Wednesday, May 7, 2014

Diabetes Of Mothers

What is gestational diabetes?

Media last reviewed: 11/04/2012
Next review due: 11/04/2014

Diabetes and your unborn baby

Diabetes is a condition in which the amount of sugar (glucose) in the blood is too high. Glucose comes from the digestion of starchy foods, such as bread and rice. Insulin, a hormone produced by your pancreas, helps your body use glucose for energy.
Three types of diabetes can affect you when you're pregnant. Type 1 diabetes and type 2 diabetes are long-term conditions that women may have before they get pregnant (pre-existing diabetes). Gestational diabetes develops only in pregnancy and goes away after the baby is born.

Type 1 diabetes

Type 1 diabetes develops when your body can't produce any insulin. It usually begins in childhood, and most women with type 1 diabetes will be aware of their condition before they become pregnant. People with type 1 diabetes need to take insulin to control their blood glucose.

Type 2 diabetes

Type 2 diabetes develops when your body can't produce enough insulin, or when the insulin that is produced doesn't work properly. It often occurs in overweight people and is usually diagnosed in women aged 40 or over. But it can happen at a younger age, particularly in Asian and black people.
You may be aware that you have type 2 diabetes before you become pregnant, or you may be diagnosed during your pregnancy. Type 2 diabetes can usually be treated with tablets to lower blood glucose, but in some pregnant women insulin injections are needed.

Gestational diabetes

Gestational diabetes only occurs in pregnancy. It can occur at any stage of pregnancy, but is more common in the second half. It occurs when your body can't produce enough extra insulin to meet the demands of pregnancy. Gestational diabetes goes away after you've given birth.
It is important to know that you're twice as likely to develop type 2 diabetes later in life if you have gestational diabetes when you're pregnant.
Having diabetes when you're pregnant can put you and your baby at risk of complications (see below). You can reduce this risk, but it partly depends on what type of diabetes you have.

If you already have diabetes

If you already have type 1 or type 2 diabetes, you may be at a higher risk of:  
People with type 1 diabetes may develop problems with their eyes (called diabetic retinopathy) and their kidneys (diabetic nephropathy), or existing problems may get worse.
Your baby may be at risk of:
  • not developing normally and having congenital abnormalities, particularly heart and nervous system abnormalities
  • being stillborn or dying soon after birth
  • having health problems shortly after birth (such as heart and breathing problems) and needing hospital care
  • developing obesity or diabetes later in life

Reducing the risks if you have pre-existing diabetes

The best way to reduce the risk to your own and your baby's health is to ensure that your diabetes is well controlled before you become pregnant. Ask your GP or diabetologist (diabetes specialist) for advice. You should be referred to a diabetic pre-conception clinic for support before you try to get pregnant. Find diabetes support services near you.
You should be offered a blood test called an HbA1c test, which helps to assess the level of glucose in your blood. It's best if the level is no more than 6.1% before you get pregnant. If your HbA1c is higher than this, there would be benefit from getting your blood glucose under better control before you conceive in order to reduce the risk of complications for you and your baby. Your GP or diabetes specialist can advise you how best to do this.

Folic acid

Women with diabetes should take a higher dose of folic acid. The normal daily dose for women trying to get pregnant and for pregnant women is 400 micrograms. Diabetic women should take 5 milligrams (5mg) a day. Your doctor can prescribe this high-dose folic acid for you. Taking folic acid helps prevent your baby from developing birth defects, such as spina bifida. You should take folic acid until you are 12 weeks pregnant.

Your treatment

Your diabetic treatment regime is likely to need adjusting during your pregnancy, depending on your needs. If you take drugs for conditions related to your diabetes, such as high blood pressure, these may have to be altered.
It's very important to keep any appointments that are made for you, so that your care team can monitor your condition and react to any changes that could affect your own or your baby's wellbeing.
Expect to monitor your blood glucose levels more frequently during pregnancy. Your eyes and kidneys will be screened more often to check that they are not deteriorating in pregnancy, as eye and kidney problems can get worse. You may also find that as you get better control over your diabetes, you have more hypoglycaemic (low blood sugar) attacks. These are harmless for your baby, but you and your partner need to know how to cope with them. Find out more about treating a hypoglycaemic attack, and talk to your doctor or diabetes specialist.

If you develop gestational diabetes

You're more likely to develop gestational diabetes if:
  • you're overweight, with a BMI (body mass index) above 30 (use the BMI healthy weight calculator, but note that this calculator is not suitable for use during pregnancy)
  • you've given birth to a large baby, weighing more than 4.5kg (9.9lb), in the past
  • you've had gestational diabetes before
  • you have a parent, brother, sister or grandparent with diabetes
  • your origin is south Asian, black Caribbean or Middle Eastern   
If you're in any of these higher risk categories, you should be offered a test to check for gestational diabetes. You may be given a home testing kit to check your blood glucose levels, or you may be offered an oral glucose tolerance test (OGTT or GTT) at 28 weeks or earlier.
A GTT test is a blood test that's done after a period of not eating. You'll be told how long not to eat for before the test (it's often overnight). You'll then be asked to have a glucose drink and take another blood test two hours later.
If you're diagnosed with gestational diabetes, you're at risk of: 
  • having a large baby, which increases the risk of a difficult delivery, having your labour induced or a caesarean section
Your baby may be at risk of: 
  • stillbirth
  • health problems shortly after birth (such as heart and breathing problems) and needing hospital care
  • developing obesity or diabetes later in life

Controlling gestational diabetes

Gestational diabetes can often be controlled by diet. A dietitian will advise you how to choose foods that will keep your blood sugar levels stable. You'll also be given a kit to test your blood glucose levels. If your blood sugar levels are unstable, or your baby is shown to be large on an ultrasound scan, you may have to take tablets or give yourself insulin injections.
Whatever type of diabetes you have, you will have more frequent – and sometimes time-consuming – antenatal appointments to check your and your baby's progress. You will be offered advice on diet and treatments to control your blood glucose levels.

Labour and birth

If you have diabetes, it's strongly recommended that you give birth with the support of a consultant-led maternity team in a hospital. Find out more about where you can give birth, including in hospital.
Babies born to diabetic mothers are often larger than normal. This is because blood glucose passes directly from you to your baby, so if you have high blood glucose levels your baby will produce extra insulin to compensate. This can lead to your baby storing more fat and tissue. This in turn can lead to birth difficulties, which requires the expertise of a hospital team.

After the birth

Two to four hours after your baby is born, they will have a heel prick blood test to check whether their blood glucose level is too low. Feed your baby as soon as possible after the birth (within 30 minutes) to help keep your baby's blood glucose at a safe level.
If your baby's blood glucose can't be kept at a safe level, they may need extra care. Your baby may be given a drip to increase their blood glucose. Find out more about special care for babies. 
When your pregnancy is over, you won't need as much insulin to control your blood glucose. You can decrease your insulin to your pre-pregnancy dose or, if you have type 2 diabetes, you can return to the tablets you were taking before you became pregnant. Talk to your doctor about this.
If you had gestational diabetes, you can stop all treatment after the birth. You should be offered a test to check your blood glucose levels before you go home and at your six-week postnatal check. You should also be given advice on diet and exercise.
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Diabetes Photos

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Sunday, May 4, 2014

Anemia

Welcome to the MNT Knowledge Center, your source for our most detailed content on specific conditions and subjects. Click through to Knowledge Center Home to read more.

What Is Anemia? What Causes Anemia?

Saturday 25 July 2009 - 12am PST
 
Blood / Hematology
Urology / Nephrology
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When the number of red blood cells or concentrations of hemoglobin are low a person is said to have anemia. Hemoglobin is a protein (metalloprotein) inside the red blood cells that contains iron and transports oxygen.

Anemia is the most common disorder of the blood. Approximately 3.5 million Americans are affected by it. It is much more common in developing countries, especially in very poor areas where people suffer from malnutrition. In many parts of Africa severe anemia is also caused by Malaria.

As many people who become infected with Malaria already have pre-existing anemia, most commonly due to malnutrition and helminthiasis (a disease caused by a parasitic worm), the problem is compounded.

There are hundreds of types of anemia, which is divided into three groups:

Excessive blood loss anemia

Chronic bleeding (long-term bleeding) is often undetected for a long time. The patient gradually loses blood, which means a loss of red blood cells and hemoglobin. Acute bleeding (not long term), can also reduce red blood cell count. Excessive blood loss can be caused by:
  • Stomach ulcers.

  • Hemorrhoids.

  • Inflammation of the stomach (gastritis).

  • Cancer - sometimes cancer of the stomach or colon can cause bleeding.

  • Some medications - NSAIDS (nonsteroidal anti-inflammatory drugs) if used for prolonged periods, or in high doses, can occasionally cause stomach bleeding.

  • Childbirth - childbirth often involves the loss of blood.

  • Menstruation - women who have very heavy periods (menorrhagia) have a higher risk of developing anemia.

  • Surgery

  • Trauma which results in bleeding, such as a car accident.

  • Blood donations - some regular blood donors may develop anemia.

Excessive red blood cell destruction (hemolysis) anemia

A red blood cell usually lives for 110-120 days, after which it breaks down and is removed by the spleen. Some illnesses and conditions cause red blood cells to die too early. When this happens the bone marrow has to make more red blood cells than normal. If the bone marrow cannot keep up with the needed red cell production caused by their early deaths, the red blood cell count will start to fall, leading to hemolysis (anemia caused by excessive red blood cell destruction)

The following can cause hemolysis:
  • Immune reactions
  • Infections
  • Some medications
  • Toxins (poisons)
  • Some medical procedures, such as using a heart-lung bypass machine, or hemodialysis (used by patients with kidney problems)

Decreased or deficient red blood cell production anemia

In this type of anemia the body either does not produce enough red blood cells, or they may not work properly. People with this type of anemia may have:
  • Sickle cell anemia - an inherited disorder which causes the red blood cells to have a crescent shape. The red blood cells break down rapidly, before sufficient oxygen and nutrients can reach vital organs.

  • Not enough iron (iron deficiency) - lack of iron is generally caused by poor diet, blood loss, or an inability to absorb sufficient iron from food. Anemia due to iron deficiency among pregnant women who do not take an iron supplement is common.

  • Not enough vitamins (vitamin deficiency) - such as vitamin B12, often caused because the stomach cannot produce enough of a substance called intrinsic factor. This intrinsic factor is vital for vitamin B12 to be absorbed from food and drink. People with anemia for this reason have pernicious anemia. The deficiency may be caused by poor diet.

    A high percentage of older women with anemia are not eating healthily, researchers from Tucson, Arizona, reported in the Journal of the American Dietetic Association (March 2011 issue).

    They found that anemia in older women was associated with poor consumption of vitamin B12, vitamin C, protein, energy, red meat and folate. They also found that the deficiencies in iron, folate, and vitamin B12 were each linked to a 10% to 20% higher risk of anemia - and a 21% higher risk of chronic anemia. They also found that smoking, BMI (body mass index) and age were linked to anemia risk.

  • Bone marrow problems - red blood cells are made in the bone marrow. If the bone marrow is faulty it may not be producing enough. This may be caused by a lack of vitamin B12, a serious bone marrow disorder (e.g. leukemia), long term inflammation (e.g. rheumatoid arthritis), or long term infection.

  • Some conditions/diseases - people with HIV/AIDS, rheumatoid arthritis, and Crohn's disease may have problems with adequate red blood cell production. Malaria causes anemia in millions of people worldwide. A protein produced by immune cells during malaria infection triggers severe anemia, researchers from Yale University discovered. Patients with chronic kidney disease often have low levels of erythropoietin (a hormone that stimulates the formation of red blood cells) and develop anemia. A study published by the Canadian Medical Association Journal reported that anemia may be beneficial to patients with inflammatory disease, and advocate restraint in treating mild to moderate forms of anemia.

  • Some medications - especially some cancer medications which are given in combination. A cancer drug,Avastin, given in combination with Sutent, is linked to microangiopathic hemolytic anemia, which is caused by by a build up of platelets and other organic obstructions on the inner walls of very small blood vessels. These shred healthy red blood cells as they pass through, eventually leading to a whole body shortage of them.

What are the symptoms of anemia?

People whose anemia develops gradually may have no symptoms for a long time. If it develops rapidly symptoms will usually be felt much sooner. Symptoms will vary according to the type of anemia, its underlying cause, and if there are any underlying health problems.

Below are some symptoms linked to anemia - tiredness and lethargy are the most common ones: Lethargy is a mental state while fatigue is a physical state. Lethargy may or may not be associated with physical symptoms. If somebody suffers from fatigue - is physically tired - it is not uncommon for his/her mental state to be affected as well.
  • Fatigue (tiredness)
  • Lethargy - sluggishness, apathy, a feeling of laziness
  • Malaise - a vague feeling that one is not well
  • Dyspnea - shortness of breath; difficult or labored breathing
  • Poor concentration
  • Palpitations - unpleasant irregular and/or forceful beating of the heart
  • Sensitivity to cold temperatures

    • The following symptoms are possible, but less common
  • Tinnitus (ringing in the ears)
  • Headache
  • Sense of taste is affected
  • Sore tongue
  • Dysphagia - difficulty is swallowing
  • Pallor (pale complexion)
  • Atrophic glossitis - very smooth tongue
  • Dry and flaky nails
  • Angular chelosis - ulcers in the corner of the mouth
  • Restless leg syndrome - this is more common among patients with iron deficiency anemia

    • The following symptoms are possible, but extremely rare
  • Swelling of the legs and/or arms
  • Chronic heartburn
  • Vomiting
  • Increased sweating
  • Blood in stools (feces)

How is anemia diagnosed?

A GP (general practitioner, primary care physician) will probably carry out a physical examination, order a blood test, and ask the patient some questions.
  • Blood test

    A blood test will measure the patient's red blood count and levels of hemoglobin. If the levels are low the patient has anemia. The blood test will also reveal whether the blood cells have an unusual shape, color or size. Patients with iron deficiency have smaller and paler red blood cells compared to healthy individuals. A patient with a vitamin deficiency will have fewer and larger red blood cells.

    Adults should have hematocrit values (red blood cell count) between 32% and 43%, and hemoglobin values from 11 to 15 grams per deciliter.

  • Some questions the doctor may ask

    The doctor will also try to find out what may be causing or contributing to the anemia by asking:

    • Diet - what the patient eats, and whether his/her diet includes enough vitamins and minerals, - especially iron and vitamin B12.

    • Medications - what drugs the patient has been taking, how often, for how long, and what doses.

    • Menstruation - whether periods are heavy (menorrhagia) and whether heavy periods have been happening for a long time.

    • Family history - whether any close relatives have/had anemia, blood disorders, or gastrointestinal bleedin/g. A close relative is usually limited to siblings and parents.

    • Medical history - whether the patient has a chronic disease.

    • Blood donation - whether the patient is a regular blood donor.
  • Physical examination

    • Rectal examination - a doctor may carry out a rectal examination to determine whether something in the gastrointestinal tract may be causing bleeding. GPs are used to doing this kind of examination. If an abnormality is detected the GP will refer the patient to a specialist (gastroenterologist).

    • Pelvic examination - if the GP suspects heavy menstrual bleeding may be causing the anemia he/she may carry out a pelvic examination. If the patient does not respond to iron supplement treatment and has heavy periods the GP may refer her to a gynecologist.

What is the treatment for anemia?

  • Iron deficiency - the GP will prescribe an iron supplement to restore body levels of iron. An example is ferrous sulphate, which is taken orally up to three times daily. Side effects, which are rare, may includediarrhea, constipation, stomach upset, and heartburn. Patients who find ferrous sulphate unsuitable may be given ferrous gluconate, which is less likely to have side effects but takes longer to work.

  • Diet - patient's whose diets are found to be lacking in iron will be encouraged to consume plenty of iron-rich foods, such as dark-green leafy vegetables, artichokes, apricots, beans, lentils, chick peas, soybeans, meat, nuts, prunes, and raisins.

  • Underlying causes - if there is an underlying cause for the anemia this must be treated. If non-steroidal anti-inflammatory drugs (NSAIDs) are found to be a contributory factor the doctor will prescribe an alternative medication.
The doctor will ask the patient to return a few weeks later to check that the treatment is working. If treatment has not worked the doctor will try to find out whether any undesirable side-effects may have made the patient stop taking the iron supplements.

What are the complications of anemia?

  • Pregnancy

    Pregnant women who are severely anemic have a significant risk of complications, especially when they give birth and afterwards. Giving birth often involves losing blood; being anemic already and then losing blood can result in serious complications. If a mother is severely anemic her baby is much more likely to be born prematurely and underweight. Babies born to mothers with anemia are much more likely to have problems with anemia themselves later on in infancy.

  • Fatigue

    Fatigue may have a considerable impact on the quality of life of the patient. If the anemia is severe the patient may feel too tired to work, or carry out essential daily tasks. Long-term fatigue may eventually lead to clinical depression.

    Researchers from Wake Forest University Baptist Medical Center found that elderly people with anemia have more disabilities and score lower on physical performance and strength tests than those without anemia.

  • Susceptibility to illness and infection

    People with untreated anemia are more susceptible to illness and infection, compared to healthy people.

  • Heart Problems

    The heart needs to pump more blood to make up for the lack of oxygen and nutrients if you are anemic. This can eventually lead to congestive heart failure.

    Researchers from Charles Sturt University found that the presence of anemia in patients with chronic heart failure is associated with a significantly increased risk of death.

  • Nerve damage

    Lack of vitamin B-12, one of the causes of anemia, can result in nerve damage. Good nerve function requires an adequate supply of vitamin B-12.
Written by Christian Nordqvi
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Eperythrozoonosis


(365) Eperythrozoonosis is caused by a small ricketsial bacterium called Eperythrozoon suis (Epe) which attaches itself to the red cells in the blood, damaging them and causing them to break apart. This causes an anaemia associated with a reduction in the number of red blood cells and haemoglobin the substance by which oxygen is transported around the body. When large numbers of red cells are damaged, jaundice may result.
The disease is somewhat of an enigma because the organism can be identified both in normal animals and in those severely affected with disease. It is likely that Epe is very widespread and most sources of pigs examined (varying health status) have shown evidence of the bacteria.
In the majority herds where it has been identified there have been no clinical problems and the significance therefore of the organism in relation to infection in these cases must be in doubt. However, in the past two years a positive diagnosis associated with disease has become more common. Epe can cross the placenta and be responsible for poor pale pigs at birth and high pre-weaning mortality.
Clinical signs
Epe affects all classes of pigs from sows and piglets through to weaners and growers. Clinical pictures vary, particularly if there are secondary infections involved. It is useful however, to look at the clinical symptoms in acute and chronic disease. In piglets and weaners the acute disease is manifest by primary anaemia and secondary infections, whilst the more chronic picture appears related to slow growth, variable growth rate and poor-doing pigs. The chronic symptoms in sows are associated with reproductive failure and if there is stress at farrowing, fevers and agalactia may be experienced.
If pale anaemic pigs are evident during sucking or in the immediate post-weaning period and an injection of iron has been given, the possibility of Epe should be considered.

Diagnosis
The presence of the organism does not necessarily confirm disease. The following need to be considered to clarify the relationship between Epe and disease.
  • The presence of pale and anaemic pigs.
  • The identification of the organism in blood smears stained with Wright's stain. Fifty microscopic fields should be examined before a negative diagnosis is arrived at.
  • The clinical picture on the farm should include lowered reproductive performance.
  • Jaundice, particularly in young growing pigs from 7 to 21 days of age.
  • Serological tests are being developed including an ELISA but at the time of writing they are still unreliable.
  • Eliminate other causes of anaemia.
  • Blood samples should be examined for packed cell volume (PCV) and haemoglobin levels. In normal pigs the mean PCV would be around 35% and in clinically affected pigs 24%. Haemoglobin levels would normally range from 9 to 14g per 100ml but in anaemic pigs they would be as low as 3 to 7g per 100ml.
Similar diseases
  • Actinobacillus pleuropneumonia.
  • Chronic respiratory disease complexed with PRRS and influenza.
  • Glässer's disease - Haemophilus parasuis.
  • Iron / copper anaemia.
  • Leptospirosis (L. icterohaemorrhagiae and L. canicola).
  • Malabsorption and chronic enteritis.
  • Pale piglet syndrome - haemorrhages.
  • Porcine enteropathy (PE, NE, PHE and PIA).
Treatment
Consider the following and discuss with your veterinarian:
  • The response to treatment is not very good.
  • Inject piglets with oxytetracycline at 10mg/kg daily for 4 days or use long-acting preparations, three injections each two days apart.
  • In-feed medicate sows at 800gms/tonne of OTC for 4 weeks and repeat again 4 weeks later.
  • Arsanilic acid in-feed at 85gms/tonne is reported to have an effect but in many countries there is no licensed product in food producing animals. Where it is available it is probably the medicine of choice.
  • The response to other medicines is poor.
Management control and prevention
Epe suis is spread by inoculation (including inoculation by insects). In a problem herd it is important to eliminate possible methods of spread including:-
Sows
  • Vaccinating sows with the same needle - Wipe the needle between inoculation with cotton wool well dampened with surgical spirit and change every third sow.
  • Tagging gilts - Wash the applicators between animals or hold three pairs in an antiseptic solution and rotate.
  • Eliminate lice or mange mites.
  • Prevent or control fighting, vulval and tail biting etc.
  • Do not feed back placenta or farrowing house material.
  • Control biting insects.
  • Control internal parasites.
  • Wear plastic arm sleeves when attending a farrowing.
Piglets
  • Spread occurs during tailing, teething and iron injections.
  • Control as for sows.
Weaners and growers
  • Prevent fighting at weaning. Reduce mixing.
  • Prevent tail biting and vice.
  • Reduce mixing and use Stresnil to prevent fighting.
  • Prevent spread through vaccination and inoculations between pigs.
  • Control biting insects.
  • Control respiratory diseases.
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Anemia


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Friday, May 2, 2014

Cardialogy Heart


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Funny mouse


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