Sunday, October 21, 2018
Sunday, December 10, 2017
BLOOD IN URINE SYMPTOM Hematuria
BLOOD IN URINE SYMPTOM
Blood in urine - known medically as hematuria - is usually not a reason for major alarm.
Because blood in urine can be a sign of a serious medical condition, however, it shouldn't be ignored. All cases of hematuria should be evaluated by a doctor who can order tests to confirm or rule out an underlying cause.
There is no specific treatment for hematuria, because it's a symptom and not a specific condition. Instead, treatment is aimed at the underlying cause if one can be found. In many cases, no treatment is necessary.
Where Blood in Urine Might Come From
Blood in urine can come from the kidneys, where urine is made. It also can come from other structures in the urinary tract, such as:
- Ureters (the tubes from the kidneys to the bladder)
- Bladder (where urine is stored)
- Urethra (the tube from the bladder to the outside of the body)
Symptoms That May Accompany Hematuria
If there is blood in urine, the symptom is obvious. Instead of its normal pale yellow color, your urine may be pink, red, brownish-red, or tea-colored. This is what doctors call gross hematuria.
Sometimes, blood in urine is not visible to the naked eye and the presence of red blood cells can only be detected by the lab. This is what doctors call microscopic hematuria. It's usually only discovered when a urine sample is tested with a dipstick and the results are confirmed with a microscopic examination.
Hematuria may occur without any other symptoms. Some underlying causes, however, are associated with additional symptoms that can be moderate to severe. These include:
- Bladder infections (acute cystitis). In adults, bladder infections usually cause burning or pain with urination. Infants with bladder infections may have fever, be irritable, and feed poorly. Older children may have fever, pain and burning while urinating, urgency, and lower belly pain.
- Kidney infections (pyelonephritis). Symptoms may include fever, chills, and flank pain, which refers to pain in the lower back.
- Kidney stones. Symptoms may include severe abdominal or pelvic pain.
- Kidney diseases. Symptoms may include weakness, high blood pressure, and body swelling, including puffiness around the eyes.
Blood in urine facts
- Blood in urine can sometimes be visible only with a microscope.
- Evaluating blood in urine requires consideration of the entire urinary tract.
- Tests used for the diagnosis of blood in urine may include a CT scan, cystoscopy, ultrasound, IVP, MRI, urine culture, and urine cytology.
- Management of blood in the urine depends upon the underlying cause.
What are the causes of blood in urine?
The causes of gross and microscopic hematuria are similar and may result from bleeding anywhere along the urinary tract. One cannot readily distinguish between blood originating in the kidneys, ureters (the tubes that transport urine from the kidneys to the bladder), bladder, or urethra. Any degree of blood in the urine should be fully evaluated by a physician, even if it resolves spontaneously.
Infection of the urine, (often called a urinary tract infection or UTI) stemming either from the kidneys or bladder, is a common cause of microscopic hematuria. Urine is naturally sterile and should not contain bacteria. Kidney and bladder stones can cause irritation and abrasion of the urinary tract, leading to microscopic or gross hematuria. Trauma affecting any of the components of the urinary tract or the prostate can lead to bloody urine. Hematuria can also be associated with renal (kidney) disease, as well as hematologic disorders involving the body's clotting system. Medications that increase the risk of bleeding, such as aspirin, warfarin (Coumadin), or clopidogrel (Plavix), may also lead to bloody urine. Lastly, cancer anywhere along the urinary tract can present with hematuria.
How is blood in urine diagnosed?
The evaluation for blood in urine consists of taking a history, performing a physical examination, evaluating the urine with a chemical test strip and under a microscope, and obtaining a culture of the urine to identify any bacteria present. Lower urinary tract symptoms, such as urgency (feeling a strong need to urinate) and frequency (needing to urinate frequently), as well as the presence of fever or chills, are suggestive of infection. Recent trauma, even if believed by the patient to have been inconsequential, should be considered as a potential cause. Abdominal or flank pain, especially if radiating to the inguinal or the genital area, may suggest ureteral or kidney stones. All recent medications, including vitamins or herbal supplements, should be reviewed with the health-care professional. However, it is important to note that even if the patient has been taking a medication that is associated with bleeding, a full workup (as listed below) should still be undertaken.
The physical exam will focus on possible sources of hematuria. Bruising over the back or abdomen may indicate trauma. A digital rectal exam should be performed, especially in males, as findings consistent with prostatitis (for example, tenderness on palpation of the prostate) or an enlarged prostate suggestive of benign prostatic hyperplasia (BPH), may be useful in making a diagnosis. The finding of a nodule or an area of induration of the prostate may be indicative of cancer. A repeat urinalysis, as well as a urine culture, should be obtained. The presence of white blood cells on urinalysis is more consistent with a urinary tract infection. Protein, glucose, or sediment in the urine may indicate the presence of a disease of the kidneys. Blood tests are also important, as they will aid in assessing renal function and identifying any clotting abnormalities.
In addition to the basic history and physical exam, there are three additional components for any workup of hematuria: imaging, urine cytology, and cystoscopy.
The CT scan is an imaging evaluation of the urinary tract. Prior to the procedure, the patient drinks an oral contrast agent and a dye is injected intravenously. The patient then goes through the CT scan machine and images are taken of the abdomen and pelvis. Another test that can be performed, the intravenous pyelogram (IVP), is also a type of X-ray evaluation of the urinary tract. In this procedure, a dye is injected into the veins, and this is filtered by the urinary tract. A series of X-rays are then taken over a 30-minute period to look for abnormalities. The CT scan is more commonly performed than the IVP to evaluate the urinary tract and should be considered the test of choice. Both of these studies are especially useful for evaluating the kidneys and ureters, but not the bladder, prostate, or urethra. Therefore, a second examination called a cystoscopy is necessary. This is a simple 10-minute procedure using a thin, flexible cystoscope (or fiberoptic camera) is inserted via the urethra into the bladder to directly visualize any lesions or sources of bleeding. This is usually done with local anesthetic jelly injected into the urethra. Finally, urine cytology involves giving a urine sample to be analyzed by a pathologist for the presence of cancerous or abnormal-appearing cells.
Saturday, July 9, 2016
Anti Skin aging endogenous or intrinsic and exogenous
Skin aging is a complex biological process influenced by a combination of endogenous or intrinsic and exogenous or extrinsic factors. Because of the fact that skin health and beauty is considered one of the principal factors representing overall “well-being” and the perception of “health” in humans, several anti-aging strategies have been developed during the last years. It is the intention of this article to review the most important anti-aging strategies that dermatologists have nowadays in hand, including including preventive measurements, cosmetological strategies, topical and systemic therapeutic agents and invasive procedures.
Introduction
Skin aging is a part of a natural human “aging mosaic” which becomes evident and follows different trajectories in different organs, tissues and cells with time. While the aging signs of internal organs are masked from the ambient “eyes,” the skin provides first obvious marks of the passing time.
Skin aging is a complex biological process influenced by combination of endogenous or intrinsic (genetics, cellular metabolism, hormone and metabolic processes) and exogenous or extrinsic (chronic light exposure, pollution, ionizing radiation, chemicals, toxins) factors.1 These factors lead together to cumulative structural and physiological alterations and progressive changes in each skin layer as well as changes in skin appearance, especially, on the sun-exposed skin areas.2-12 In contrast to thin and atrophic, finely wrinkled and dry intrinsically aged skin, premature photo-aged skin typically shows a thickened epidermis, mottled discoloration, deep wrinkles, laxity, dullness and roughness.13-18 Gradual loss of skin elasticity leads to the phenomenon of sagging.19 Slowing of the epidermal turnover rate and cell cycle lengthening coincides with a slower wound healing and less effective desquamation in older adults. This fact is important when esthetic procedures are scheduled.20 On the other side, many of these features are targets to product application or procedures to accelerate the cell cycle, in the belief that a faster turnover rate will yield improvement in skin appearance and will speed wound healing.21 A marked loss of fibrillin-positive structures22 as well as a reduced content of collagen type VII (Col-7), may contribute to wrinkles by weakening the bond between dermis and epidermis of extrinsically age skin.23 Sun-exposed aged skin is characterized by the solar elastosis. The sparse distribution and decrease in collagen content in photoaged skin can be due to increased collagen degradation by various matrix metalloproteinases, serine, and other proteases irrespective of the same collagen production.24-28 In older skin, collagen looks irregular and disorganized, the ratio of Col-3, to Col-1 has been shown to increase, due, significantly, to a loss of Col-1.29 The overall collagen content per unit area of the skin surface is known to decline approximately 1%/year.30Glycosaminoglycans (GAGs) are among the primary dermal skin matrix constituents assisting in binding water. In photo-aged skin, GAGs may be associated with abnormal elastotic material and thus be unable to function effectively.31 The total hyaluronic acid (HA) level in the dermis of skin that age intrinsically remains stable; however, epidermal HA diminishes markedly.32
Three primary structural components of the dermis, collagen, elastin and GAGs have been the subjects of the majority of anti-aging research and efforts for aesthetic-anti-aging strategies pertaining to the skin, from ”anti-wrinkle creams” to various filling agents.21
Presentation of aging of the entire face is associated with the gravity impact, muscles action, loss of volume, diminishing and redistribution of superficial and deep fat, loss of bony skeleton support what all together lead to the face sagging, changes in shape and contour. Regardless of the fact that aging is a biological inevitable process and not a pathological condition it is correlated with various skin and body pathologies, including degenerative disorders, benign and malignant neoplasms.
The ‘successful aging’ paradigm, focuses on health and active participation in life, counters traditional conceptualizations of aging as a time of disease and is increasingly equated with minimizing age signs on the skin, face and body.33-35 From this perspective, preventative aesthetic dermatology might supplement the request for healthy aging, treat or prevent certain cutaneous disorders, notably skin cancer, and delay skin aging combining local and systemic methods of therapy, instrumental devices and invasive procedures.36,37 The mainspring of any skin anti-aging therapy is to achieve a healthy, smooth, blemish-free, translucent and resilient skin.38 In clinical practice, “to look better” doesn’t mean to “look younger.” That is why it is so important to understand patients’ wishes and to orientate them to the treatment modality that will give the most satisfying results whereas knowing all available treatment techniques.39The age, previous procedures or surgery, general health status, type of the skin, style of life and many other factors should be taken into consideration before choosing the strategy for the individual case. The desired therapeutic anti-aging effect of the skin is continuous, step-by step process, which combines various methods of the skin bio-revitalization and rejuvenation, augmentation, restoration of each skin layer individually and in the light of many other factors—from a style of the life to the immune, genetic, emotional and health status in general. This review will emphasize the most important topical and systemic therapeutic agents and trends in the use of invasive procedures.
Skin Aging Prevention and Therapy
The skin anti-aging strategies attempted to reverse the dermal and epidermal signs of photo- and chronological aging can be grouped under the following approaches (Table 1).
Table 1. Skin antiaging approaches
Skin Care
Healthy and functioning skin barrier is important protector against dehydration, penetration of various microorganisms, allergens, irritants, reactive oxygen species and radiation. The skin barrier may be specifically adjusted to allow penetration. For this reason daily skin care may increase skin regeneration, elasticity, smoothness, and thus temporarily change the skin condition.40,41 However, it is necessary to stop the degradation of the skin primary structural constituents, such as collagen, elastin, to prevent the formation of wrinkles. Although the technology required to suitably deliver these compounds into the skin has not yet been developed, some products do promote the natural synthesis of these substances except elastin enhancing.42-45 Another integral approach preventing wrinkle formation is the reduction of inflammation by topical or systemic antioxidants which should be used in combination with sunscreens and retinoids to enhance their protective effects.21
Photoprotection and Systemic Antioxidants
Chronic photodamage of the skin manifests itself as extrinsic skin aging (photoageing). DNA photodamage and UV-generated reactive oxygen species (ROS) are the initial molecular events that lead to most of the typical histological and clinical manifestations of chronic photodamage of the skin. Wrinkling and pigmentary changes are directly associated with premature photo-aging and are considered its most important cutaneous manifestations. The strategies aimed at preventing photo-aging include sun avoidance, sun protection using sunscreens to block or reduce skin exposure to UV radiation, retinoids in order to inhibit collagenase synthesis and to promote collagen production, and anti-oxidants, particularly in combination, to reduce and neutralize free radicals (FR).21,46
Interventional studies indicate that it is in fact possible to delay skin aging and to improve skin conditions through administration of selected nutritional supplements. Nutritional antioxidants act through different mechanisms and in different compartments, but are mainly FR scavengers: (1) they directly neutralize FRs, (2) they reduce the peroxide concentrations and repair oxidized membranes, (3) they quench iron to decrease ROS production, (4) via lipid metabolism, short-chain free fatty acids and cholesteryl esters neutralize ROS.47 Endogenous antioxidant defenses are both non-enzymatic (e.g., uric acid, glutathione, bilirubin, thiols, albumin, and nutritional factors, including vitamins and phenols) and enzymatic [e.g., superoxide dismutases, glutathione peroxidases (GSHPx), and catalase]. The most important source of antioxidants is provided by nutrition. To the most known systemic antioxidants belong vitamin C, vitamin E, carotenoids, and from the trace elements copper and selenium.48-50 There are also studies demonstrating that vitamins C and E combined with ferulic acid impart both a sunscreen and an anti-oxidant effect
Topical Pharmacological Agents with Anti-Aging Properties
There are two main groups of agents that can be used as anti-aging cream components, the antioxidants and the cell regulators. The antioxidants, such as vitamins, polyphenols and flavonoids, reduce collagen degradation by reducing the concentration of FR in the tissues. The cell regulators, such as retinols, peptides and growth factors (GF), have direct effects on collagen metabolism and influence collagen production.
Vitamins C, B3, and E are the most important antioxidants because of their ability to penetrate the skin through their small molecular weight.52 The water-soluble, heat-labile local L-ascorbic acid (vitamin C) in concentrations between 5 and 15% was proven to have a skin anti-aging effect by inducing the production of Col-1, and Col-3, as well as enzymes important for the production of collagen, and inhibitors of matrixmetalloproteinase (MMP) 1 (collagenase 1).43,53 Clinical studies have proven that the antioxidative protection is higher with the combination of vitamins C and E than with the vitamin C or E alone.54,55 Niacinamide (vitamin B3) regulates cell metabolism and regeneration, and it is used in 5% concentration as an anti-aging agent.56 In some studies, improvement of skin elasticity, erythema and pigmentations after 3 mo of topical treatment has been observed.52,54 Vitamin E (α-tocopherol) used as a component of skin products has anti-inflammatory and antiproliferative effects in concentrations between 2 and 20%. It acts by smoothing the skin and increasing the ability of the stratum corneum to maintain its humidity, to accelerate the epithelialization, and contribute to photoprotection of the skin. The effects are not as strong as with vitamins C and B3.57
An in vivo study has proven that the topical application of green tea polyphenols before UV exposure leads to an increase of the minimal erythema dose, decreases the number of Langerhans cells and reduces DNA damage in the skin.58 Other botanicals that act as antioxidants are for example the isoflavones from soya.
Cell regulators, such as vitamin A derivatives, polypetides and botanicals, act directly on the collagen metabolism and stimulate the production of collagen and elastic fibers.
Vitamin A (retinol) and its derivates (retinaldehyde and tretinoin) are also a group of agents with antioxidant effects. They can induce the biosynthesis of collagen and reduce the expression of MMP 1 (collagenase 1). Retinol is, at the moment, the substance that is most often used as an anti-aging compound and, compared with tretinoin, causes less skin irritation.59,60 It has been shown that retinol has positive effects not only on extrinsic but also on intrinsic skin aging and has a strong positive effect on collagen metabolism.60,61 Tretinoin, a non-aromatic retinoid of the first generation, is approved for application as an anti-aging treatment in a concentration of 0.05% in the United States. It has been shown to be able to reduce the signs of UV-induced early skin aging, such as wrinkles, loss of skin elasticity and pigmentation.
Polypeptides or oligopeptides are composed of amino acids and can imitate a peptide sequence of molecules such as collagen or elastin. Through topical application, polypeptides have the ability to stimulate collagen synthesis and activate dermal metabolism.62
Invasive Procedures
There are various in-office procedures, most of which are intended to ‘resurface’ the epidermis: to remove the damaged epidermis and replace the tissue with remodeled skin layers and sometimes spur the formation of new collagen.21,63 It is possible that the potential of GF, cytokines and telomerase will eventually be harnessed via technological advancement and innovation in the burgeoning fields of tissue engineering and gene therapy in the nearest future.64
US National Library of Medicine
National Institutes of Health
http://www.ncbi.nlm.nih.gov/pmc/
http://usa.loccitane.com/immortal,82,1,76825,891670.htm?srch=1&gclid=Cj0KEQjwoYi4BRDF_PHHu6rI7NMBEiQAKZ-JuChvK4GlmD1o14PLOOm8hzHvwSVZDPTUt-JmBkMtz8IaAmBD8P8HAQ
Medicare Supplement Plan B
Plan B is one of the cheapest plans out of the 10 Medicare Supplement insurance plan options available in most states. (Minnesota, Massachusetts, and Wisconsin have different options.)
Plan B quickfacts
- About 3% of Medigap policyholders had a Plan B policy in 2014.1
- It covers 5 out of the 9 available Medigap benefits.
- It is one of the cheapest plans.2
Your Medicare out-of-pocket costs with Plan B vs. without Plan B
The table below shows some of your potential Medicare out-of-pocket costs in 2016 with Plan B vs. without Plan B.
| Medicare out-of-pocket costs | With Plan B | Without Plan B |
|---|---|---|
| Part A deductible | $0 | $1,288 per year |
| Inpatient hospital stay co-insurance | $0 | Up to $644 per day |
| Part B co-insurance or co-payment | $0 | 20% of the cost of care |
| Blood (first 3 pints) | $0 | 100% of the cost of the first 3 pints |
| Hospice care co-insurance or co-payment | $0 | 5% of the cost of respite care $5 per prescription drug |
There are other Medigap plan options available. Click on one of the following buttons to learn more about each Medigap plan option:
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