Sober Mix With Extra Remedies, The 000 Party Recovery Boost

Sober Mix With Extra Remedies, The 000 Party Recovery Boost

Sober Mix With Extra Remedies – When you were drunk, life seemed to slide by quickly. Without having to worry much about how to occupy your time. Life was consumed by buying and using alcohol. Once you get sober, though, staying sober may be difficult because you have much more free time than you did before. What are you supposed to do if you’re not drinking alcohol? How can you stay sober when it’s so difficult to live life this new, uncomfortable way?

After drinking for so long, your brain may struggle to remember what you’re supposed to do. Sobriety may seem boring but it’s actually the beginning of a beautiful life. You’ll rediscover lost interests or develop new ones. You’ll realize how much time you wasted while drinking alcohol. But now you have the opportunity to spend your time doing enjoyable, healthy things.

Also Read High Vitamin C IV, The 000 Fit C

Drunk with alcoholic drinks

Consuming ‘liquor’ (liquor or alcohol) is not without risk, especially if it is frequent and excessively drunk. Check out the various health problems that can arise as a result of frequent drinking.

In Indonesia, adults aged 21 years are allowed to consume alcoholic beverages. There are many types of alcoholic beverages, with varying levels of alcohol. But in general, the alcohol consumed should be no more than 14 units.

If consumed in excess, alcohol can cause a decrease in concentration and loss of self-control, thereby increasing the risk of accidents. Meanwhile, if drunk continuously for a long time, alcohol can lead to various chronic diseases, even death.

The risk of disease due to frequent drunken alcohol

These are the following diseases can arise from frequent drinking in the long term:

Liver disease

When consumed, alcohol will be absorbed into the bloodstream, then collect in the liver to be broken down and neutralized so that it can be removed from the body. However, the liver’s ability to process alcohol is very limited. If you drink more alcohol than your liver can process, your blood alcohol level will increase. If it continues, the liver will experience disturbances, ranging from fatty liver, hepatitis, cirrhosis, to liver cancer.

Heart and blood vessel disease

Other consequences of frequent hangovers are impaired heart rate, increased blood pressure and heart rate, an enlarged heart, and an increased risk of stroke and heart disease.

Cancer

The more often you drink alcohol, the greater your risk of developing cancer and dying from the disease. In addition to liver cancer, other types of cancer that can also occur due to frequent hangovers are mouth cancer, throat cancer, esophageal cancer, colon cancer, and even breast cancer.

Brain and nerve disorders

Consuming too much alcohol can also cause brain disorders. According to research, frequent drunkenness can make the brain shrink or shrink. The more alcohol consumed, the greater the shrinkage. In addition, drinking too much alcohol can also reduce the ability to think and weaken memory, as well as make reflexes and coordination of body movements impaired.

Depression

Some people think that being drunk can help with depression. However, what happened was the opposite. Excessive alcohol consumption can actually cause or worsen depression. Research shows that people who drink alcohol frequently have a higher risk of suicide and developing anxiety disorders.
How could that be? When you drink too much alcohol, the function of brain chemicals that regulate mood is disrupted, causing symptoms of depression.

Alcohol addiction

Frequent consumption of alcohol to drunkenness can also lead to addiction. Although aware of the dangers of alcohol, people who are addicted will continue to drink alcohol and find it difficult to stop. In the end, these habits will have an impact on their health and social life.

Recover your body with our sober mix with extra remedies IV

You want to get treatment to overcome the problem of drunkenness? If you have just had a party and drink alcohol, the next morning your body will feel uncomfortable.

We suggest you to overcome this so that your body can get back in shape. You can try our sober mix with extra remedies IV. With an offer price that fits in your pocket with extraordinary benefits to help you overcome the problem of drunkenness. So what are you waiting for? Book now.

References

Vitamins and Minerals IV, The 000 Ever Young

Vitamins and Minerals IV, The 000 Ever Young

Vitamins and Minerals IV – There are various vitamins and minerals that are important for your health. You can get these nutrients by eating foods, such as vegetables and fruits. Also by giving injection treatments at the clinic.

It is important for you to know more about the vitamins and minerals your body needs to maintain your health.

Vitamins and minerals are included in the types of nutrients that play an important role. It’s can maintaining the health of your body, of course. With adequate daily intake of vitamins and minerals, the function of organs and your metabolic processes can run smoothly.

Vitamins and minerals can also reduce the risk of certain diseases, such as malnutrition and anemia.

Therefore, keep your nutritional intake by eating a variety of foods or drinks that are rich in vitamins and minerals.

What are the Functions of Vitamins and Minerals?

Vitamins and minerals boost the immune system, support normal growth and development, and help cells and organs do their job. For example, you may have heard that carrots are good for the eyes. Carrots are full of substances called carotenoids that the body converts into vitamin A, which helps prevent eye problems.

Vitamin K helps blood to clot, so cuts and scrapes stop bleeding quickly. You’ll find vitamin K in green leafy vegetables, broccoli, and soybeans. If you want to have strong bones, you need to eat foods like milk, or green leafy vegetables. Which are rich in the mineral calcium.

How Do I Get the Vitamins and Minerals I Need?

Eating well right now is very important to you. Because the body needs a variety of vitamins and minerals to grow and stay healthy in this pandemic.

When deciding what to eat, choose foods that are rich in vitamins and minerals. For example, when choosing a drink, you will find that a glass of milk is a good source of vitamin D, calcium, phosphorus and potassium. Because a glass of soda, on the other hand, has no vitamins or minerals.

Eating a mixed diet is the best way to get all the vitamins and minerals you need each day. Fruits and vegetables, whole grains, low-fat dairy products, lean meats, fish, and poultry are the best choices for getting the nutrients your body needs.

If you are a vegetarian, you should plan carefully for a diet that includes the vitamins and minerals you need. The best sources of the minerals zinc and iron are meat, fish and poultry. But you can get them from dried beans, seeds, nuts, and green leafy vegetables like kale.

Vitamin B12 is important for making red blood cells and keeping nerves working properly. It is only found in animal products. If you don’t eat meat, you can get vitamin B12 from eggs, milk and other dairy foods.

Some types of vitamins and minerals that need to be fulfilled everyday

There are several types of vitamins and minerals that you must meet every day, including:

1. Vitamin A

Vitamin A is important for maintaining healthy eyes and skin, as well as strengthening the immune system. Types of foods that are good sources of vitamin A are vegetables, such as spinach, carrots, sweet potatoes, and potatoes. In addition to vegetables, vitamin A can also be found in tomatoes, mangoes, and melons.

2. Vitamin B complex

There are various types of B vitamins and each of these vitamins has its own function.

For example, vitamin B1 functions to support the growth of body tissues and convert carbohydrates into energy, vitamin B9 or folate is important to support fetal growth and prevent birth defects, while vitamin B6 and vitamin B12 play a role in protein metabolism, maintaining healthy brain and nerves, and produce red blood cells.

Vitamin B complex can be obtained from various types of food, such as meat, fish, eggs, various fruits and vegetables, nuts, and milk and processed products, such as cheese and yogurt.

3. Vitamin D

Unlike other types of vitamins, vitamin D can be produced naturally by the body when exposed to sunlight. In addition, vitamin D can also be obtained from several types of food, such as fish and mushrooms. Certain beverages, such as milk and juices, are also fortified with vitamin D.

4. Vitamin E

It is a vitamin that has antioxidant properties. Thanks to its antioxidant properties, vitamin E is useful for protecting body cells from free radical damage. You can get enough vitamin E by eating nuts, lean meats, green vegetables, and eggs.

5. Zinc

Zinc is useful for strengthening the immune system, maintaining healthy body tissues, and helping the wound healing process. In children, zinc plays an important role in supporting their growth and development.

6. Calcium

Calcium is also one of the important minerals for the body. This mineral is known to play an important role in maintaining the health and strength of bones and teeth. Adequate calcium intake is known to prevent bone loss or osteoporosis.

Vitamins and Minerals IV, The 000 Ever Young

If you do not have enough time to consume foods and drinks that are high in vitamins and minerals you can visit our clinic. We have a variety of treatments for IV that are useful for your body’s health.

One of them is The 000 Ever Young Treatment, where this treatment will provide you with a high nutritional intake of vitamins and minerals IV for your body needs. You can come to our clinic to try this one treatment, and of course the price is very affordable.

References

Vitamin B Complex IV, The 000 Be Fit Shot

Vitamin B Complex IV, The 000 Be Fit Shot

Vitamin B complex IV – There are 8 types of water-soluble vitamins, namely B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 ​​(pyridoxine), B7 (biotin), B9 (folic acid), and B12. (cobalamin).

Vitamin B Complex IV are found in many everyday foods such as eggs, nuts, fruits and vegetables, meat, whole grains, and dairy products. Each of these B vitamins has its own role in the body. What are the roles and benefits of these B complex vitamins?

Having the right levels of B complex vitamins can improve your health. B vitamins play a role in many important body functions, such as:

  • Red blood cell growth
  • Proper level of digestion and appetite
  • Hormone production
  • Cardiovascular health and efficiency
  • Proper levels of B complex vitamins protect you from developing muscle tone and poor eyesight. It supports proper brain function and healthy cellular metabolism. You’ll look and feel better when your B vitamin levels remain optimal. Several B vitamins contribute to better athletic performance by helping your body synthesize oxygen better.

You can also protect yourself from developing conditions like migraines and reduce stress symptoms when you take B-complex vitamins. They can lower cholesterol levels naturally.

Many pregnant women have seen the benefits of B vitamins as well. B complex can protect the fetus from developing birth defects. Vitamins also promote healthy brain development, and they can reduce nausea during the first few months of pregnancy, when so many expectant mothers have difficulty holding down food. Men can also increase their testosterone levels when they increase their intake of B vitamins.

Some benefits of vitamin B complex for your body

Vitamin B complex plays a role in various functions for your body. This includes the production of energy, hormones, and cholesterol, maintenance of the function of the brain, eyes, digestion, nerves, heart, cellular metabolism, and the formation of red blood cells in your body.

You need to know that in women, this B vitamin is very important, especially for pregnant and lactating women because of its ability to help fetal brain development and reduce the risk of birth defects. Other benefits of vitamin B complex, especially if you are a woman, are able to increase energy and reduce nausea in pregnant women, and reduce the risk of preeclampsia.

But if you are a man, B vitamins are useful for increasing testosterone levels and helping build muscle. To ensure the needs of B vitamins are met because the vitamin B complex functions to support a healthy stress response in the body.

The indications and usage

In disorders requiring parenteral vitamin administration, i.e. pre- and post-operative treatment. When the need is increased, such as fever, severe burns, increased metabolism, pregnancy, gastrointestinal disorders that interfere with vitamin intake or absorption, prolonged illness or wasting, alcoholism and where there is a deficiency. other.

Vitamin B Complex injections

Vitamin B-Complex 100 Injection is a sterile solution for slow intramuscular or intravenous injection consisting of vitamins that can be categorized as the Vitamin B Complex group.

Each mL contains: Thiamine Hydrochloride 100 mg, Riboflavin 5′ Phosphate Sodium 2 mg, Pyridoxine Hydrochloride 2 mg, Dexpanthenol 2 mg, Niacinamide 100 mg, with Benzyl Alcohol 2% as preservative, in Water for Injection. Sodium Hydroxide and/or Hydrochloric Acid may have been used to adjust the pH.

Vitamin B complex IV in Bali, “The 000 Be Fit Shot”

If you are looking for vitamin b complex IV, Bali, especially the Sanur area, we Bali000 provide it at a price that fits in your pocket. What are you waiting for ? Booking Now for to boost your healthy and immune to reduce the risk of exposure to the corona virus.

Maybe you also like High Vitamin C IV, The 000 Fit C

References

High Vitamin C IV, The 000 Fit C

High Vitamin C IV, The 000 Fit C

High Vitamin C IV has been studied as a treatment for patients with cancer since the 1970s. A Scottish surgeon named Ewan Cameron worked with Nobel Prize-winning chemist Linus Pauling to study the possible benefits of vitamin C therapy in clinical trials of cancer patients in the late 1970s and early 1980’s.

Vitamin C can be found in many healthy foods, especially:

  1. Citrus fruit and juice
  2. Red and green peppers
  3. Broccoli
  4. Strawberry
  5. Brussels sprouts

Vitamin C is an essential nutrient in our diet. It has many important roles in our immune function, including:

  1. Wound healing
  2. Prevent cell damage
  3. Build collagen
  4. Produce chemical messengers called neurotransmitters

You can also get vitamin C from dietary supplements. Vitamin C supplements are available in various forms:

  1. High Vitamin C IV is also available by prescription as an injection. Vitamin C injections can be given into a vein (intravenous), into a muscle (intramuscularly), or under the skin (subcutaneously).
  2. Oral tablet
  3. Chewable tablet
  4. Extended release tablets
  5. Extended release capsules

The purpose of injections of High Vitamin C IV “The 000 Fit C”

Many people take vitamin C for general health or to boost their immune system. It is also taken to treat vitamin C deficiency.

Vitamin C deficiency can cause scurvy. Typical symptoms of vitamin C deficiency include:

  1. Swollen and bleeding gums
  2. Fatigue
  3. Poor wound healing
  4. Joint pain
  5. Loose teeth
  6. Colored spots on the skin

Benefits of Vitamin C IV “The 000 Fit C”

According to Emedicinehealth, here’s the benefitst of vitamin C therapy :

  1. Vitamin C is a nutrient found in foods and dietary supplements. It is an antioxidant and also plays a key role in making collagen.
  2. High doses of vitamin C can be given by intravenous (IV) infusion (through a vein into the bloodstream) or orally (by mouth). When taken by intravenous infusion, vitamin C can reach much higher levels in the blood than when the same amount is taken by mouth.
  3. Laboratory studies have shown that high doses of vitamin C can slow the growth and spread of prostate, pancreatic, liver, colon, and other types of cancer cells.
  4. Some laboratory and animal studies have shown that combining vitamin C with anticancer therapy can help, while other studies have shown that certain forms of vitamin C may make chemotherapy less effective.
  5. Several human studies of high-dose IV vitamin C in patients with cancer have shown improvements in quality of life, as well as improvements in physical, mental, and emotional functioning, symptoms of fatigue, nausea and vomiting, pain, and loss of appetite.

High Vitamin C IV “The 000 Fit C” in Bali000

If you are looking for iv therapy in Bali, especially the Sanur area, we Bali000 provide it at a price that fits in your pocket. What are you waiting for ? Booking Now for to boost your healthy and immune to reduce the risk of exposure to the corona virus.

References

What is Rheumatoid Arthritis ? Find it Out Here!

What is Rheumatoid Arthritis ? Find it Out Here!

What is Rheumatoid Arthritis ? When we are talking about autoimmune disease it is not about one kind of disease. There are many different types of autoimmune disease or even a hundred. When the body senses danger from a virus infection, the immune system kicks into gear and attacks it. This is called an immune response. In our normal conditions, an immune response cannot be triggered against the cells of one’s own body. Sometimes, healthy cells and tissues are caught up in this response, resulting in autoimmune disease.1 

Autoimmune diseases affect approximately 8% of the population, 78% of whom are women. The reasons for the high prevalence in women are unknown, but circumstantial evidence links autoimmune diseases with preceding infections.4 Autoimmune diseases are the third most common category of disease in the United States after cancer and heart disease; they affect approximately 5%-8% of the population or 14-22 million persons.2  Autoimmune diseases can affect virtually every site in the body, including the endocrine system, connective tissue, gastrointestinal tract, heart, skin, and kidneys. At least 15 diseases are known to be the direct result of an autoimmune response, while circumstantial evidence implicates >80 conditions with autoimmunity.3

Now, we want to discuss one of these autoimmune diseases called Rheumatoid Arthritis(RA). The global prevalence of  RA between 1980 and 2019 was 460 per 100.000 population, with variations due to geographical location and study methodology.5

Also Read What is Sudden Death? is it Necessary to Watch Out?

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a disease of unknown origin, which is characterized by inflammatory(redness, swelling, pain, tenderness, heat, and disturbed function of an area of the body, especially as a reaction of tissue injury)  changes of the synovial tissue of joints, of cartilage and bone and, less frequently, of extra-articular(means outside of or other than a joint)sites. Somehow people can’t make the difference between arthritis and rheumatoid arthritis. Whenever there’s joint pain, there must be rheumatoid arthritis, is a big NO. 

The fact is not every arthritis was an autoimmune disease. For example: Rheumatoid arthritis and osteoarthritis  both cause joint pain, stiffness and limited range of motion, but the two diseases are distinct in their root cause and treatment. RA is a complex disease that affects approximately 0,5% of the adult population worldwide, and occurs in 20-50 cases per 100.000 annually, mainly in women after their 40s.5

Sign & Symptoms

RA commonly involves multiple joints of both hands with morning stiffness that may last for several hours. It has symptom duration of fewer than six months is defined as early, and when the symptoms have been present for more than months, it is defined as established.6,7,8

There are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission. Sign and symptoms of RA include:9

  • Pain or aching in more than one joint
  • Stiffness in more than one joint
  • Tenderness and swelling in more than one joint
  • The same symptoms on both sides of the body (such as in both hands or both knees)
  • Weight loss
  • Fever 
  • Fatigue or tiredness
  • Weakness

Risk Factor

An autoimmune disease like rheumatoid arthritis, something goes awry. Instead of protecting the body from infection or disease as it normally does the immune system attacks and destroys the body’s healthy tissue. When the disease affects many organs, as in lupus, it’s called a systemic autoimmune disease.  

Researchers had found many mechanisms that cause the risk of RA. And here some characteristics that increase risk of having RA :9

  • Age: RA can happen at any stage of your life, but likelihood increases with age. The onset of RA is highest among adults in their sixties.
  • Sex: New cases of RA are typically two-to-three times higher in women than men.
  • Genetics/inherited traits: there are specific genes that more likely this person will develop RA. These genes, called HLA /Human Leukocyte Antigen class II genotypes, can also make your arthritis worse. This risk of RA may be highest when people with these genes are exposed to environmental factors like smoking or when a person is obese. 
  • Smoking: multiple studies show that cigarette smoking increases a person’s risk of developing RA and can make the disease worse.
  • History of live births: women who have never given birth may be at greater risk of developing RA.
  • Early life exposures: some early life exposures may increase risk of developing RA in adulthood.10 For example: one study found that children whose mothers smoked had double the risk of developing RA as adults. 
  • Obesity: Being obese can increase the risk of developing RA. 

If there are some characteristics that can cause people to develop RA. Is there any characteristic that could be decreasing the risk???

YES, THERE IS IT. 

Breastfeeding women: In a new study of over 7,000 older Chinese women published online today in the journal Rheumatology, breastfeeding especially for a longer duration is shown to be associated with a lower risk of rheumatoid arthritis (RA). Specifically, it showed that women who had breastfed their children were around half as likely to have RA, compared to women who had never breastfed.11

Figure 1. Bone joint differentiation of normal and Rheumatoid arthritis the pathophysiological mechanism of rheumatoid arthritis and the immune response involves a sequence of events. (Source: Pradeepkiran, Jangampalli Adi. Insight of rheumatoid arthritis risk factors and associations. Elsevier: Journal of Translational Autoimmunity. August 2019.)

Diagnostic & Treatment

There is no specific test for diagnosis of RA. In 2010, the American College of Rheumatology and European League Against Rheumatism collaborated to create new classification criteria for RA. The 2010 new criteria rates on a scale from 0-10 points were assigned in four separate domains of signs and symptoms namely:1) joint involvement 2) serology 3) duration of symptoms 4) acute phase reactants. Patients are definitely diagnosed with RA if they score 6 or more points according to the following criteria. This criteria can be applied to any patient with and there is no explanation for synovitis which can not be attributed to other entities and there is no explanation for synovitis.13 

Many rheumatic conditions can be diagnosed or suspected based on taking history and physical examination. Sometimes, diagnosis of RA maybe possible based on clinical grounds alone, nevertheless there are no disease-specific clinical features or laboratory tests to be diagnostic for RA.14 Early symptoms of RA may appear as vague pain with gradual appearance without classic symptoms of joint swelling or tenderness. Prolong duration of morning stiffness with arthralgia , or arthritis in a limited number of joints may be a clue for considering RA diagnosis.15 

The therapy is complex and includes different classes of drugs with different routes of application but also non drugs interventions. The most important are patient education followed by exercise and physical and occupational therapy. Patient and the medical staff must go together to get the goal of the treatment. Because of an increased risk of coronary atherosclerosis, efforts should be made to reduce risk factors such as smoking, hyperlipidemia , hypertension, and obesity. To relieve pain and swelling fast and to gain control of the inflammation, glucocorticoids  are used widely in acute disease flares either orally or as joint injections .16 Oral glucocorticoid is for short-term use (up to 3-4 month) only should be tapered to prevent side effects as soon as possible.17 To control inflammation in the long run, Disease Modifying Anti-Rheumatic Drugs (DMARD) to spare glucocorticoid are needed. 

References

  1. https://www.hopkinsmedicine.org/health/wellness-and-prevention/autoimmune-disease-why-is-my-immune-system-attacking-itself.  Access: 24 June 2021
  2. National Institutes of Health Autoimmune Disease Coordinating Committee Report 2002. Bethesda (MD): The Institutes; 2002.
  3. Rose NR An immunology primer. In: Morton CC, Fagan T, editors. Proceedings from Sex Differences in Immunology and Autoimmunity, Society for Women’s Health Research, Boston, MA, 8 Nov 2001. Washington: Society for Women’s Health Research; 2002. p. 7–9.
  4. Women and Autoimmune Diseases. DeLisa Fairweather, Noel R. Rose. Emerg Infect Dis. 2004 Nov; 10(11): 2005–2011. doi: 10.3201/eid1011.040367. PMCID: PMC3328995
  5. Almutairi K, Nossent J, Preen D, Keen H, Inderjeeth C. The global prevalence of rheumatoid arthritis: a meta-analysis based on a systematic review. Rheumatol Int. 2021 May;41(5):863-877. doi: 10.1007/s00296-020-04731-0. Epub 2020 Nov 11. PMID: 33175207.
  6. Carbone F, Bonaventura A, Liberale L, Paolino S, Torre F, Dallegri F, Montecucco F, Cutolo M. Atherosclerosis in Rheumatoid Arthritis: Promoters and Opponents. Clin Rev Allergy Immunol. 2020 Feb;58(1):1-14.
  7. Cai Q, Xin Z, Zuo L, Li F, Liu B. Alzheimer’s Disease and Rheumatoid Arthritis: A Mendelian Randomization Study. Front Neurosci. 2018;12:627.
  8. Voigt A, Seipelt E, Bastian H, Juche A, Krause A. [Improved early diagnostics of rheumatic diseases : Monocentric experiences with an open rheumatological specialist consultation]. Z Rheumatol. 2018 Nov;77(9):844-849
  9. Rheumatoid Arthritis. Access: https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html
  10. Colebatch AN, Edwards CJ. The influence of early life factors on the risk of developing rheumatoid arthritis. Clin Exp Immunol. 2011;163(1):11-16. doi:10.1111/j.1365-2249.2010.04263.x
  11. Oxford University Press (OUP). “Breastfeeding is associated with a lower risk of rheumatoid arthritis, according to a new study.” ScienceDaily. ScienceDaily, 7 January 2014. <www.sciencedaily.com/releases/2014/01/140107093037.htm>.
  12. Pradeepkiran, Jangampalli Adi. Insight of rheumatoid arthritis risk factors and associations. Elsevier: Journal of Translational Autoimmunity. https://doi.org/10.1016/j.jtauto.2019.100012. August 2019.
  13. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G. Arthritis Rheum. 2010 Sep; 62(9):2569-81.
  14. Heidari, Behzad. “Rheumatoid Arthritis: Early diagnosis and treatment outcomes.” Caspian journal of internal medicine vol. 2,1 (2011): 161-70.
  15. Emerging trends in diagnosis and treatment of rheumatoid arthritis.. Birch JT Jr, Bhattacharya S. Prim Care. 2010 Dec; 37(4):779-92, vii.
  16. Kohler M.Birgit, Gunther Janine, Kaudewitz Dorothee, Martin Lorenz-Hanns. Current Therapeutic Options in the Treatment of Rheumatoid Arthritis. J. Clin. Med. 20198(7), 938; https://doi.org/10.3390/jcm8070938
  17. Hoes, J.N.; Jacobs, J.W.G.; Boers, M.; Boumpas, D.; Buttgereit, F.; Caeyers, N.; Choy, E.H.; Cutolo, M.; Silva, J.A.P.D.; Esselens, G.; et al. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann. Rheum. Dis. 200766, 1560–1567.
Becker’s Nevus Syndrome, What kind of Syndrome is This?

Becker’s Nevus Syndrome, What kind of Syndrome is This?

Becker’s Nevus Syndrome – A simple nevus but many distributed to our body may not be so disturbing. But, how could it be? If those nevus appeared only on one side of your body following hypertrichosis?

Becker’s nevus syndrome (BNS) is characterized by the simultaneous occurrence of a circumscribed patch of light or dark brown hyperpigmentation with a sharply outlined but irregular border (resolving into small spots reminiscent of an archipelago) and hypertrichosis (the so-called Becker’s nevus).1,2 

Becker’s nevus was first described  by Becker in 1949. Happle in 1997, described Becker’s nevus syndrome or hairy epidermal nevus syndrome, where BNS was associated with multiple skin and musculoskeletal(is made up of bones, muscles, joints, tendons and ligaments which all work together to provide the body)  abnormalities, mostly on the same side. Becker nevus usually presents as numerous macules, especially located unilaterally(only on one side) on the trunk and shoulders. It mostly appears in the adolescent period, being five times more frequent in men than in women.3

Also Read What is Sudden Death? is it Necessary to Watch Out?

Manifestations

1. Skin Manifestation

The nevus is characterized by the presence of light or dark brown macule with a sharply outlined but irregular and bizarre borders that resolve into small spots reminiscent of an archipelago.4 Becker’s Nevus mainly appears in the first and second decades of life, sometimes after sun exposure, and it is rarely described at birth. 

Most lesions are one side of the body area, localized to the upper quadrant of the chest and shoulder, but they can be found on any area of the body including the forehead, face, neck, lower, trunk, extremities, and buttocks.5,6,7   After its appearance, Becker’s Nevus may grow for a year or two but then remains fixed in size. In the course of time, pigmentation can fade however.6

2. Breast Manifestation

Another Becker’s nevus manifestation has reported in some cases unilateral hypoplasia(incomplete development/underdevelopment of an organ or tissue) of the breast. Both men and women are equal in prevalence, but this manifestation is more seen in women. 

A case report: A 24-year old woman was presented with a brown discoloration which initially appeared as a little spot on her left breast 11 years ago and then expanded with time. IN addition, the underlying left breast tissue had not grown during the peripubertal period(the 40-60 days period before first ovulation when a majority of these dynamic changes occur is referred to as the peripubertal period). From USG and MRI of the left breast showed hypoplasia.8 

3. Maxillofacial  Abnormalities

A case of 14-year-old boy with Becker’s nevus presented with abnormal symptoms including an asymmetric face, hemi maxillary enlargement, and abnormal teeth, all constituents of HATS syndrome.9 HATS or hemi maxillary enlargement, asymmetry of the face, tooth abnormalities, and skin findings is a rare developmental disorder involving the first and second branchial arches.

4. Maxillofacial  Abnormalities

Bone and muscle anomalies are frequently observed. They can include scoliosis(is a medical condition in which a person’s spine has a sideways curve. The curve is usually “S”- or “C”-shaped over three dimensions.). Vertebral defects (including hemivertebrate  and spina bifida occulta, fused or accessory cervical ribs(A cervical rib is an extra rib that forms above the first rib, growing from the base of the neck just above the collarbone), pectus excavatum (is a condition in which a person’s breastbone is sunken into his or her chest)  or carinatum (or pigeon chest is when part of your child’s breastbone is pressed outwards or raised up), asymmetry of scapulae(also known as the shoulder blade), short limb or other forms of limbs asymmetry, bilateral tibial torsion(is the twisting of a child’s shinbone, also known as the tibia and caused a toddler’s legs and feet to turn inward, giving them a pigeon-toed appearance), ipsilateral hypoplasia of the shoulder girdle (including absence of the pectoralis major muscle/large muscle in the upper chest, fanning across the chest from the shoulder to the breastbone), hypoplasia of the sternocleidomastoid muscle, and umbilical hernia.10, 11, 12, 13

5. Other Anomalies

A 15- year old female patient presented with a large dark-colored patch over genitals, upper and inner aspects of both the thighs, and in front of the neck.

The lesions started at the age of 5 years. The lesions were smaller in size initially and they gradually increased. The patients started walking and speaking at the age of 5 years. She was a dwarf, deaf, and had not attained her menarche.14

What caused Becker’s Nevus Syndrome ?

The exact cause of Becker’s Nevus remains unclear. There are 2 main hypotheses concerning this disorder. First, genetics. Genetic associates the syndrome with the occurrence of a postzygotic autosomal fatal mutation(is a change in an organism’s genome  that is acquired during its lifespan, instead of being inherited from its parents through fusion of two haploid gametes  that can “survive” only in a mosaic pattern: it is corroborated by the fact that the majority of cases are sporadic and familial grouping is very rare, similar to what happens in other neurocutaneous phenotypes.

The second hypothesis states that BNS is a hormone-dependent disorder; this theory is based on the increased number of androgen receptors  in the affected areas: for this reason, the appearance of lesions is more frequent in puberty, and alteration such as hypertrichosis and acneiform eruptions are restricted to the regions.15, 16, 17, 18 

Treatment

There is no special treatment for treating BNS. Therefore, patients should be recommended to come to regular clinical follow up to examine whether any associated abnormalities are developed in time. Although patients may feel significantly disturbed because of the conspicuousness of BNS, therapeutic modalities are limited. The treatment is essentially cosmetic. Potential therapeutic options include electrolysis , waxing, makeup, or laser treatment.19

There is also medication that is used for treating hormonal problems such as Spironolactone . Spironolactone is an antiandrogen used in other dermatological diseases due to the hormonal action. In relation to breast hypoplasia, its action is not fully understood but has been proposed to respond to negative feedback of androgen receptors. In a dosage of 50 mg/day, improvement of breast hypoplasia has been described.20

In some cases, breast hypoplasia and bone abnormalities, such as scoliosis, were corrected surgically.21

References

  1. Tymen R, Forestier JF, Boutet B, Colomb D. Late Becker’s nevus. One hundred cases [article in French]. Ann Dermatol Venereol 1981;108(01):41–46
  2. Danarti R, König A, Salhi A, Bittar M, Happle R. Becker’s nevus syndrome revisited. J Am Acad Dermatol 2004;51(06):965–969)
  3. Cosendey FE, Martinez NS, Bernhard GA, Dias MF, Azulay DR. Case Report Becker nevus syndrome. An Bras Dermatol. 2010;85:3.
  4. Cucuzza et al. Becker’s Nevus Syndrome. Journal of Pediatric Neurology. 2018. DOI https://doi.org/ 10.1055/s-0038-1667168. ISSN 1304-2580.)
  5. Van Gerwen HJ, Koopman RJ, Steijlen PM, Happle R. Becker’s nevus with localized lipoatrophy and ipsilateral breast hypoplasia. Br J Dermatol 1993;129(02):213)
  6. Rasi A, Berenji AH, Tabaie SM. Hypertrichosis is not so prevalent in Becker’s nevus: nevus: analysis of 47 cases. IRSN Dermatol 2014;201:953747. doi: 10.1155/2014/953747)
  7. Fegeler F, Schreiner H. Familiäres Vorkommen von systematisierten Pigmentnaevi mit circumscripter Sklerodermie im gleichen Hautsegment. Hautarzt 1954;5(06):253–255)
  8. Suzan Demir Pektas, Gulsen Akoglu, Ahmet Metin, Nuran Sungu Adiyaman, Mustafa Erol Demirseren. Indian J Dermatol. 2014 Nov-Dec; 59(6): 634. doi: 10.4103/0019-5154.143587. PMCID: PMC4248539)
  9. HATS syndrome: hemi maxillary enlargement, asymmetry of the face, tooth abnormalities, and skin findings.Al Shaiji JM, Handler MZ, Huo R, Freedman A, Schachner LA. Cutis. 2014 Oct; 94(4):E18-21.)
  10. Happle R, Koopman RJ. Becker nevus syndrome. Am J Med Genet 1997;68(03):357–361)
  11. Sugarman JL. Epidermal nevus syndromes. Semin Cutan Med Surg 2004;23(02):145–157)
  12. Ruggieri M, Pavone V, Polizzi A, et al. Tuberculosis of the ankle in childhood: clinical, roentgenographic and computed tomography findings. Clin Pediatr (Phila) 1997;36(09):529–534)  
  13. Sorge G, Ruggieri M, Polizzi A, Scuderi A, Di Pietro M. SHORT syndrome: a new case with probable autosomal dominant inheritance. Am J Med Genet 1996;61(02):178–181)
  14. (Becker’s Nevus Syndrome. Sathyanarayana B Dasegowda, GB Basavaraj, KC Nischal, MR Swaroop, NP Umashankar, Suchetha S Swamy. Indian J Dermatol. 2014 Jul-Aug; 59(4): 421. doi: 10.4103/0019-5154.135530PMCID: PMC4103296)
  15. Ruggieri M, Praticò AD. Mosaic neurocutaneous disorders and their causes. Semin Pediatr Neurol 2015;22(04): 207–233)
  16. Ruggieri M, Iannetti P, Pavone L. Delineation of a newly recognized neurocutaneous malformation syndrome with “cutis tricolor”. Am J Med Genet A 2003;120A(01):110–116)
  17. Lionetti E, Pavone P, Kennerknecht I, et al. Neurological manifestations in individuals with pure cutaneous or syndromic (Ruggieri-Happle syndrome) phenotypes with “cutis tricolor”: a study of 14 cases. Neuropediatrics 2010;41(02):60–65
  18. 4 Wagner RF Jr, Grande DJ, Bhawan J, Hellerstein MK, Longcope C. Unilateral dermatomal superficial telangiectasia overlapping Becker’s melanosis. Int J Dermatol 1989;28(09):595–596) 
  19. Metelitsa A, Rohrer T, Arndt KA. Laser and light therapy for cutaneous hyperpigmentation. UpToDate. 2017. Available at: https://www.uptodate.com/contents/laser-and-light-therapyfor-cutaneous-hyperpigmentation. Accessed December 18, 2017
  20. Taheri A, Mansoori P, Sandoval LF, Feldman SR. Treatment of Becker nevus with topical flutamide. J Am Acad Dermatol 2013; 69(03):e147–e148
  21. 5 Ruggieri M, Praticò AD, Evans DGE. Diagnosis, management and new therapeutic options in childhood neurofibromatosis type 2 and related disorders. Semin Pediatr Neurol 2015;22(04):240–258
What is Sudden Death? is it Necessary to Watch Out?

What is Sudden Death? is it Necessary to Watch Out?

What is Sudden Death? People nowadays are more critical yet still not knowing much about medical or medical term in the medics problem. The term that I want to bring up right now is about sudden death. People said the sudden death was someone who experienced an unexplained condition before death, or death while they’re sleeping. 

From American Heart Association journal, sudden death has come into the focus of the discussion on ischemic heart disease (IHD). At the present time, the meaning of the attribute “sudden” in this context is subject to considerable variation, ranging from death occurring within a few minutes to death within 24 hours2 of the onset of acute symptoms.   

In adults, the most common cause of sudden death is coronary heart disease or defects in the cardiac conduction system3 however there are some cause of sudden death is not from cardiac problems.

Data from Open Heart Journal in North Carolina(U.S) by following adjudication, 190 sudden unexpected deaths including 122 men and 68 women were identified. Estimated incidence was 32,1 per 100.000 person/years overall: 42,7 among men and 22,4 among women. The majority of victims were white, unmarried men over age 55 years, with unwitnessed deaths at home. Women who were under age 55 years with coronary disease accounted for over half of female participants with coronary artery disease. Hypertension and dyslipidemia were common in men and women.4

Also Read What Is Irritable Bowel Syndrome? What is The Cause?

Definition

Sudden death is a sudden, natural and unexpected death: in witnessed cases as an acute change in cardiovascular status with time to death being <1 hour and in un-witnessed cases as a person last seen alive and functioning normally <24 hours before being found dead. 

Causes

In one retrospective study assessed the underlying causes of sudden unexpected death in 162 subjects (aged 9 to 39 years) over 10-years period (1976 to 1985). In this study they divided into 3groups there are Cardiac, Non-cardiac causes and Unidentifiable causes in subjects aged <20 years the major underlying causes were Myocarditis , hypertrophic cardiomyopathy  and conduction system abnormalities . In subject aged ≥30 years the most frequent cause is coronary artery disease  followed by myocarditis. In the 20-29 year old age group, coronary artery disease and myocarditis were the most frequent causes, followed by hyperthrophic cardiomyopathy. The noncardiac cause happened to 8 subjects with Intracranial hemorrhage  as the most common cause. The hemorrhage(bleeding) was intra cerebral(brain) in 4 subjects, subarachnoid  in 3 and combined in 1. Circle of Willis  aneurysm (is weakening and bulging of an artery wall) was identified only in 1 of 8 subjects. Glioblastoma multiform  accounted for intracranial bleeding  in 1 younger subject.5In 6 subjects, infectious disease, mostly respiratory tract infection. Cardiac causes of sudden death were more frequent in men (105 of 134 [78%]) than in women (13 of 28 [46%]; p <O.Ol). Non-cardiac causes were more often encountered in women (11 of 28 [39%]) than in men (14 of 134 [IO%]; p <O.Ol).5

Coronary artery disease is the most common cause of sudden cardiac death, accounting for up to 80% of all cases. The most common causes of non-ischemic sudden cardiac death are cardiomyopathy  related to obesity, alcoholism, and fibrosis .6 Another resource that I found, there are 6 case reports have been published linking recent use of cannabis with sudden death.7,8 

Can Sudden Death be Prevented ?

Since this can occur people even seem to be in good health, so prevention is too difficult. However, as explained above, the most frequent cause is heart problems so everyone must know how to live a healthy life. 

Here’s what you should know: if there is a person in your family history who died with heart problems before, or having hypertension (high blood pressure), cholesterol problem or diabetes (high blood glucose level) or even obesity, you should care more about your future. Unexplained death wasn’t completely unknown, if there is a risk factor that can be the trigger. If you are the one who has those risk factors, you should have a routine medical check-up, control your diet, and keep a good and healthy lifestyle. 

References

  1. Working Group on Ischaemic Heart Disease Register, Report (Part I). Copenhagen, World Health Organization, Regional Office for Europe, 1969
  2. Sudden Unexpected Death. Suggestion for Classification Adopted by the International Society of Cardiology, Geneva, 1969
  3. Aquilla, Isabella PhD,MD; Boca,Silvia MD; Caputo, Fiorella MD; Sacco, Matteo A. MD; Gratteri, Santo PhD, MD; Fineschi, Vittorio PhD, MD; Ricci, Pietrantonio PhD, MD. An Unusual Case of Sudden Deathh Is There a Relationship Between Thyroid Disorders and Fatal Pulmonary Thromboembolism? A Case Report and Review of Literature. The American Journal of Forensic Medicine and Pathology. September 2017. Vol 38, Issue 3. P 229-232. DOI: 10.1097/PAF0000000000000317
  4. Lewis ME, Lin F-C, Nanavati P, et al. Estimated incidence and risk factors or sudden unexpected death. Open Heart 2016; 3:e000321.doi:10.1136/openhrt-2015-000321
  5. Drory Y, Turetz Y, Hiss Y, Lev B, Fisman EZ, Pines A, Kramer MR. Sudden unexpected death in persons less than 40 years of age. Am J Cardiol. 1991 Nov 15;68(13):1388-92. doi: 10.1016/0002-9149(91)90251-f. PMID: 1951130.
  6. Yow AG, Rajasurya V, Sharma S. Sudden Cardiac Death. [Updated 2020 Aug 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507854/ 
  7. A.M. Dines, D.M. Wood, M. Galicia, C.M. Yates, F. Heyerdahl, K.E. Hovda, I. Giraudon, R. Sedefov, D.E.N.R.G. Euro, P.I. Dargan, Presentations to the emergency department following cannabis use—a multi-centre case series from ten European countries, J. Med. Toxicol. 11 (4) (2015) 415–421.
  8. J. Orsini, C. Blaak, S. Rajayer, V. Gurung, E. Tam, J. Morante, B. Shamian, R. Malik, Prolonged cardiac arrest complicating a massive ST-segment elevation myocardial infarction associated with marijuana consumption, J. Community Hosp. Intern. Med. Perspect. 6 (4) (2016) 31695.
World Blood Cancer Day – Leukaemia

World Blood Cancer Day – Leukaemia

Cancer was the scariest diagnosis that people can hear. May 28 became the world blood cancer day, which is a global day of awareness dedicated to the fight against blood cancer. 

The World Health Organization in 2019 estimated that cancer is the first or second leading cause of death before the age of 70 years in 112 of 183 countries and ranks third of fourth in further 23 countries.1,2 Between 30 and 50%of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. Many cancers have a high chance of cure if diagnosed early and treated appropriately. Many of the known risk factors for cancer can be prevented. Tobacco use, infectious agents, unhealthy diet, excess body weight, physical inactivity, and alcohol consumption account for the majority of cancer deaths caused by known factors.3 

According to the Global Cancer Observatory in 2018, World Health Organization reports deaths in Indonesia caused by Leukemia was 11.314 people.

Also Read Fact About Baldness That You Must Know!

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Figure 1: National ranking of Cancer as a Cause of Death at Ages <70 Years in 2019. The numbers of countries represented in each ranking group are included in the legend. Source: World Health Organization.4

Blood Cyclopedia

Blood is a body fluid in humans that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells. Blood performs many important functions within the body, including:5  

  • Supply of oxygen to tissues (bound to hemoglobin , which is carried in red cells)
  • Supply of nutrients such as glucose, amino acids , and fatty acids 
  • removal of waste such as carbon dioxide, urea , and lactic acid 
  • immunological functions, including circulation of white blood cells , and detection of foreign material by antibodies 
  • Coagulation , the response to a broken blood vessel, the conversion of blood from a liquid to a semisolid get to stop bleeding
  • Messenger functions, including the transport of hormones  and the signaling of tissue damage
  • Regulation of core body temperature

Blood also has 4 main parts:7 

  1. Blood Plasma: is yellowish liquid component of blood that holds the blood cells, proteins and other constituents of whole blood in suspension.6 Plasma function is to transports nutrients, waste products, and proteins, and other molecules responsible for affecting the function of various parts of the body, including regulating body temperature and fluid balance.
  2. Red Blood Cells: the cells responsible for transporting oxygen to lungs and tissue.
  3. White Blood cells: The cells responsible for protecting against infections.
  4. Platelets: The cells that form blood clots and prevent blood loss. 

Blood Cancer Definition

Blood cancer is a complex group of disease linked by their origins in the bone marrow , where blood is produced. Blood cancer arises from abnormalities in the blood cells affect normal blood cell production and function. 

Then, why is there blood cancer ?

It is important to know that every second of every day a person’s body is replenishing its cells, including its blood cells, by making and destroying old ones. A person’s body can make the right number of each type of cell to keep the person healthy. To make blood cells, stem cells(basic material cell) in the bone marrow mature and develop into one of four types(blood plasma, red blood cells, white blood cells, and platelets) of blood cells. 

If the DNA in the stem cells that tells the body how to make blood cells changes (mutates), these blood cells might start to develop abnormality, or fail to die when they should. These are the “cancerous” cells that cause blood cancer. These abnormal blood cells prevent the blood from performing many of its usual functions, like fighting off infections, bringing oxygen to other tissues or helping to repair the body. 

Blood cancer is a complex group of disease linked by their origins in the bone marrow , where blood is produced. Blood cancer arises from abnormalities in the blood cells affect normal blood cell production and function. 

Leukaemia

Leukaemia are a group of hematologic disorders characterized by the dysfunction proliferation and development of leukocytes . They classified as acute or chronic, according to the degree of cell differentiation and as myelocytic  or lymphocytic  according to the predominant type of cell involved. Symptoms are nonspecific and can include fever, fatigue, weight loss, bone pain, bruising, or bleeding. Definitive diagnoses often require bone marrow biopsy , the result of which inform interprofessional treatment ranging from chemotherapy  to stem cell transplantation. 

Leukaemia has 2 major classification and 4 major subtypes.

  • Acute vs Chronic : acute leukemias are characterized by abnormal cells that are less mature, develop quickly, and leave the bone marrow as dysfunctional cells called “blasts (immature cells)”. These blasts crowd out healthy cells in the bone marrow , causing the rapid onset of symptoms. Blasts normally make up 1%$ top 5% of marrow cells, and having more than 20% blasts in the bone marrow is required for a diagnosis of acute leukemia. In contrast, chronic leukemias develop slowly and may take years to develop symptoms. They are composed primarily of more mature and functional cells and there are generally not elevated numbers of blasts.
  • Myeloid vs. Lymphoid : Hematopoietic stem cells  give rise to two types of blood cells: myeloid and lymphoid . Myeloid cells  include monocytes , macrophages , neutrophils , basophils , eosinophils , erythrocytes/red blood cells, and megakaryocytes .   
  • Acute lymphoblastic leukemia (ALL): ALL occurs when primitive white blood cells of lymphoid origin reproduce without developing into normal B and T cells. It is the most common leukemia in pediatrics, accounting for up to 80% of cases in this group vs. 20% of cases in adults.
  • Acute myelogenous leukemia (AML): AML is also characterized by the hyperplasia  of blasts, but in this case, of myeloid origin. It accounts for half of the leukemia cases diagnosed in teenagers and people in their 20s. It is the most common acute leukemia in adults.
  • Chronic lymphocytic leukemia (CLL): CLL occurs when mature but abnormal white blood cells of lymphoid origin undergo hyperplasia, leading to a monoclonal population  of dysfunctional lymphocytes. Most cases occur in people between ages 60 and 70.
  • Chronic myelogenous leukemia (CML): A monoclonal population of self-renewing, dysfunctional myeloid cells (e.g., neutrophils, basophils, eosinophils, macrophages) characterizes CML. Most cases occur in people between ages 25 and 60.

Several Risk Factors are associated with a higher risk of developing leukemia: Exposure to ionizing radiation is associated with an increased risk of multiple subtypes of leukemia; Exposure to benzene is a risk factor for leukemia in adults, particularly AML12; Previous exposure to chemotherapy, especially alkylating agents  and topoisomerase inhibitors , increase the risk for acute leukemia later in life10,11 ; A history of any hematologic malignancy is a risk factor for subsequently developing another subtype of leukimia13; Viral Infections (e.g., human T-cell leukemia virus, Epstein Barr virus) are linked with subtypes of ALL13;Several genetic syndromes (e.g., Down syndrome, Fanconi anemia() , Bloom syndrome , Li-Fraumeni syndrome ) are associated with an increased risk of AML and ALL14.

Diagnosis

Leukaemia and other blood cancers are usually not easily caught. The symptoms of it are not special so we also consider other differential diagnoses. One must rule out infection, drug effects, vitamin/micronutrient deficiencies, and other myelodysplastic disorders that can cause abnormalities in blood cell lines. These some of condition that you must be considered due to abnormalities on your blood count: B12 and folate deficiencies, Copper deficiencies, Viral infections (e.g., HIV, Cytomegalovirus, Epstein Barr virus), Drugs (chemotherapeutic agents, valproic acid, ganciclovir , myocophenolate mofetil ), Autoimmun  conditions (e.g., systemic lupus erythematosus

Treatment

We must understand that cancer is not one disease, but many, influenced by genetic mutations that affect both disease development and treatment options. For blood cancer, there are 2 main model therapies. 1called Curative therapy and the other one called Palliative therapy. 

Chemotherapy and radiotherapy was included in curative and palliative treatment to cure blood cancer. Curative therapies aim to cure the disease. These treatments eliminate the blood cancer cells, whereas palliative treatments ease the pain caused due to symptoms, but not actually remove the cancer.  

Now, the advance technology, science, and medication has been approved to help the treatments for blood cancer such as CAR-T , CRISPR technologies , PARP inhibitors . We also hope that every kid and adult who has this kind of disease can be manageable and we can also reduce the recurrence.

Refferences

  1. World Health Organization (WHO). Global Health Estimates 2020: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2019. WHO; 2020. Accessed December 11, 2020. who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death
  2. Bray F, Laversanne M, Weiderpass E, Soerjomataram I. The ever-increasing importance of cancer as a leading cause of premature death worldwide. Cancer. In press.
  3. Jemal,Ahmedin. Torre,Lindsey. Soerjomataram, Isabelle. Bray, Freddie. The Cancer Atlas. American Cancer Society. 2019. P 18
  4. Sung, H, Ferlay, J, Siegel, RL, Laversanne, M, Soerjomataram, I, Jemal, A, Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021: 71: 209- 249. https://doi.org/10.3322/caac.21660
  5. https://en.wikipedia.org/wiki/Blood Access: 26 May 2021
  6. https://en.wikipedia.org/wiki/Blood_plasma Access: 26 May 2021
  7. https://www.yalemedicine.org/conditions/blood-cancers#:~:text=Leukemia%3A%20Your%20doctor%20will%20obtain,be%20examined%20under%20a%20microscope. Access: 26 May 2021
  8. State of the Nation: Blood Cancer in Australia. Final Report to the Leukaemia Foundation. February 2019. Page 1-2
  9. Lyengar V, Shimanovsky A. Leukemia. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560490/
  10. Bispo JAB, Pinheiro PS, Kobetz EK. Epidemiology and Etiology of Leukemia and Lymphoma. Cold Spring Harb Perspect Med. 2020 Jun 01;10(6)
  11. Miranda-Filho A, Piñeros M, Ferlay J, Soerjomataram I, Monnereau A, Bray F. Epidemiological patterns of leukaemia in 184 countries: a population-based study. Lancet Haematol. 2018 Jan;5(1):e14-e24.)
  12. Snyder R. Leukemia and benzene. Int J Environ Res Public Health. 2012 Aug;9(8):2875-93.
  13. Davis AS, Viera AJ, Mead MD. Leukemia: an overview for primary care. Am Fam Physician. 2014 May 01;89(9):731-8.
  14. Stieglitz E, Loh ML. Genetic predispositions to childhood leukemia. Ther Adv Hematol. 2013 Aug;4(4):270-90.)

Covid-19 Variants in Indonesia and How is it?

Covid-19 Variants in Indonesia and How is it?

The latest headline news in Indonesia recently was that the Ministry of Health stated that they found new Covid-19 variants in Indonesia, mutated strains of the coronavirus that cause COVID-19. The variation of new COVID-19 strains are widely happening around the world. 

The Indonesia Ministry of Health has announced on May 4th that new corona virus variants have already entered Indonesia, such as B.1.1.7 ; B.1.3.5.1; and B.1.6.1.7. Press secretary of Indonesian Ministry of Health said  3 types of variants classified with Variant of Concern (VoC) that are aware of these types and this variant B.1.1.7 is known to have a higher transmission rate approximately 36 to 75 percentage compared to other strains of virus previously.1 The distribution of new Covid-19 variants in Indonesia includes 1 case variant type B.1617 found in Riau Island, and 1 case in DKI Jakarta. 2 cases variant B.117 found in North Sumatera, 1 case from South Sumatera, 1 case from Banten, 5 cases from West Java, 1 case from East Java, 1 case from Bali and 1 case from East Kalimantan. Meanwhile, variant B 1351 was found 1 case in Bali.1 

Also Read PEDIATRIC ASTHMA AND COVID-19

I. What’s the meaning of Virus Mutation ?

Viruses are simple entities, lacking an energy-generating system and having very limited biosynthetic capabilities. Viruses are subject to mutations, the genomes of different viruses can recombine to form novel progeny, the expression of the viral genome can be regulated, and viral gene products can interact.2

Viruses are continuously changing as a result of genetic selection. They undergo subtle genetic changes through mutation and major genetic changes through recombination. Mutation occurs when an error is incorporated in the viral genome. Recombination  (produced by the combining of genetic material from more than one origin) occurs when co-infecting(living with two or more viruses at the same time) viruses exchange genetic information, creating a novel virus.2 

All viruses, including SARS-CoV-2, evolve over time. When a virus replicates or makes copies of itself, it sometimes changes a little bit, which is normal for a virus. These changes are called mutations and one or more new mutations is referred to as a variant of the original virus.3

II. What is the difference between new Covid-19 variants in Indonesia ?

  • B.1.1.7 : This variant was first discovered in the South East of England (known as B.1.1.7 or VUI 202012/01) are more likely to have a cough, sore throat, fatigue, or myalgia than those infected with other variants, the Office for National Statistic has reported.4 The B.1.1.7 variant is thought to be much more infectious and possibly more deadly, although this is still being investigated.6 The report, which covered cases in England from 15 November 2020 to 16 January 2021, said, “Loss of taste and loss of smell were significantly less common in new variant compatible positives than triple positives, whereas other symptoms were more common in new variant compatible positives, with the largest differences for cough, sore throat, fatigue, myalgia, and fever. There is no evidence of difference in gastrointestinal symptoms, shortness of breath, or headaches.
  • B.1.3.5.1 : this variant first detected in South Africa in October 2020 also known as 501Y.V2. This variant is linked to higher viral load and increased transmission (approx. about 50% increased transmission)7 But, there is still no evidence that B.1.3.5.1 is associated with increased severity of disease.8  
  • B.1.6.1.7 : This variant was first detected in India in October 2020. The B.1.6.1.7 variant carries two mutations including the L452R and E484Q which have been seen separately before in other variants but never together in one variant. The L425R mutation which has been spotted in fat-spreading variants in California can reportedly increase the binding power of the virus’s spike protein with human cells, making it more transmissible and can also potentially increase viral replication. The E484Q is reportedly similar to the E484K mutation found in the UK and South African variants of the coronavirus which have shown to lower the effectiveness of antibodies generated by vaccine or a previous infection of COVID-19. Researchers are still trying to find the answer about this double mutation. Is it more deadlier than other variants and do existing vaccines work against it? It’s still in search.9 

III. The Impact of Vaccine to the New Variants of COVID-19

WHO said that the COVID-19 vaccines that are currently in development or have been approved are expected to provide at least some protection against new virus variants because these vaccines elicit a broad immune response involving a range of antibodies and cells. Therefore, mutations in the virus should not make vaccines completely ineffective. In the event that any of these vaccines prove to be less effective against one or more variants, it will be possible to change the composition of the vaccines to protect against these variants. And WHO and all researcher still in searching and learn more about that.10

IV. What Should We Do ?

Some variants and also Covid-19 variants in Indonesia appear to spread more easily between people and also may spread more easily. But we know we can all still having part to control the spread of COVID-19 and its new variants by keeping the health protocols (included: Washing our hands, Wearing a mask, Staying at least 1 m apart, and limiting time in or avoiding enclosed/crowded spaces)3and get the vaccine!

REFERENCES

  1. https://www.kemkes.go.id/article/view/21050500003/virus-corona-varian-baru-b-117-b-1351-b-1617-sudah-ada-di-indonesia.html. Visited: May 13,2021
  2. Fleischmann WR Jr. Viral Genetics. In: Baron S, editor. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston; 1996. Chapter 43. Available from: https://www.ncbi.nlm.nih.gov/books/NBK8439/
  3. WHO.COVID-19 new variants. https://www.who.int/news-room/feature-stories/detail/the-effects-of-virus-variants-on-covid-19-vaccines?gclid=CjwKCAjw-e2EBhAhEiwAJI5jg6LtkOylLSj2pwQ9is0C79Rft0WuJiY-Da3fRZGVz8w-ondGiJdaMBoC75wQAvD_BwE. Visited: May 13, 2021
  4. Office for National Statistics. (Covid-19) infection survey: characteristics of people testing positive for covid-19 in England. 27 Jan 2021. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19infectionsinthecommunityinengland/characteristicsofpeopletestingpositiveforcovid19inengland27january2021 
  5. Mahase E. Covid-19: What have we learnt about the new variant in the UK?BMJ 2020;371:m4944. https://www.bmj.com/content/371/bmj.m4944 . doi: 10.1136/bmj.m4944 pmid: 33361120
  6. Iacobucci G. Covid-19: New UK variant may be linked to increased death rate, early data indicate. BMJ 2021;372:n230. https://www.bmj.com/content/372/bmj.n230 . doi: 10.1136/bmj.n230 pmid: 33500262 
  7. Pearson CAB, Russell TW, Davies NG, et al. Estimates of severity and transmissibility of Novel South Africa SARS-CoV-2 variant 501Y.V2. visited:May 13 2021
  8. WHO. SARS-CoV-2 Variants. https://www.who.int/csr/don/31-december-2020-sars-cov2-variants/en/. Visited: May 13 2021
  9. Ray, Siladitya. “Double Mutant” Covid Variant: Here’s What We Know as Israel Reports Vaccine Efficacy Against Variant First Detected in India.  Forbes. Apr;l 20, 2021. https://www.forbes.com/sites/siladityaray/2021/04/20/double-mutant-covid-variant-heres-what-we-know-as-israel-reports-vaccine-efficacy-against-variant-first-detected-in-india/?sh=4b82b7052fb3
  10. WHO. The effects of virus variants on COVID-19 vaccines. https://www.who.int/news-room/feature-stories/detail/the-effects-of-virus-variants-on-covid-19-vaccines. Visited: May 13 2021
What Is Irritable Bowel Syndrome? What is The Cause?

What Is Irritable Bowel Syndrome? What is The Cause?

What is Irritable Bowel Syndrome? Is this just simple constipation? But I got this for such a long time. As you can say, I’m living with this gut. Alright, you might not really worry about your constipation, because you are living with this condition in a long term period 6-7 years.

But do you know that constipation might be linked to one of the symptoms of Irritable Bowel Syndrome (IBS)? Yes, it’s linked. For mine, I am also a post IBS’s patient, and not knowing this diagnosis for about almost 7 years. So, In this month this IBS awareness month, so I loved to share this information for all of you so you can be more aware and go get your medical check up if you possibly get the symptoms of IBS.

Also Read Fact About Baldness That You Must Know!

What is Irritable Bowel Syndrome (IBS) ?

Irritable bowel syndrome is a common medical condition characterized by chronic, recurrent, abdominal pain and discomfort, and altered bowel habits that occur in the absence of other organic gastrointestinal (GI) disease.1 IBS is the most common reason to visit a gastroenterologist and the second most common reason, after common flu, to be absent from work.1 Usually, women are more commonly affected than men, in ratio of 2:1, and the peak of the disease often starts in early adulthood.2 In general, patients are evenly distributed among 3 subtypes diarrhea-predominant [IBS-D], constipation-predominant [IBS-C], or mixed [IBS-M]. 

The underlying cause is still being defined but is thought to be multifactorial.1

Signs and Symptoms 

Common sign and symptoms of IBS are abdominal pain, bloating, straining during defecation, sensation of incomplete evacuation3, mucus with stools, urgency, postprandial symptoms, depression, and anxiety.5

Things Cause IBS

  1. Food Intolerance

One of the most common factors causing symptoms in IBS patients is food intolerance.6 They believed that specific types of food trigger their symptoms. Foods that contain fermentable oligosaccharides, disaccharides, monosaccharides and polyols  (FODMAP) are known triggers that worsen IBS symptoms because of their osmotic and fermentation effects.7 

Table 1. High FODMAP Foods

2. Enteric Infection

Enteric infection known as post-infectious IBS6 and usually occurs after an acute bacterial, viral or protozoal gastroenteritis, when around 20% of patients will develop symptoms of IBS.9 The groups of pathogens that lead to IBS symptoms are still unknown, but colonic spirochetosis  was linked previously with colonic eosinophilia , lymphoid follicles, and IBS-D(IBS Diarrhea).10,11 

3. Stress-depression

Up to 75% of patients with IBS symptoms usually have coexisting or depression.10 One study that compared anxiety and depression levels in IBS patients and healthy individuals found that the activity of the dorsolateral prefrontal cortex  in IBS patients was dysregulated in behavioral selection duties.12 Norepinephrine  production by stressful stimuli appears to enhance the growth of many intestinal pathogens, including Campylobacter jejuni13, Escherichia coli (E.coli) and E. Coli 0157:H7, with activation of the HPA axis.14 It appears that this stress stimulation also affects the non-pathogenic bacteria, such as Lactobacilli and Bifidobacteria, promoting even more invasion from other potential pathogens.15

4. Microbiota

IBS patient assumed have altered microbiota in their intestines.16 Observation from a study in 110 IBS patients show that patients with IBS have different intestinal microbiota.17 

Lactobacillus and Bacteroides species, known beneficial bacteria, are also depleted, while the number of pathogenic bacteria, such as Streptococcus spp., are increased.18 In a study of IBS patients with abdominal pain, the investigators observed that patients with pain had 5 times smaller amounts of Bifidobacteria in their intestines.19 

Conclusion

Inflammatory Bowel Syndrome is a disease that is manageable. The cause IBS is multifactorial and not completely elucidated. The initiation of treatment of IBS starts with identifying the severity and predominant symptoms of the disorder. If symptoms do not significantly affect quality of life, management with lifestyle modification and education is a reasonable choice. Treatment is based on a trial of lifestyle changes and symptom management. The low FODMAP diet and exercise should be recommended for lifestyle changes. Pain and bowel cramping can be treated with antispasmodics  and peppermint oil, tricyclic antidepressants , counseling, probiotics, or a trial of rifaximin.1

This month awareness of IBS just wants people to be more concerned about their gut changes activity. If you find something uncomfortable, painful, or even bloody stool please be more concerned and go to see your doctor!

Stay safe and Healthy!

REFERENCES

  1. Defrees DN, Bailey J. Irritable bowel syndrome: epidemiology, pathophysiology, diagnosis, and treatment. Prim Care 2017;44:655-671.
  2. Mayer EA. Clinical practice. Irritable bowel syndrome. N Engl J Med 2008;358:1692-1699.
  3. Enck P, Aziz Q, Barbara G, et al. Irritable bowel syndrome. Nat Rev Dis Primers 2016;2:16014.
  4. Böhn L, Störsrud S, Törnblom H, Bengtsson U, Simrén M. Selfreported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013;108:634-641.
  5. Jerndal P, Ringström G, Agerforz P, et al. Gastrointestinal-specific anxiety: an important factor for severity of GI symptoms and quality of life in IBS. Neurogastroenterol Motil 2010;22:646-e179.
  6. Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA 2015;313:949-958.
  7. Shepherd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 2008;6:765-771.
  8. Vakil, Namish. Dietary Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAPs) and Gastrointestinal Disease. Nutrition in Clinical Practice. Vol 00 Number 0. 2018;1-8. American Society for Parenteral and Enteral Nutrition. DOI: 10.1002/ncp.10108
  9. Keely S, Walker MM, Marks E, Talley NJ. Immune dysregulation in the functional gastrointestinal disorders. Eur J Clin Invest 2015;45:1350-1359.
  10. Holtmann GJ, Ford AC, Talley NJ. Pathophysiology of irritable bowel syndrome. Lancet Gastroenterol Hepatol 2016;1:133-146.
  11. Walker MM, Talley NJ, Inganäs L, et al. Colonic spirochetosis is associated with colonic eosinophilia and irritable bowel syndrome in a general population in Sweden. Hum Pathol 2015;46:277-283.
  12. Aizawa E, Sato Y, Kochiyama T, et al. Altered cognitive function of prefrontal cortex during error feedback in patients with irritable bowel syndrome, based on FMRI and dynamic causal modeling. Gastroenterology 2012;143:1188-1198
  13. Xu F, Wu C, Guo F, et al. Transcriptomic analysis of Campylobacter jejuni NCTC 11168 in response to epinephrine and norepinephrine. Front Microbiol 2015;6:452.
  14. Raskov H, Burcharth J, Pommergaard HC, Rosenberg J. Irritable bowel syndrome, the microbiota and the gut-brain axis. Gut Microbes 2016;7:365-383 
  15. Pigrau M, Rodiño-Janeiro BK, Casado-Bedmar M, et al. The joint power of sex and stress to modulate brain-gut-microbiota axis and intestinal barrier homeostasis: implications for irritable bowel syndrome. Neurogastroenterol Motil 2016;28:463-486.
  16. Bhattarai Y, Muniz P DA, Kashyap PC. Irritable bowel syndrome: a gut microbiota-related disorder? Am J Physiol Gastrointest Liver Physiol 2017;312:G52-G62
  17. Tap J, Derrien M, Törnblom H, et al. Identification of an intestinal microbiota signature associated with severity of irritable bowel syndrome. Gastroenterology 2017;152:111-123.
  18. Parkes GC, Rayment NB, Hudspith BN, et al. Distinct microbial populations exist in the mucosa-associated microbiota of subgroups of irritable bowel syndrome. Neurogastroenterol Motil 2012;24:31-39.
  19. Jalanka-Tuovinen J, Salonen A, Nikkilä J, et al. Intestinal microbiota in healthy adults: temporal analysis reveals individual and common core and relation to intestinal symptoms. PLoS One 2011;6:e23035.