Three decades-old antibiotics could offer an alternative to opioid-based painkillers

Three decades-old antibiotics administered together can block a type of pain triggered by nerve damage in an animal model, UT Southwestern researchers report. The finding, published online today in PNAS, could offer an alternative to opioid-based painkillers, addictive prescription medications that are responsible for an epidemic of abuse in the U.S.

Over 100 million Americans are affected by chronic pain, and a quarter of these experience pain on a daily basis, a burden that costs an estimated $600 billion in lost wages and medical expenses each year. For many of these patients – those with cancer, diabetes, or trauma, for example – their pain is neuropathic, meaning it's caused by damage to pain-sensing nerves.

To treat chronic pain, prescriptions for opioid painkillers have increased exponentially since the late 1990s, leading to a rise in abuse and overdoses. Despite the desperate need for safer pain medications, development of a new prescription drug typically takes over a decade and more than $2 billion according to a study by the Tufts Center for the Study of Drug Development, explains study leader Enas S. Kandil, M.D., associate professor of anesthesiology and pain management at UTSW.

Seeking an alternative to opioids, Kandil and her UT Southwestern colleagues – including Hesham A. Sadek, M.D., Ph.D., professor of internal medicine, molecular biology, and biophysics; Mark Henkemeyer, Ph.D., professor of neuroscience; Mahmoud S. Ahmed, Ph.D., instructor of internal medicine; and Ping Wang, Ph.D., a postdoctoral researcher – explored the potential of drugs already approved by the Food and Drug Administration (FDA).

The team focused on EphB1, a protein found on the surface of nerve cells, which Henkemeyer and his colleagues discovered during his postdoctoral training nearly three decades ago. Research has shown that this protein is key for producing neuropathic pain. Mice genetically altered to remove all EphB1 don't feel neuropathic pain, he explains. Even mice with half the usual amount of this protein are resistant to neuropathic pain, suggesting EphB1's promise as a target for pain-relieving drugs. Unfortunately, no known drugs inactivate EphB1.

Exploring this angle further, Ahmed used computer modeling to scan a library of FDA-approved drugs, testing if their molecular structures had the right shape and chemistry to bind to EphB1. Their search turned up three tetracyclines, members of a family of antibiotics used since the 1970s. These drugs – demeclocycline, chlortetracycline, and minocycline – have a long history of safe use and minimal side effects, Ahmed says.

To investigate whether these drugs could bind to and inactivate EphB1, the team combined the protein and these drugs in petri dishes and measured EphB1's activity. Sure enough, each of these drugs inhibited the protein at relatively low doses. Using X-ray crystallography, Wang imaged the structure of EphB1 with chlortetracycline, showing that the drug fits neatly into a pocket in the protein's catalytic domain, a key portion necessary for EphB1 to function.

In three different mouse models of neuropathic pain, injections of these three drugs in combination significantly blunted reactions to painful stimuli such as heat or pressure, with the triplet achieving a greater effect at lower doses than each drug individually. When the researchers examined the brains and spinal cords of these animals, they confirmed that EphB1 on the cells of these tissues had been inactivated, the probable cause for their pain resistance. A combination of these drugs might be able to blunt pain in humans too, the next stage for this research, says Kandil.

Unless we find alternatives to opioids for chronic pain, we will continue to see a spiral in the opioid epidemic. This study shows what can happen if you bring together scientists and physicians with different experience from different backgrounds. We're opening the window to something new."

Enas S. Kandil, M.D., Associate Professor, Anesthesiology and Pain Management, UT Southwestern


UT Southwestern Medical Center

Posted in: Medical Science News | Medical Research News | Pharmaceutical News

Tags: Anesthesiology, Animal Model, Antibiotic, Cancer, Cardiology, Chronic, Chronic Pain, Crystallography, Diabetes, Drugs, Education, heat, Medicine, Minocycline, Molecular Biology, Nerve, Neuropathic Pain, Neuroscience, Opioids, Pain, Pain Management, pH, Prescription Drug, Protein, Receptor, Research, Tetracycline, Trauma, X-Ray

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Ergonomic Consultation Spares Endoscopists a Pain in the Neck

Assessment of position and posture by a physical therapist can help reduce and prevent injury in endoscopists, based on data from a pilot study of eight individuals.

Musculoskeletal injuries among endoscopists are gaining more attention: One technical review indicated that the “prevalence of musculoskeletal pain or injuries ranged from 29% to 89% of gastroenterologists.” While data on avoiding musculoskeletal injury related to endoscopy are limited, recognition of the role of ergonomics is increasing, Stacy A. Markwell, a physical therapist in Chapel Hill, N.C., and colleagues, wrote in a study published in Gastrointestinal Endoscopy.

The mental concentration required along with the physical demands on manipulating the scope have been shown to negatively impact posture, the researchers noted.

The researchers reviewed data from eight endoscopists who were aged 32-71 years; they had a range of clinical experience and were performing 6-30 colonoscopies and 3-21 upper endoscopies per week.

These endoscopists volunteered for an ergonomic intervention involving use of an individualized wellness plan. They completed the Nordic Musculoskeletal Questionnaire to evaluate musculoskeletal complaints during the past 12 months and the past 7 days. Three of the eight participants reported pain at work at initial assessment, which often worsened over the course of the day, and five mentioned fatigue while working. They specified 22 pain sites, mainly in the neck and back. In addition, participants were photographed to evaluate posture in a static position and self-selected “tired” positions.

“When frequent or consistent posturing resulted in suboptimal joint alignment, muscle length, loading at end range of muscle or joints, and/or prolonged static active positioning, participants were photographed to provide personalized feedback for wellness education,” the researchers wrote.

The physical therapist used information from the evaluation and photographs to develop individual plans to improve the ergonomics of the endoscopic suite with adjustments to the location of the bed and positioning of chairs, standing surfaces, and monitors and keyboards. In addition to adjusting the endoscopic suite, the physical therapist developed individual wellness plans including exercises to relieve pain and improve posture, as well as pain education to help clinicians recognize and manage pain and fatigue.

By the end of the study, in a follow-up 6-12 months after the wellness intervention, 63% of pain sites (14 of 22) reported by participants were reduced in intensity or resolved, 32% were unchanged (7 of 22), and 4% increased (1 of 22).

Overall, seven of the eight participants said that the pictures of their posture along with the movement analysis was helpful, and three participants asked for reassessment by the physical therapist. In this study, the average cost of the wellness program was $500.

“All endoscopists reported that the wellness plan was helpful, with procedure suite and posture recommendations being the most beneficial,” the researchers reported. “Upon gaining insight with visualization of their posture and movement during endoscopy, participants’ understanding and motivation to make corrections was intensified.”

The study findings were limited by several factors including the small size, use of a single physical therapist, short follow-up, lack of controls, and use of a single site, the researchers noted. However, “our study provides a detailed, pragmatic, and reproducible framework for performing an individualized physical therapist–directed comprehensive assessment and personalized wellness plan in the workplace to help meet the challenges of ergonomics in endoscopy.”

Recognition of the Value of Ergonomics Is Rising

“Endoscopy related injury and disability is a known hazard of our profession,” said Gyanprakash A. Ketwaroo, MD, of Baylor College of Medicine, Houston, in an interview. “Any studies to assess and, more importantly, offer ways to prevent such injury are immediately relevant. In this context, ergonomics for endoscopy is an increasing area of research.”

Ketwaroo said that the study results were not surprising. “I agree with authors that there is a paucity of general ergonomic training and assessment. Specific individualized wellness plans are rare. Developing an individual plan based on observation by physical therapists, and taking into account baseline injury or predisposition to injury would be expected to be more high yield for preventing injury and improving performance

“I believe the main take-home message from the study is that an individualized ergonomic plan based on assessment and feedback by physical therapists appears promising for optimizing endoscopic performance to minimize injury and reduce fatigue,” Ketwaroo said. However, “long-term studies in much larger samples will be needed to document objective findings of reduced injury or fatigue.”

The study received no outside funding. The researchers had no financial conflicts to disclose. Ketwaroo serves on the GI & Hepatology News editorial advisory board.

This article originally appeared on, part of the Medscape Professional Network.

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No damsels in distress: Women report lower pain sensitivity when tested by men


Big girls don’t cry—especially not in front of men. While stereotypes may suggest that women in pain seek attention and sympathy from men, researchers at Murdoch University, Australia found that women report feeling less pain when tested by men than by other women.

In a new study “‘Big Girls Don’t Cry’: The effect of the experimenter’s sex and pain catastrophising on pain,” published in DeGruyter’s Scandinavian Journal of Pain, Dr. Lechi Vo and Professor Peter Drummond explored how gender stereotypes affect the reporting of pain.

Male and female participants rated the pain experienced from heat, pressure, pin pricks and high-frequency electrical stimulation. Either a male or female experimenter team applied the stimuli, then the researchers analyzed how their gender affected pain ratings.

“Traditional gender stereotypes imply that males underreport pain to show how strong they are, while females tend to overreport pain, especially to male experimenters to seek attention or protection,” said Vo. “Our results suggest quite the opposite.”

Evidence suggests women were more likely to be anxious about pain—an attitude called pain catastrophizing—than men, so Vo expected them to report higher pain sensitivity. And indeed, Vo found a link between pain catastrophizing and pain reports in women but not in men. But in front of men, women reported lower pain sensitivity when moderate to intense pain was caused.

Women appeared to underreport their pain responses when the experimenters were males, indicating that gender role biases may sometimes overshadow catastrophic attitudes about pain. One explanation could be that a growing number of women no longer want to appear as the ‘weaker sex’, thus opposing traditional female norms.

Vo’s research may have implications for pain assessment in the healthcare setting. “We already see gender biases as pain is assessed depending on the patient’s sex,” she said. “We want to further understand how gender biases influence the way female chronic pain patients report pain and urge healthcare professionals to be aware of these potential biases when assessing their patients’ pain.”

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Diagnosis of food poisoning

Food poisoning is usually a mild illness that may resolve on its own after a bout of stomach upset. However, in some cases it might be more serious needing therapy.

Symptoms of food poisoning like abdominal cramps, nausea and vomiting, diarrhea and weakness and association with a recent intake of contaminated food or water is often diagnostic of the condition.

However, sometimes blood tests, tests for the infected stools or even a sigmoidoscopy and other imaging tests may be prescribed to find out the causative organism. (1)

There are several steps for the diagnosis of food poisoning. (1-5)

History of intake of contaminated food

In most cases, the patient volunteers such information.

History of recent return from travel to a developing or underdeveloped country and drinking contaminated water or eating contaminated food should also be mentioned.

Physical examination

A complete physical examination may be needed especially to rule out signs of dehydration.

Dehydration is usually caused due to excessive fluid loss due to diarrhea or vomiting.

Dehydration is characterized by dry skin that remains tented after a pinch, sunken eyes, dry mouth, no sweating in the groins or armpits, no urination for long durations etc.

Weakness or paralysis may also be diagnosed on physical examination and may be indicative of Botulism which needs immediate therapy.

Blood pressure, pulse and temperature are also measured. Severe dehydration is manifested with weak pulse and low blood pressure.

If there is accompanying fever, temperature assessment may be helpful.

Routine blood tests

Routine blood tests may be ordered in some patients with severe food poisoning.

Sometimes these are ordered to check for levels of blood electrolytes and to check for adequate kidney functions.

In case of suspected hepatitis A liver function tests may also be ordered.

Stool examination

Stool samples are examined in case of Salmonella, Shigella and Campylobacter. These infections commonly lead to bloody diarrhea.

If there is a suspected parasitic infestation the stool samples are examined and the parasite is identified under the microscope.

Sometimes stool culture may be prescribed. The sample is allowed to stand in the laboratory in ideal environmental conditions and growth of the microorganism is checked.

Rectal examination

Rectal examination may be needed especially in case of bloody stools.

The doctor inserts a lubricated and gloved finger gently into the rectum for this tests and assess if there are breaks in the rectal wall.

Imaging studies

If the symptoms are suspected to be caused by any other illness, imaging studies are recommended.

These include CT scan of the abdomen.

Sometimes a sigmoidoscopy may be recommended. This involves insertion of a thin long tube within the rectum up to the colon. The tube has a camera on the tip. This helps diagnose any pathology within the intestinal walls.

Toxoplasmosis test

In pregnant women with symptoms there may be a risk of Toxoplasma infection. For this a toxoplasmosis test is advised.


  3. and Tests

Further Reading

  • All Food Poisoning Content
  • What is Food poisoning?
  • Food poisoning Causes
  • Food poisoning Symptoms
  • Food poisoning Treatment

Last Updated: Jun 4, 2019

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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What is bruxism (teeth-grinding)?

Bruxism is where a person has a tendency to clench their teeth together or grind their teeth (which means to rub the teeth back and forth over one another). (1)

Bruxism can occur whilst you are awake or asleep. The former tends to only involve clenching rather than grinding; whereas the latter can involve both. (2)

Symptoms of bruxism

The symptoms of bruxism, particularly of nocturnal bruxism (that which occurs at night), include grinding noises. These may be commented upon by a sleeping partner or roommate. This is because the bruxist – the person with bruxism – may not realize that they grind their teeth. They may only discover that they have bruxism because their partner notices the grinding noise. (3)

Other tell-tale signs that you may have bruxism include:

  • headaches
  • facial muscle pain
  • aching jaw and limited mouth opening
  • earache
  • tightness and stiffness of the shoulders (4, 5)

In addition to these symptoms, bruxists may also develop more long-lasting problems including worn and cracked teeth. This may be repaired by dental work; however, the enamel of the teeth, which may be damaged by bruxism, cannot grow back. (3, 5)

Other long-term symptoms of bruxism include:

  • tooth sensitivity – the teeth may be sensitive to hot, cold or sweet foods
  • pain and stiffness of the jaw joint
  • inflammation and recession of the gums
  • premature loss of teeth (4, 5, 6)

Diagnosis of bruxism

Bruxism may be identified by a dentist. This is because bruxism can lead to the tips of the teeth becoming flat. (7)

Bruxism may also be diagnosed based on the excessive wear and thin enamel caused by clenching and grinding of the teeth. (8)

Causes of bruxism

There are several potential causes of bruxism. The main cause is thought to be due to stress or anxiety. Consequently, bruxism often affects the following types of people:

  • those with a highly-demanding job
  • those going through difficult life events
  • those who are angry, in pain or frustrated
  • those with aggressive tendencies
  • those who are overly competitive (7, 9)

Bruxism can also be caused by an occlusal discrepancy, also known as an imperfect or abnormal bite. This is where there is a problem with the way the two sets of teeth come together. (3, 9)

Certain lifestyle choices may also affect a person’s risk of bruxism. In particular, the following people may be more likely to suffer from bruxism:-

  • those who consume high levels of alcohol
  • those who have a high caffeine intake – particularly those who drink more than 6 cups of tea or coffee a day
  • those who use tobacco
  • those who take recreational drugs, such as ecstasy (9, 10, 11)

Certain medications may also increase a person’s risk of bruxism. These include antidepressants, particularly a type called selective serotonin reuptake inhibitors (SSRI), such as paroxetine, fluoxetine and setraline. (9)

How common is bruxism?

According to the Bruxism Association, between 8 and 10% of people are affected by bruxism. Bruxism tends to occur in adults aged 25-44. (2, 12)

According to Colgate, an American personal product producer, bruxism affects somewhere between 30 and 40 million people in the United States. (13)

Treatments for bruxism

Treatments for bruxism include treating the symptoms and the causes of bruxism.

One way the symptoms of bruxism can be treated is by wearing a protective guard. This is like a sports mouth guard and it protects the teeth from further damage from clenching and grinding. The appliance may also reduce the noise created by grinding. (14, 15)

Other treatments for the symptoms of bruxism include visiting the dentist for any necessary dental work to repair the damage caused by bruxism. This may include crowns and root canal treatment. Bruxists may also require re-shaping work on their teeth, particularly when sensitivity has arisen from the wearing down of teeth. (15)

In addition to treating the symptoms of bruxism, it is also possible to try to treat the causes of bruxism. If bruxism is caused by stress then stress management techniques may help to treat bruxism. These include:

  • Counseling
  • Cognitive behavioral therapy (CBT)
  • Exercise
  • Meditation
  • Bio-feedback – this involves a device which measures the amount of muscle activity occurring in the mouth, this allows the patient to realize when there is too much and thus to try to change their behavior (7, 14, 15)

Medications may also be used to try to reduce bruxism, although this is not common. Ibuprofen, or other Non-steroidal anti-inflammatory drugs (NSAIDs), may be suggested to reduce any pain or inflammation which may occur due to bruxism.

Other potential medications that may be suggested include muscle relaxants and mild sleeping aids. (8, 15)

Bruxism in children

Bruxism sometimes occurs in children when they are teething. Estimates vary as to how many children bruxism affects, but it is thought to be somewhere between 15 and 33% of children.

Often the condition comes to an end when a child’s permanent teeth are fully formed.

Bruxism is also thought to occur more when children are sitting school exams. (9, 13, 16)



Further Reading

  • All Bruxism Content
  • All Teeth Content
  • Dental Health in Children
  • Foods Good for Teeth
  • Tooth Polishing Procedure

Last Updated: Jun 28, 2019

Written by

April Cashin-Garbutt

April graduated with a first-class honours degree in Natural Sciences from Pembroke College, University of Cambridge. During her time as Editor-in-Chief, News-Medical (2012-2017), she kickstarted the content production process and helped to grow the website readership to over 60 million visitors per year. Through interviewing global thought leaders in medicine and life sciences, including Nobel laureates, April developed a passion for neuroscience and now works at the Sainsbury Wellcome Centre for Neural Circuits and Behaviour, located within UCL.

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Symptoms of Gynecomastia

Gynecomastia describes the swelling of breast tissue in males, caused by a decrease in the level of testosterone compared with the level of estrogen. The condition can affect one or both breasts and can develop in newborns, during puberty or in older men, usually as a result of normal hormonal changes.

In infants, gynecomastia affects over half of males born due to the effect of their mother’s estrogen and the swollen breast tissue usually disappears within three weeks after birth. During puberty, hormonal changes commonly cause gynecomastia and in the majority of cases, the issue resolves independently after six months to two years. In older individuals, the condition is more likely to develop between the ages of 50 and 80, with a quarter of this age group being affected. As men become older, their testosterone level tends to decrease and they also tend to gain weight. The lowered testosterone can cause the breast glands to enlarge and the weight gain means fatty tissue accumulates under the breast, leaving the man with a larger quantity of glandular tissue and more fat in the breast. As fat cells are estrogenic, this additional fat can further disrupt the balance between testosterone and estrogen.

Gynecomastia is not generally a serious issue, although it can be difficult to cope with as it can be painful and cause feelings of embarrassment. The condition can resolve independently of any intervention but if it persists, medication or surgery may be recommended.

Aside from natural hormonal changes, the use of certain medications can cause gynecomastia and examples of these include anabolic steroids, androgens, anti-androgens, anti-anxiety medications, antibiotics, chemotherapy, heart medications and drugs used to treat AIDS. Other causes include the use of substances such as alcohol, marijuana, methodone, heroin and amphetamines; health conditions including hyperthyroidism, kidney failure, liver disease and malnutrition and the use of herbal products such as shampoos, lotions or soaps containing tea tree or lavender.

The symptoms of gynecomastia include the following:

  1. The main symptom of gynecomastia is enlargement of either one or both breasts. The enlarged glandular tissue usually occurs in both breasts but in some cases it is unilateral. The breast growth may be uniform or uneven with respect to the nipple. It may feel rubbery or firm. The growth may appear just behind the nipple.
  2. The breast or nipple may be painful or tender when touched.
  3. In boys, there may be a breast bud in one or both breasts that is around the size of a quarter or nickel. These commonly occur in boys during puberty and can persist for up to two years.
  4. It is important to distinguish gynecomastia from male breast cancer. When cancer is present, only one breast is usually affected and the tissue is not necessarily hard or firm. Cancer may also be associated with dimpling of the skin, nipple discharge, retraction of the nipple and enlarged lymph nodes under the arms.
  5. Another problem that can cause male breast swelling is a breast abscess, although this is rare in men. Affected individuals may develop a fever or chills. The swelling may be very painful and hot to touch and skin across the swelling may appear reddish in color.

Evaluation of symptoms

When examining a male patient with enlarged breasts, a doctor will want to clarify the duration of the enlargement; whether or not secondary sexual characteristics are fully developed; any association between puberty and onset of the enlargement; breast symptoms such as nipple discharge or pain and whether any genital symptoms are present such as erectile dysfunction or lowered libido.

When evaluating the patient, the doctor will look for symptoms that could indicate the potential cause of the enlargement such weight loss or fatigue which could be caused by kidney disease or hyperthyroidism; discoloration of the skin which could indicate liver or kidney disease; cognitive or mood changes indicative of hypogonadism and hair loss, which could suggest malnutrition.

The patient’s medical history will also be reviewed to check for any disorders that could cause gynecomastia and the use of any medications that may trigger the condition.


Gynecomastia usually resolves without any treatment being required, but if the cause is an underlying health condition such as liver disease or hypogonadism, that condition will need to be treated before the breast symptoms resolve. Among teenagers where there is no apparent cause of the gynecomastia, a doctor may advise evaluations every three to six months to check whether symptoms are improving. If the condition does not improve after two years or if it is causing significant pain or embarrassment, treatment may be required. A medication to adjust the hormone imbalance such as an anti-oestrogen or aromatase inhibitor may be prescribed.

If a patient still experiences bothersome symptoms after monitoring or initial treatment, surgery may be advised. Liposuction may be recommended to remove the breast fat or mastectomy may be recommended to remove the breast gland.


Gynecomastia is not usually associated with long-term problems, but people who develop the condition are at around five times the risk of developing male breast cancer compared with the population in general. This is probably because the hormonal changes that result in gynecomastia are also the changes that increase the risk of male breast cancer.



Further Reading

  • All Gynecomastia Content
  • What is Gynecomastia?
  • Gynecomastia Causes
  • Gynecomastia Diagnosis
  • Gynecomastia Treatments

Last Updated: Aug 23, 2018

Written by

Sally Robertson

Sally has a Bachelor's Degree in Biomedical Sciences (B.Sc.). She is a specialist in reviewing and summarising the latest findings across all areas of medicine covered in major, high-impact, world-leading international medical journals, international press conferences and bulletins from governmental agencies and regulatory bodies. At News-Medical, Sally generates daily news features, life science articles and interview coverage.

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Irritable Bowel Syndrome (IBS) Prognosis

Nearly one half of all patients who suffered from abdominal pain in childhood have been seen to suffer from irritable bowel syndrome after three decades.

The symptoms usually persist throughout life and may get aggravated with certain stressful life situations.

Outcome of post infectious irritable bowel syndrome

Most patients with infectious gastric enteritis recover rapidly without any residual symptoms. Some patients, however, may have persistent symptoms for many years and meet the criteria for a diagnosis of irritable bowel syndrome.

Several studies have shown that the percentage of infected individuals who develop post-infectious irritable bowel syndrome vary from 3.7% to 36% among populations.

Some of the predictors that can estimate the risk of developing post infectious irritable bowel syndrome include:

  • being a female
  • developing the infection at a younger age
  • prior anxiety or depression
  • both fever and weight loss during the acute gastroenteritis

Among these, female gender, younger age and weight loss during the episode of acute gastroenteritis are seen to be the strongest links to development of post infectious irritable bowel syndrome.

Change in irritable bowel syndrome characteristics over time

Studies have shown that nearly 63% of cases of post infectious irritable bowel syndrome following Campylobacter jejuni-associated enteritis eventually meet the Rome II criteria for diarrhea-predominant irritable bowel syndrome.

Studies have also shown that nearly 90% of the patients with diarrhea-predominant irritable bowel syndrome may have had constipation-predominant irritable bowel syndrome or unsubtyped irritable bowel syndrome a few years before.

Irritable bowel syndrome and cancer

Unlike inflammatory bowel diseases like ulcerative colitis, irritable bowel disease does not damage the inner walls of the intestines and does not cause permanent damage to the intestines. Thus there is no association between irritable bowel syndrome and bowel cancers.

However bowel cancers may mimic the features of irritable bowel syndrome and cancer needs to be ruled out while diagnosing irritable bowel syndrome.

Irritable bowel syndrome and life span

Irritable bowel syndrome tends to last a life time and the symptoms often come and go. Many patients may have long symptom-free years interspersed between periods of severe symptoms.

Irritable bowel syndrome does not shorten lifespan or lead to major life threatening complications in most patients.



Further Reading

  • All Irritable Bowel Syndrome Content
  • What is Irritable Bowel Syndrome (IBS)?
  • Irritable Bowel Syndrome (IBS) Symptoms
  • Irritable Bowel Syndrome (IBS) Causes
  • Irritable Bowel Syndrome (IBS) Diagnosis

Last Updated: Aug 23, 2018

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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What is a Vitrectomy?

A vitrectomy is a surgical procedure that may be carried out for a number of reasons:

  • improving vision in patients experiencing complications from diabetes
  • removing foreign bodies from the eye in cases of trauma
  • taking a biopsy to diagnose infections or diseases
  • as part of other operative procedures on the retina

The aim of the procedure in most cases is to remove the vitreous humour to allow access to other parts of the eye.

The vitreous humour is usually a transparent, gelatinous substance inside the eye, found behind the iris and the lens, and in front of the retina. Its only purpose is to give volume to the eye.

There are two different types of vitrectomies, posterior pars plana vitrectomy and anterior vitrectomy.

Posterior pars plana vitrectomy

This type of vitrectomy is carried out by a retina specialist. This procedure involves removing the vitreous gel from the eye through the pars plana, the region of the eye that is thought to have no function in the post-fetal period and as such is thought to be the safest point of entry into the eye. Surgical instruments are also introduced into the eye through the pars plana.

The vitreous jelly is dissected and then peeled or sucked out through small 1mm cuts made into the white of the eye. Any necessary repairs to the retina are carried out, as well as removing any foreign bodies, or, in the case of surgery to treat complications of diabetes, leaking blood vessels are sealed.

Image Credit: Saginbay / Shutterstock

Anterior vitrectomy

Anterior vitrectomies are carried out when vitreous gel leaks through the pupil and into the anterior (front) chamber of the eye. Eye trauma, cataracts of the lens, and corneal or glaucoma surgery, can cause this to occur. Anterior vitrectomies aim to minimize the risk of developing future problems due to leaking vitreous fluid, and to improve visual recovery.

Vitrectomy procedure: steps

Before the vitrectomy is done, pre-operative assessments are carried out. A full history is taken, covering both general and eye health, and details of medications prescribed for other conditions are discussed. Checks to ensure that anesthesia may be safely used on the individual patient will also be carried out. General anesthesia is usually used for vitrectomy procedures, but local anaesthetic can also be used if precisely placed.

Once a patient is underneath anesthesia, the eye is kept open with forceps. The doctor will make a small (1mm) incision, and cut through the pars plana, also known as the sclera or the white of the eye. A surgical microscope that allows a wide view of the inside of the eye, along with a magnified view, is inserted. Fiberoptic cables are also used to illuminate the inside of the eye. These instruments are inserted via separate openings. The vitreous fluid is then extracted using a vitrectomy probe and any retinal problems are treated at the same time. In diabetics, leaking blood vessels are laser-coagulated at this time.

The procedure usually takes several hours.

As vitreous jelly does not reform by itself, it is necessary to replace it with one of the substances below:

  • A gas bubble that is absorbed naturally over 2-3 weeks
  • Air that is absorbed within 24-36 hours
  • A blend of gas and air
  • An oil or heavy liquid that is surgically removed later

The chamber that was once filled with vitreous jelly will be filled naturally with aqueous humour after the gas and air have been absorbed.

Recovery from vitrectomy surgery

After vitrectomy surgery, vision will be blurred for several weeks. The eye will be sensitive and swollen, and improvement may not be seen until two weeks after the surgery.

If gas or oil has been used to replace the vitreous jelly, some patients are told to position their head in a downward tilt to ensure that the gas or oil is against the treated area of the retina, as gas will float to the top of the eye. Patients are asked to do this for around 4 to 14 days, for 50 minutes per hour, although this can change depending on the reason for the surgery. To make this more comfortable, neck pillows can be used. It is also advised that patients lie on their front when sleeping. All of these measures help the retina to heal in the right place.

Complications from vitrectomy procedures

Cataracts are known to occur after vitrectomies. The formation of cataracts has been linked to high oxygen levels in the proximity of the lens, which isn’t usually exposed to a lot of oxygen. It is hypothesized that the substances used to replace vitreous fluid do not keep oxygen away from the lens as efficiently as the natural vitreous fluid does. Retinal damage can also occur when air is inserted into the eye to replace the vitreous fluid.

If patients experience a significant decrease in vision quality, or increase in colored discharge, pain, swelling, light sensitivity or redness, emergency medical attention from an eye hospital should be sought.

Some patients may experience high pressure in the eye, which is treated with eye drops. Increased pressure in the eye can cause double vision and pain.

There is also a risk of infection, as with any surgical procedure. Infections will usually be treated with antibiotics.

Other complications include:

  • Bleeding in the eye
  • Damage to the lens
  • Problems with eye movement
  • Inflammation
  • Retinal re-detachment
  • Drooping eyelid
  • Distorted or blurred vision



Further Reading

  • All Vitrectomy Content

Last Updated: Feb 26, 2019

Written by

Lois Zoppi

Lois is a freelance copywriter based in the UK. She graduated from the University of Sussex with a BA in Media Practice, having specialized in screenwriting. She maintains a focus on anxiety disorders and depression and aims to explore other areas of mental health including dissociative disorders such as maladaptive daydreaming.

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African Sleeping Sickness Symptoms

African sleeping sickness (Human African Trypanosomiasis) is a tropical disease that is endemic in many areas of Sub-Saharan Africa, with a prevalence of around ~60 million people worldwide. In the acute phase, patients typically present with fever, headache, and joint pain. In the chronic disease, the infection manifests in other body areas, including the CNS, and affects the sleep cycle, hence the name.

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African sleeping sickness is a serious disease that can cause meningoencephalitis, coma, or death. The condition is caused by two species of Trypanosoma brucei; Trypanosoma brucei rhodesiense (East African Sleeping Sickness) which causes a more acute illness (~2% cases), and Trypanosoma brucei gambiense (West and Central African sleeping sickness) which presents initially as intermittent fever or headache and slowly becomes a chronic disease (~98% cases).

The disease is mainly transmitted by tsetse flies that feed on human blood, but can also be acquired through mother-to-child (vertical) infection, mechanical transmission, accidental infections, and sexual transmission.

Symptoms of African Sleeping Sickness

Human African trypanosomiasis is a condition that, when left untreated, causes high morbidity. The earliest symptom of East African sleeping sickness is a local skin reaction called Trypanosomal chancre that appears about five days after being bitten by a tsetse fly. Regional lymphadenopathy may also be present.

First stage

The initial and most common manifestation of a generalized infection with Trypanosoma brucei is the occurrence of fever which comes and goes in a periodic cycle that is aligned with parasitic multiplication in the body. Other symptoms include headaches, muscle pain and joint ache.

In East African sleeping sickness, these clinical features appear within a few weeks of infection, and can also include lymphadenopathy. This type of sleeping sickness is more severe, and can result in myocardial dysfunction and death within a few weeks.

West African trypanosomiasis presents with less significant symptoms, including hepatosplenomegaly and rash, making early diagnosis more difficult.

Second stage

A few months after a person has been infected by West African Sleeping Sickness, the parasite begins to cross the blood-brain-barrier (BBB), and enter the central nervous system (CNS). At this stage, patients begin to experience mental and cognitive changes, caused by chronic encephalopathy. This typically manifests as the patient being unable to concentrate for long periods of time, along with a disrupted sleeping pattern.

Prognosis for patients with African Sleeping Sickness

In it's early stages, the symptoms of African Sleeping Sickness are no different from many other conditions, meaning some patients will go undiagnosed until they enter the chronic stage. As such, there are an estimated 50,000-500,000 deaths each year from this condition. As the acute phase occurs so rapidly, early detection is essential.

This disease is treatable if diagnosed within about two to three weeks after infection, before the parasite has reached the CNS. Almost all patients who get appropriate treatment within this period recover fully, except for an estimated 2.5% who will develop encephalopathy as a side effect of Stage 1 treatment.

Current studies into the prognosis of African sleeping sickness show that while treatment is still possible in the second stage, the survival rate is low. Mortality is also high in patients who remain untreated during the six months after infection, due to the crossing of the BBB by the parasite.

Records of patient mortality show that more than 80% of African sleeping sickness deaths occur because of minimal to no intervention for the condition.


Patients with African sleeping sickness may fully recover from the condition as long as appropriate treatment is provided early in the course of the illness. The lack of treatment opportunities for many patients suffering from the disease is the primary cause of continued high mortality and fatality rates.


  • Trypanosomiasis, human African (sleeping sickness). World Health Organization.
  • African Trypanosomiasis. Centers for Disease Control and Prevention.
  • Human African trypanosomiasis. The BMJ.
  • Human African trypanosomiasis. ESAI Access to Medicines.
  • African Sleeping Sickness. University of Rochester Medical Center.
  • African Sleeping Sickness and its Mark on the Human Genome: An Evolutionary Tale. Harvard University Graduate School of Arts and Sciences.
  • Duration of symptoms and case fatality of sleeping sickness caused by Trypanosoma brucei rhodesiense in Tororo, Uganda. East African Medical Journal.

Further Reading

  • All African Sleeping Sickness Content
  • What is African Sleeping Sickness?
  • African Sleeping Sickness Causes
  • African Sleeping Sickness Treatments

Last Updated: Dec 21, 2018

Written by

Gaea Marelle Miranda

Gaea graduated from the University of the Philippines, Manila, with a degree in Behavioral Sciences,cum laude . Majoring in psychology, sociology, and anthropology, she approaches writing with a multidisciplinary perspective.

Source: Read Full Article

African Sleeping Sickness Treatments

African Sleeping Sickness (Human African Trypanosomiasis) is found in more than 30 regions in Sub-Saharan Africa. It is a national health concern that affects 60 to 70 million people.

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If left untreated, African Sleeping Sickness can causes meningoencephalitis, coma, and death. The disease is spread through tsetse flies that feed on infected hosts. In 2015, 84 percent of Trypanosoma brucei infections (the main cause of the disease) were recorded in the Democratic Republic of Congo.

Early stage symptoms include a cyclical fever, headache, and muscle and joint pain. However, once the parasite has entered the CNS, symptoms become more severe, manifesting as cognitive and behavioral changes, as well as sleep disruption and encephalopathy. Read more about the symptoms of African Sleeping Sickness.

Treating African Sleeping Sickness

Patients diagnosed with African Sleeping Sickness who receive early and specific treatment have an excellent chance of survival. However, due to the non-descript symptoms of the early stages of this disease, it is often diagnosed late.

The treatment plan depends on the clinical presentation of the disease, and the parasitic cause; Trypanosoma brucei rhodesiense (East African Sleeping Sickness), which causes ~2% cases and is more severe, or Trypanosoma brucei gambiense (West and Central African sleeping sickness), which affects ~98% patients and is a chronic disease.

Below are the five chemicals mainly utilized for the treatment of African Sleeping Sickness:

For Stage 1 treatment:

  • Pentamidine isethionate – This chemical compound was discovered in 1940 and is primarily used to treat patients infected by Trypanosoma brucei gambiense (West African sleeping sickness).
  • Sodium suramin – This chemical compound was discovered in 1920 and is primarily used to treat patients infected by Trypanosoma brucei rhodesiense (East African Sleeping Sickness).

For Stage 2 treatment:

  • Arsenic derivatives – these compounds may be used to treat both types of African sleeping sickness and are considered he first line of treatment for Trypanosoma brucei rhodesiense and the second option for resistant Trypanosoma brucei gambiense. However, recent studies have shown that in several populations in Central Africa, resistant strains of T. brucei gambiense are highly prevalent.
  • Alpha-difluoromethylornithine – while effective for treating Trypanosoma brucei gambiense, this compound requires a more complex and meticulous treatment plan and is therefore seldom used.
  • Nitrofuran thiazine – a treatment plan that combines alpha-difluoromethylornithine and nitrofuran thiazine and was developed in 2009. This treatment requires less frequent treatment and is therefore recommended by the WHO as a first-line treatment for T. gambiense infection.

There are a limited number of pharmacologic interventions for African sleeping sickness. It is hoped that further research into this condition will result in more effective treatment.


  • Trypanosomiasis, human African (sleeping sickness). World Health Organization.
  • African Trypanosomiasis. Centers for Disease Control and Prevention.
  • Human African trypanosomiasis. The BMJ.
  • Human African trypanosomiasis. ESAI Access to Medicines.
  • African Sleeping Sickness. University of Rochester Medical Center.
  • African Sleeping Sickness and its Mark on the Human Genome: An Evolutionary Tale. Harvard University Graduate School of Arts and Sciences.

Further Reading

  • All African Sleeping Sickness Content
  • What is African Sleeping Sickness?
  • African Sleeping Sickness Causes
  • African Sleeping Sickness Symptoms

Last Updated: Dec 21, 2018

Written by

Gaea Marelle Miranda

Gaea graduated from the University of the Philippines, Manila, with a degree in Behavioral Sciences,cum laude . Majoring in psychology, sociology, and anthropology, she approaches writing with a multidisciplinary perspective.

Source: Read Full Article