging (MPI) in the detection of ischemia in asymptomatic diabetics (DIAD). The main results of this trial are:

  • Silent ischemia was found in only 22% of patients. Most patients have mild perfusion abnormalities that are not suitable for reuse, And perfusion defects cannot be easily detected by a simple risk factor analysis.
  • Although the prevalence of myocardial ischemia has not increased over time, many perfusion disorders have resolved with current appropriate medical treatment.
  • Although a high-risk screening group was identified with MPI, the screening results did not change favorably.

Based on these results, and because aggressive medical treatment in diabetes (CC equivalent) is already warranted, the use of screening tests to identify patients with evidence of CAD may alter the clinical management of diabetic patients. asymptomatic and unlikely to effectively affect your overall prognosis.

Laboratory tests and key images

Laboratory evaluation: The American Diabetes Association (ADA) recommends the following laboratory tests:

The fasting lipid panel, including HDL, LDL, triglycerides, and total cholesterol levels, should be assessed at the time of diagnosis, at the initial medical evaluation, and at least once every 5 years. The lipid panel should also be obtained immediately before starting statin therapy. After a patient has taken statins, individual LDL cholesterol testing may be considered (eg, to monitor adherence and efficacy).

Hemoglobin a1c: The ratio of serum creatinine and urinary albumin/creatinine if the urine dipstick is negative for proteinuria.

  • Liver function tests.
  • Thyroid function tests.

Disease management and treatment

Treatment of cardiovascular disease risk factors in a diabetic patient Common conditions that coexist with diabetes, such as hypertension and dyslipidemia, are more likely to increase the risk of cardiovascular disease in this patient population, and treatment that aggressively addresses these comorbidities in diabetic patients should follow an approach globally.

Blood pressure: Blood pressure is a common comorbidity of diabetes and contributes to an increased risk of both microvascular and macrovascular disease. The control of blood pressure (BP) in diabetic patients should follow the recommendations of the ADA. Blood pressure (BP) should be less than the target of 140/90 mm Hg (level A recommendation).

Low systolic and diastolic blood pressure targets, such as 130/80 mmHg, may be appropriate for those at risk for cardiovascular disease if they can be achieved without unnecessary treatment burden (level C recommendation).

Diabetic patients with BP greater than 140/90 mm Hg should begin drug therapy in conjunction with lifestyle changes, preferably with a regimen that has been shown to reduce cardiovascular events, such as ACE inhibitor, angiotensin II receptor blocker (BRA), thiazide. The diuretic or dihydropyridine is similar to the calcium channel blocker and should contain multiple pharmacological agents (level A recommendation; trial evidence: Advance, ACCOMPLISH, HOT, ACCORD) if necessary to obtain target blood pressure.

For patients with blood pressure> 120/80 mmHg, lifestyle intervention may include weight loss if they are overweight or retarded; Dietary Approaches to Stopping Blood Pressure (DASH) – Diet-style approach, such as reducing sodium and increasing potassium intake; Control of alcohol intake; And more physical activity (level B recommended).

Dyslipidemia: The higher prevalence of lipid abnormalities in diabetic patients contributes to the increase in cardiovascular disease observed in these patients. Is lifestyle change an important part of lipid management in diabetic patients and reducing the intake of saturated fat, trans fat, and cholesterol and increase in diet? -3 Intake of fatty acids, viscous fiber, and plant stanols/sterols, as well as weight loss and increased physical activity (Level A recommendation).

Statin therapy: All diabetic patients with overt atherosclerotic cardiovascular disease (ASCVD) or older than 40 years should be treated with statins for additional risk factors for ASCVD regardless of baseline lipid levels. The severity of early statin therapy should be based on age, not on ASCVD or LDL levels, but the underlying risk determined by risk factors for ASCVD.

  • For patients of all ages with diabetes and atherosclerotic cardiovascular disease, high-intensity statin therapy should be included in lifestyle therapy (level A recommendation).
  • For patients with diabetes over 40 years of age with additional factors of atherosclerotic cardiovascular disease, consider the use of moderate or high-intensity statins and lifestyle therapy (level C recommendation).
  • For patients with diabetes ages 40 to 75 without additional atherosclerotic cardiovascular disease factors, use moderate-intensity statins and lifestyle therapy (level A recommendation).
  • For patients with diabetes ages 40 to 75 with additional factors of atherosclerotic cardiovascular disease, use high-intensity statins and lifestyle therapy (level B recommendation).
  • For patients with diabetes older than 75 years without additional atherosclerotic cardiovascular disease factors, consider using moderate-intensity statin therapy and lifestyle therapy (level B recommendation).
  • For patients with diabetes older than 75 years with additional factors of atherosclerotic cardiovascular disease, consider using moderate or high-intensity statin therapy and lifestyle therapy (level B recommendation).

The severity of statin therapy should be adjusted based on the patient’s response to the patient’s medications (eg, side effects, tolerance, LDL cholesterol levels) (level E is recommended). At present, there are no reliable data on whether treatment with low HDL levels and high triglycerides can lead to a further reduction in CVD risk when targeting LDL statin therapy. Furthermore, combination therapy increases the risk of transaminitis, myositis, and rhabdomyolysis. Therefore, treatment with low HDL or elevated triglycerides is not recommended at this time.

Combination therapy (statin/fibrate) improves the outcome of atherosclerotic cardiovascular disease and is generally not recommended (level A recommendation). However, men with triglyceride levels> 204 mg / dL (2.3 mmol / L) and HDL cholesterol levels <34 mg / dL (0.9 mmol / L) (recommended level B) are considered to be treated with statins and fenofibrates.

Combination therapy (statin/niacin) has not been shown to provide additional cardiovascular benefit than statin therapy alone and increases the risk of stroke and is generally not recommended (level A recommendation). Agetimib has been shown to provide additional cardiovascular benefit in addition to moderate-intensity statin therapy compared to moderate-intensity statin therapy only in patients with recent acute coronary syndrome and LDL cholesterol> 50 mg / dL (1.3 mmol / L). It is also considered in these patients (level A recommendation) and patients with diabetes and a history of intolerance to high-intensity statin therapy (level E recommendation).

Patients with severe hypertriglyceridemia (fasting triglyceride levels> 500 mg/dl or 5.7 mmol / l) may require medical treatment with fibrates, niacin, or fish oil to reduce the risk of pancreatitis (level C recommended).

Treatment for cardiovascular endocrinology disease in diabetic patients

Acute myocardial infarction (AMI) in diabetic patients

The presence or absence of diabetes should not affect the decision-making process regarding coronary perfusion in patients with AMI. In particular, in diabetic patients with ST-segment elevation myocardial infarction (STEMI), an immediate resuscitation strategy should be followed, preferably percutaneous coronary intervention (PCI) or thrombolytic therapy if PCI is not available promptly. However, diabetic patients do better with PCI compared to fibrinolysis.

  • Antiplatelet therapy
  • Antiplatelet therapy in the context of AMI
  • All patients with myocardial infarction should receive aspirin indefinitely, with or without diabetes.
  • In the context of PCI for NSTEMI or STEMI, a P2Y12 inhibitor such as clopidogrel, ticagrelor, or prasugrel should be administered in addition to aspirin, with a duration of P2Y12 inhibitory administration depending on the type of stent.
  • In patients with persistent, medically treated NSTEMI, the P2Y12 inhibitor, such as clopidogrel or ticagrelor, but not Prasugrel, should be administered with aspirin for at least 1 year.
  • In patients with diabetes and pre-myocardial infarction (1 to 3 years of age), the addition of ticagrelor to aspirin significantly reduces the risk of recurrent ischemic events, including death from heart and coronary disease.