Response from Dr. David Bruining, Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA:

While ulcerative colitis currently has no medical cure, there are many effective therapies to control symptoms. The causes, diagnosis and treatment of inflammatory bowel diseases are issues that are investigated extensively. The results of these studies may help scientists discover new ways to better control the ulcerative colitis.

Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation in the colon. When only involves the rectum, the condition is called ulcerative proctitis. The signs and symptoms of ulcerative colitis vary, depending on the extent and severity of the disease. The signs and symptoms are rectal bleeding, pain, bloody diarrhea and abdominal cramps. In some cases, ulcerative colitis may also cause inflammation in other organs, such as joints, eyes and skin.

The cause of ulcerative colitis is uncertain. Many scientists believe that damage to the tissues of the digestive system of people with ulcerative colitis is the result of a dysregulated immune response or inadequate. In other words, ulcerative colitis may be an autoimmune disorder in which the immune system attacks its own tissues and organs, causing inflammation and damage.

The first step in the treatment of ulcerative colitis, are usually the drugs that control inflammation. For people who suffer from proctitis, mesalamine (also known as 5-aminosalicylic acid or 5-ASA) can usually relieve the symptoms and signs either of the disease. Other common medications for ulcerative colitis are drugs that reduce inflammation by suppressing the immune system, such as prednisone, azathioprine, 6-mercaptopurine and infliximab. In severe cases of ulcerative colitis unresponsive to medical treatment, surgery is an alternative and usually involves removing the entire colon to create an internal pouch that connects to the anus, allowing normal transit stool toward the rectum.

There are many studies that examine the inflammatory bowel diseases and the results of these studies may impact on the control of ulcerative colitis. A recent large clinical trial focused on Crohn’s disease (another type of inflammatory bowel disease), for example, found that the mixture of two drugs, infliximab and azathioprine, seems to improve treatment outcomes in some people. Scientists hope that studies such as the above also achieve further define what the best treatment strategies for ulcerative colitis.

If you are interested in participating in a clinical trial related to inflammatory bowel diseases (ulcerative colitis or Crohn’s disease), talk to your doctor about the studies that would be available in your area. You can also refer to several electronic sources for more information. Clinical trials are currently available through the National Institutes of Health (NIH), under www.clinicaltrials.gov. You can also search through clinical trials at Mayo Clinic in clinicaltrials.mayo.edu. America Foundation Crohn’s Disease and Colitis is another good source of information where you can also contact other people and families dealing with inflammatory bowel disease.

Ulcerative colitis is a chronic condition requiring ongoing medical monitoring. The specialists who usually serve the people with ulcerative colitis are gastroenterologists and colorectal surgeons. With careful control and monitoring, you can almost always significantly reduce the signs and symptoms of ulcerative colitis.

Response from Dr. Ravid Mrazek, Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA:

Depression goes beyond feeling sad for a few days and it is a much more serious problem that can be identified by a variety of symptoms. Antidepressants may help people diagnosed with depression, but it takes several weeks to start working and what is usually wise to take them at least one year after symptoms are resolved.

Depression, also called clinical depression, major depression and major depressive disorder is a disease that can cause a range of emotional and physical symptoms. The diagnosis of depression is based on the presence of certain symptoms.

The symptom most commonly associated with depression is that lasting feeling of sadness, emptiness and worthlessness. On the other hand, depression can also be linked to irritability and frustration, so that when these symptoms persist for two weeks or more, the source of the problem could be depression. Depressed people may also lose interest in daily life and activities that normally enjoy. This is sometimes accompanied by fatigue or lack of energy and inability to finish what is usually easy to do.

Physical symptoms of depression may include changes in sleep patterns, such as trouble falling or staying asleep, in addition to sleeping more than usual. Similarly, depression can cause changes in appetite, some people may lose weight because they have no interest in eating, while others feel cravings and weight gain. Other symptoms of depression are feeling restless and, conversely, do things more slowly, have difficulty concentrating or making decisions and, in some people, repeated thoughts of death or suicide.

Many people manage to alleviate the symptoms of depression with antidepressants, and of these, the most common are within the category of selective inhibitors of serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). The drugs known as inhibitors of serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq) is also often used to treat depression.

When someone begins taking an antidepressant, waiting to feel better within days, but symptoms generally do not begin to decrease within a week. The most common is that within two to four weeks to notice the symptoms decrease significantly and in many cases, it may take up to eight or nine weeks.
About 50 percent of people with depression can completely relieve your symptoms with the first antidepressant they take as long as the drug is carefully chosen based on symptoms, medical history and the ability to metabolize the antidepressant selected. About 20 percent of people respond well, that is, more than half relief of symptoms with the first drug chosen.

There remains, then, 30 percent of people who make little or nothing to alleviate the symptoms with the first antidepressant they take. The good news is that this amount, about half can relieve symptoms enough medicine with the second try. Therefore, these drugs in general can be very effective when the recipe carefully and rigorously taken.

Once it reaches a good response and symptoms of depression begin to disappear, it is important to be careful to stop the drug. Many people rests upon discontinuation of medication for depression after six months, since the most common is to take it for a year. However, many psychiatrists believe that treatment with an antidepressant to last two years provides a more appropriate period to see if the depression is resolved, before starting to taper off the medication.

Note that the correct diagnosis and successful treatment of depression rely heavily on personal circumstances and a medical situation. For lasting relief, it is best to work closely with a mental health professional who knows about depression, to guide you in your care.

A Meckel’s diverticulum may be difficult to diagnose because it is not observed in the common tests to detect intestinal bleeding or obstruction. Symptoms of Meckel’s diverticulum can mimic other conditions such as appendicitis or gallbladder problems.

One of the best ways to confirm the presence of a Meckel’s diverticulum through a scan by injecting a small dose of radioactive dye into the bloodstream. This dye stays in the stomach tissue, and thus appears diverticulum scintigraphy if stomach tissue. X-rays show if the bowel is blocked, however, fail to identify whether the diverticulum is the cause.

Duration

Meckel’s diverticulum does not disappear unless surgically removed.

Prevention

There is no way to prevent the formation of Meckel’s diverticulum during fetal development.

Treatment

Most people with Meckel’s diverticulum or even know they have, and no treatment is needed. When problems arise, treatment depends on the type and severity of these problems. Infections are treated with antibiotics. It might take blood transfusions in case of heavy bleeding. It could also be required iron replacement to correct anemia. Sometimes when there is an obstruction, are set to “bowel rest”, meaning that the patient is not allowed to eat, drink or take pills, but that power and fluid intravenously (into a vein). Finally, a diverticulum that causes problems may need to be surgically removed.

When To Call a Professional

Seek medical attention right away if any of the symptoms of Meckel’s diverticulum, and bleeding from the rectum or bloody stools. If you have abdominal pain or dizziness, you should contact your doctor to determine if you need immediate evaluation.

Forecast

With surgery, there may be a full recovery.

Symptoms

Most people with Meckel’s diverticulum experience no symptoms. Only if the symptoms are bleeding diverticula, become infected or cause obstruction. These symptoms usually occur during the first years of life, but may not appear until adulthood. Bleeding, even when severe, causes no pain. An infection or blockage itself can cause abdominal pain and discomfort from mild to severe.

Signs and symptoms may include:

- loss of blood alone or defecation
- blood in the stool, visible or just to make an analysis
- abdominal pain from mild to severe
- Iron deficiency, anemia and other symptoms such as pallor and fatigue

Patients with bowel disorders such as gastrointestinal bleeding, tumors, Crohn’s disease or celiac disease, can now take advantage of the great technological progress that allows doctors to better diagnose and treat these conditions.

Those are the findings of Mayo Clinic in Arizona who examined the latest diagnostic modalities such as capsule endoscopy, enteroscopy with one or two balloons and spiral enteroscopy. The above devices have facilitated the visualization and inspection of the small intestine.

“In many cases, this technology eliminates the need for invasive surgical procedures,” says Dr. Jonathan Leighton, chairman of the Division of Gastroenterology at Mayo Clinic in Arizona and author of an article published in the Journal of Gastroenterology, American Journal of Gastroenterology. “The physical constraints of the prior art which did not help either gastroenterologists to examine the small intestine for signs of bleeding, tumors, inflammatory bowel disease and celiac disease have virtually disappeared,” he adds.

Enteroscopy or small bowel visualization with a fiberoptic or wireless, has progressed to the point where they now can perform a more thorough and complete evaluation of the small intestine, “replacing the need for intraoperative assessment,” explains Dr. Leighton.

Balloon enteroscopy is to visually examine the small intestine with an endoscope. The balloon allows the instrument to reach deeper into the small intestine than previously possible.

The capsule endoscopy is a procedure that uses a tiny camera and take pictures wirelessly to the digestive system. The camera is enclosed in a capsule the size of a vitamin that the patient swallows and the hundreds of photos from inside the digestive tract that gets transmitted to a recorder for evaluation. The procedure highlights the physician’s ability to identify hemorrhagic lesions and can then direct therapeutic interventions.

According to the findings of capsule endoscopy and balloon enteroscopy may improve detection of small bowel lesions causing obscure GI bleeding. Furthermore, it appears that capsule endoscopy is also useful in the diagnosis and treatment of patients with Crohn’s disease in the small intestine.

Obscure gastrointestinal bleeding or unexplained bleeding and recurrent small bowel can lead to anemia. Today, thanks to the progress of the balloon enteroscopy and capsule endoscopy have been largely overcome the restrictions of the old diagnostic tests. Crohn’s disease is an inflammatory condition that usually occurs in the small intestine, but can develop in any other part of the digestive tract.

Similarly, it appears that capsule endoscopy can detect tumors before and polyps in the small intestine, which were difficult to diagnose due to limitations in the display of traditional diagnostic methods, and results indicate that this method could become the diagnostic procedure of choice in many situations. Capsule endoscopy may also be effective to evaluate some patients with celiac disease.

“More and more evidence is growing that the technological advances inherent in the capsule endoscopy and balloon enteroscopy lead to a large change in the paradigm of evaluation and control of these diseases,” says Dr. Leighton.

They are carried out important research to improve the technology of the capsule, including the development of remote-controlled capsules. Dr. Leighton says that the field of small bowel enteroscopy continues to evolve and then adds that “if it is necessary to perform larger studies to determine the impact on clinical outcomes, the future is bright for patients.”

Production of vertigo

- Changes in visual acuity.

- Diseases of the vestibular system (balance organ): benign positional vertigo, Ménière disease, labyrinthitis, acoustic neuroma, drugs or toxic poisoning.

- Diseases of the cervical spine: trauma, inflammation.

- Diseases of the central nervous system tumors, multiple sclerosis, shortage of blood injuries, damage to the cerebellum or cerebral cortex.

Causing alterations in the balance

- For impaired vision.

- For disorders of the vestibular system (balance organ).

- For disorders of the brain stem, cerebellum and cerebral cortex or pathways.

- By the peripheral nervous system disorders.

- For musculoskeletal disorders (bone and joint or muscle).Other causes of prelipotimia / presyncope / dizziness

- Significant blood loss by bleeding.

- Reducing the volume of venous return (coughing, urination).

- Decrease the volume of blood ejected from the heart from disease of the valves, lack of oxygen to one’s heart, heart arrhythmias, and so on.

- Decrease in blood cells or substances important for brain function, such as sugar (hypoglycemia), oxygen (hypoxia), red blood cells (anemia).

- Diseases of the blood vessels of the brain, such as thrombosis and bleeding

Ill-defined sensations of dizziness

- Causes of psychological origin: anxiety, neurosis, depression.

- A disorder of the sense organs: hearing, vision.

- Deterioration of the higher functions.

Treatment

Treatment of dizziness depends on the cause that has occurred. There are, however, many factors favoring the old man’s sickness preventable or treatable:

- Identifying and correcting the number of drugs taken or reducing the dose of these

- Maintaining good nutrition and hydration level

- Ensuring a good blood pressure control

- Taking steps at home to prevent falls, and so on.

In the case of the so-called orthostatic hypotension, postural changes progressive recommend avoiding maneuvers or turns. It may be helpful to use of elastic stockings on your legs to increase the volume of venous blood returning to the heart. In some of these cases, drinking plenty of fluids may be helpful.

credit to: Dr. Salvador Pertusa Martínez

- Dizziness or feeling or displacement rotary

- Instability or imbalance (balance difficulty)

- Lightheadedness, or prelipotimia presyncope (sensation of losing consciousness)

- Other ill-defined sensations (insecurity, floating feeling, numbness, environmental disconnection shortly).

The physical examination will provide, often, the keys to diagnosis. Physical examination and large, the doctor will check blood pressure and pulse, auscultation of the heart made an examination of the skin and mucous membranes to see their color, visual acuity, a hearing exam and a neurological examination.In light of the findings to find a doctor in the evaluation, the doctor asked the realization of an ECG as the first test will be performed and a blood test.

Stunning presyncope

Presyncope stunning is a feeling of imminent demise often described as a sort of drowsiness associated, often, lack of balance or falls. This kind of feeling is caused by temporary lack of oxygen in the brain, usually due to a decrease in the blood supply to it. Most adults, especially the elderly, experience this type of transient feeling when they get up quickly from a lying or sitting position.

In general, the cause is a problem of blood vessels outside the cranium or decreased blood volume, though not always the diagnosis of vascular origin, causes exist as some medications, infections caused by viruses, or other acute bleeding.

Orthostatic hypotension

We speak of orthostatic hypotension when we detect a decrease in systolic blood pressure (the maximum) equal to or greater than 20 mm Hg. or a decrease in diastolic blood pressure (the minimum) less than 10 mm Hg with changes in position (lying down to standing).

Some patients have the feeling they have is as if they were given time to fall and feel the need to support. This feeling lasts for a few seconds and goes quickly. These episodes occur several times throughout the day.

credit to: Dr. Salvador Pertusa Martínez

During the period of one year, nearly 20% of people 60 years or more experiencing dizziness severe enough to seek medical advice. It is estimated that nearly 1% of total clinic visits attended by the family doctor.

The practical management of dizziness by the attending physician is complex and difficult. Patients, especially the elderly, who complain of dizziness are usually directed to different specialists (otolaryngologists, orthopedists, neurologists, psychiatrists, etc.). Without adequate basic orientation. Thus began a long pilgrimage to which are added false diagnoses, it favors the emergence of problems arising from the performance of doctors and increase the patient’s anxiety (and the physicians who care for you). Thus, the symptoms can become chronic and perpetuate dizziness in time.The primary care physician is the professional who is in the best position to properly orient the patient early and suffered dizziness. When an old consult your physician for this problem, the doctor should do some detailed questions of what is happening, enabling him to clarify what the patient means by dizziness.

The doctor asked the patient to tell or describe exactly what happened or how it feels, to explain in their own words the inconvenience suffered. If the patient has difficulty defining your doctor will help with guiding questions for further research trying to realize the symptoms of dizziness. We ask questions to figure out how to start the activity you were doing at the time of sickness, the intensity, duration and frequency and the factors that have triggered or modify it.

In addition, to focus the problem, the doctor should ask about the patient’s previous illnesses, medical treatments you are receiving, even on family history, which can occasionally be useful. The doctor will try to find the symptoms associated with motion sickness and the patient should list in detail.

credit to: Dr. Salvador Pertusa Martínez

Microorganisms are formed by a cell, which can survive in hot and cold environments. They are one of the oldest life forms, as occurred for billions of years, and it is thought that helped shape and change the Earth’s early atmosphere to create atmospheric oxygen that eventually led to the development of other more complex organisms.

There are hundreds of species, which can take three forms:

- Poles (rods).
- Spheres (cocci).
- Spiral (spirochetes).

Live on or in almost any material or habitat, such as soil, water, air and animal organisms and humans. Some of them are photosynthetic, meaning they can make their own food from sunlight, as plants do. Other absorb food material in which they live.

Are the cause of various diseases such as bronchitis, bronchopneumonia, pharyngitis, laryngitis, pneumonia, sinusitis, salmonellosis, tuberculosis, tetanus, conjunctivitis, and gastritis, among others. Also, there are some that produce skin and vaginal infections (eg, acne), bad breath and body odor.

However, not all bacteria that lodge in the body are harmful and some help to fight those that do are limiting their reproduction, they are also essential for normal development of the immune system (the one who defends us from infection) of babies.

It is necessary to follow certain precautions to prevent the attack of harmful bacteria is harmful to health:

- Eating food prepared hygienically.
- Wash hands before eating and after using the toilet.
- When you suffer a wound, wash around it with soap and water, and then apply to the damaged area with a cotton ball or swab, an antiseptic solution.
- Follow a balanced diet for the immune system stays strong.
- Bathe daily.
- Brushing three times a day and use mouthwash.
- Use deodorant to prevent the odor caused by bacteria.
- There are special soaps and lotions are useful for eliminating the staying on the skin.
- If you wear contact lenses must be washed with disinfectant solutions, in addition, lubricate.
- In case of acquiring a bacterial infection of the skin, can be used to ointments and creams to treat the problem indicated. If there is a small way can be used emulsions containing triclosan.

The thermogenic are pills that are used to increase metabolism, allowing you to burn fat more easily. These supplements alone triggered by the elevation of temperature, using the calories as fuel.

The thermogenic are composed of products that accelerate the metabolism as caffeine and green tea.

The thermogenic can be purchased at specialty stores such as offering sports supplements. Currently being used by many people to supplement their diet and usually are usually accompanied by intense exercise program.

Not everyone can or should take thermogenic, especially those with heart or have problems with blood pressure, because they alter a little, because its purpose is to accelerate the metabolism.

Nor should take thermogenic who are following a diet low in carbohydrates (such as the Atkins diet, where caffeine is not recommended.)

The thermogenic reduce appetite and are also used to avoid stagnation in weight loss when it is time to diet. With the use of these supplements can “push” weight loss, when it has “stuck” and keep losing weight as in the beginning.

Not recommended to start taking thermogenics in the early days of the diet. It is best left for later, if you decide to take them, because at the beginning of any diet you lose weight faster.

Since the thermogenic accelerate metabolism, make you feel more energetic and more eager to exercise, which is beneficial for weight loss.

In the market there are many brands of thermogenic, some better known as Xenadrine, Hydroxycut, Zantrex, Animal Cut and other, more recent and Thermonex and Anadrox.

The thermogenic not work the same for everyone since not everyone has the same metabolism. May have side effects although moderate, which include insomnia, tachycardia, tremor and increased systolic blood pressure.