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EOSINOPHILIA-Origin,Definition,Causes,Diagnosis,Symptoms,Treatment…Ect..!

Eosinophilia – Definition, Causes, and Treatment.

Definition
Eosinophilia indicates elevated levels of eosinophils in the peripheral blood, usually related to an infectious, neoplastic, or allergic process. Often, high numbers of eosinophils may be present in other body fluids or tissues, but the term typically refers to peripheral blood eosinophilia. It is often defined as an absolute eosinophil count of ≥500 eosinophils/microliter (cells/microL) of blood. 500-1500cell/microL is considered mild, 1500-5000 cells moderate, and >5000 severe.

Pathophysiology
Allergic reactions are associated with a raised eosinophil count, slight at first but increasing with each exposure. Mast cells and basophils associated with a hypersensitivity reaction produce and release a number of cytokines, which evoke IgE production. IgE, elevated levels, stimulates eosinophil production. IL-5 is a chemokine that is extremely important in the final differentiation of mature eosinophils, as well as their recruitment into sites of inflammation, and their prolonged survival.

In addition, eosinophils produce growth factors which are responsible for the fibrotic response to inflammatory injury in affected tissues. This is because the eosinophils release cytokines which not only induce inflammation, but also attract more eosinophils and other immune cells of various types to the organ site. The release of various chemicals and reactive oxygen species by the eosinophils and other cells creates more tissue damage.

Types
Eosinophilia is classified as primary or secondary, in addition to the hypereosinophilic syndromes.

Primary Eosinophilia

Primary eosinophilia is a rise in the peripheral eosinophil count without any underlying condition to account for it. It is subclassified into clonal and idiopathic types.
Clonalprimary eosinophilia is the type of eosinophilia that is due to the proliferation of a clone of eosinophils in the bone marrow and is found in leukemias or other myeloproliferative disorders. Idiopathic primary eosinophilia is a term used to refer to peripheral blood eosinophilia without any detectable cause.
Secondary Eosinophilia

Secondary eosinophilia is the result of other disorders not associated with bone marrow proliferation, such as atopy, asthma, and most commonly helminthic infestations.

Hypereosinophilic Syndromes

Hypereosinophilic syndromes are disorders which are characterized by eosinophilia above 1500/µL persisting for at least 6 months, with no underlying disease condition, but associated with organ dysfunction due to eosinophil recruitment into tissues which suffer resulting damage. These include the syndromes of pulmonary eosinophilic infiltrate with eosinophilia, such as:

Churg-Strauss syndrome
Tropical pulmonary eosinophilia
Causes and Risk factors        
There are numerous reasons your eosinophil count may be elevated. Some of the causes are benign and require little treatment. It is not uncommon for the elevated count to be transient and resolve without treatment. Let’s review some of the causes now.

Parasite infections: The most common cause of eosinophilia is a parasite infection include schistosomiasis, trichinosis, strongyloidiasis, and ascariasis. 

Drug reactions:  Medications can trigger eosinophilia, sometimes without any obvious signs or symptoms. The most common medications associated with eosinophilia include antibiotics (penicillin, cephalosporins), non-steroidal anti-inflammatory medications (aspirin, ibuprofen), ranitidine (for gastroesophageal reflux), phenytoin (anti-seizure) and allopurinol (used to treat gout). The most severe form is called drug reaction with eosinophilia and systemic symptoms (DRESS). Fortunately, most people will not have these reactions when they receive these medications.

Atopy: Atopy is a particular reaction that occurs in the body. Typically, atopy refers to asthma, seasonal allergies (also called allergic rhinitis), and eczema. It is not uncommon for someone to have more than one of these medical conditions as they are related. These are some of the most common causes of mild to moderate eosinophilia, particularly in children. Similarly, food allergies can also cause elevated eosinophil counts.

Eosinophilia esophagitis (EoE):  This is a disorder characterized by eosinophils spreading to esophagus which normally does not contain eosinophils. About 50% of people with EoE will also have elevated eosinophil counts in the blood.

Cancers:  There are several cancers, particularly blood cancers that are known for increasing the eosinophil count. These include a rare type of acute myeloid leukemia (AML) called eosinophilic leukemia. Other causes include several of the myeloproliferative neoplasms (such as, essential thrombocythemia, polycythemia vera) B-cell and T-cell lymphoma, as well as adenocarcinomas of the gastrointestinal tract, lung, and cervix.

Clinical Manifestations
Symptoms of eosinophilia vary based on the underlying conditions.

Frequent wheezing and breathlessness are symptoms typical to eosinophilia caused due to asthma.
In case of eosinophilia due to parasitic infections symptoms may include

Abdominal pain
Diarrhea
Fever
Cough
Rashes
Frequent infections
Abscesses
Pneumonia
Mouth sores
Few other symptoms of eosinophilia include

Weight loss
Night sweats
Enlargement of lymph nodes
Skin rashes
Tingling and numbness due to nerve damage, these symptoms however occur rarely.
Complications arises during Eosinophilia
Weight loss
Night sweats
Lymph node enlargement
Skin rashes
Numbness and tingling due to nerve damage
Wheezing
Breathlessness
In case of eosinophilia types following complications arise

Myocardial fibrosis
Chronic heart failure
Death
Diagnosis and Test
History

First, a careful history is taken, to elicit travel to places where helminthiasis is rife; exposure to drugs; ingestion of possibly helminth-infected food; family history of myeloproliferative disorders, allergies, and drug hypersensitivity.

Symptoms which should be inquired about include:

Those of helminth infestation
Symptoms of organ involvement such as lung infiltration, inflammatory bowel disease, or vasculitis of various organs
Symptoms of allergies of the skin or respiratory system in particular
Systemic symptoms such as fever, joint pain and swelling, or lymphadenopathy
Drug exposure should be classified based on the association between the drug and the chances of eosinophilia. For instance, anticonvulsants, allopurinol (a drug used in gout), and semisynthetic penicillins have a higher chance of causing eosinophilia.

Specific findings may also point to the culprit drug, such as:

Anticonvulsants, if hepatitis or DRESS is present
NSAIDs or semisynthetic penicillins in pneumonitis
Immunevasculitis with phenytoin or allopurinol
Nephritis with cephalosporins
Physical Examination

The patient should have a detailed examination of the cardiovascular, renal, respiratory, gastrointestinal, and neurologic systems. Such findings as a skin rash, asthma or lung congestion, or generalized lymphadenopathy are suspicious of underlying conditions such as pulmonary syndromes with eosinophilia, myeloproliferative disorders, and vasculitis or atopic disease. This examination will also help to pick up complications due to hypereosinophilia, the most important of which include pulmonary, neurologic, and cardiac dysfunction.

Screening and Testing

In addition to the basic blood counts which revealed the eosinophilia, other tests may include:

Peripheral blood smear for abnormal eosinophils or blast cells suggestive of myeloproliferative disorders
Stool ova and parasite tests on three consecutive specimens
Parasite tests such as thin and thick blood smears
Specific serological tests for parasites
Anti-neutrophil cytoplasmic antibodies which are raised in some types of immune disease
Organ-specific tests such as renal or hepatic function tests as clinically indicated
Chest radiograph
Electrocardiogram,cardiac troponin
IgE levels and other immunoglobulins
Urinalysis
Serologic tests for vasculitis and other connective tissue disorders
Specialized tests such as bone marrow aspirate examination and cytogenetic tests for myeloproliferative disorders
Echocardiography if other tests are normal, or if cardiac symptoms are present
Pulmonary function tests
Tissue biopsies for parasites such as Trichinella, filariasis, and visceral larva migrans
Imaging tests based on symptoms or signs of organ involvement, such as CT scan of the chest or abdomen
Treatment and Medications
Treatment tackles the underlying cause of the condition, whether it is caused due to allergens, medical reaction or a parasitic reaction. Treatments such as intake of oral Corticosteroid drugs which are steroid hormones produced from the adrenal cortex of the vertebrates. Corticosteroid drugs such as Prednisolone are preferred at single doses of 30–60mg. These treatments are effective and non-toxic.

Natural Home Remedies foreosinophilia

Ginger, it is a very good herb in lowering down the increase count of eosinophils. It is taken by preparing its juice by mashing it properly and put this in a tea drink this tea one to two times daily for few days which gives better results.
Turmeric powder is a very good remedy to treat patients who have higher values of eosinophils. It is prepared by putting a pinch of turmeric powder in one glass of water and makes it boil and drink.
Ginseng is a very good home remedy in reducing the inflammation in airways and thus lowers down the count of high eosinophils.
Eucalyptus its oil is used in reducing the various symptoms in eosinophilia.
Fenugreekits seeds are used in combating the infections that are related to increasing eosinophilia. The seeds of fenugreek are boiled in one glass of water the two tablespoons of seeds are added in a glass of water drink this mixture every day morning and evening.
HolyBasil (Tulsi leaves) it is a very effective home remedy known for treating high eosinophilic count. The chewing of two to three leaves is recommended for better results.
Malabar Nut It is the very useful home remedy in reducing the symptoms of eosinophilia. Drink its juice daily for better results.
Neem(Azadirachta indica) It is used as medicine since many years it has a property of anti-bacterial, antifungal, antiviral, sedative, anti-diabetic so it is useful for various purposes it helps in removing unwanted harmful toxins from the body. Thus it is helpful in controlling various types of allergies related to food, in the skin like eczema, psoriasis etc.
Prevention of Eosinophilia
Cause of eosinophilia is not always clear. As a result, there are no specific steps to prevent eosinophilia.

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Sarcopenia- Origin,Definition,Causes,Diagnosis,Symptoms,Treatment…Ect..!

Definition
Sarcopenia is a disease associated with the aging process. Loss of muscle mass and strength, which in turn affects balance, gait and overall ability to perform tasks of daily living, are hallmark signs of this disease. Most people begin to lose modest amounts of muscle mass after age 30, but the resulting loss of strength increases exponentially with age.

Possible effects of sarcopenia include decreased muscle strength, problems with mobility, frailty, weak bones (osteoporosis), falls and fractures, decreased activity levels, diabetes, middle‐age weight gain and a loss of physical function and independence.

Stages of Sarcopenia
Different stages of sarcopenia may be used to help identify the severity of the condition, such as:

Pre-sarcopenia: Characterized by reduced muscle mass. No reduction in muscle strength or physical performance
Sarcopenia: Characterized by the presence of low muscle mass and low muscle function (strength OR performance)
Severe sarcopenia: Characterized by reduced muscle mass and reduction in muscle strength.
Pathophysiology
Immobility and malnutrition, especially low protein intake, could deteriorate sarcopenia, and the influence of multiple factors leading to aging-related sarcopenia. Skeletal muscle consists of two types of fibers: Type I and Type II. Type II fast fibers have a higher glycolytic potential, lower oxidative capacity, and faster response as compared to type I slow fibers. Type I fibers are known as fatigue-resistant fibers due to their characteristics that include greater density of mitochondria, capillaries and myoglobin content. With age, atrophy almost only affects type II fibers. Molecular mechanisms of sarcopenia are not fully understood. Some factors have been suggested to be involved as described below.

Changes in Hormones and Metabolism: GH is released from the pituitary gland and promotes IGF-1 secretion. IGF-1 binds to the IGF-1 receptor and activates its downstream Akt/ mammalian target of rapamycin (mTOR) pathway. mTOR induces muscle hypertrophy by promoting protein synthesis. Akt inhibits FOXO transcriptional factors and blocks the upregulation of E3 ubiquitin ligases, or muscle RING-finger protein-1 (MuRF1) and Muscle Atrophy F-Box (MAFbx), which stimulate protein degradation. Therefore, the decrease of GH and IGF-1 might be involved in sarcopenia. Insulin is also an anabolic hormone and activates Akt/mTOR pathway. Skeletal muscle protein synthesis is resistant to the anabolic action of insulin in older subjects, and this could be involved in the development of sarcopenia.

Neuromuscular Aging: Neuron loss is a progressive, irreversible process that increases with age. Multiple levels of the nervous system are affected by age, including the motor cortex, the spinal cord, peripheral neurons, and the neuromuscular junction. As age goes these leads to degeneration and could be the cause of sarcopenia.

Systemic Inflammation: As humans age, the serum level of tumor necrosis factor-a (TNF-α), interleukin-6 (IL-6), interleukin-1 (IL-1) and C-reactive protein (CRP) elevate. Adipose tissues are supposed to secrete these cytokines. A theory called inflamm-aging (inflammation +aging) proposes that, as humans age, systemic low-grade inflammation is one of the causes of various diseases such as atherosclerosis, dementia, type 2 diabetes, and osteoporosis. The high-sensitivity CRP levels are significantly and independently associated with sarcopenic obesity. Inflamm-aging might be involved in sarcopenia.

Causes and Risk factors
A common cause of sarcopenia is decreased physical activity throughout the day. However, although less frequent, some people with active lifestyles may also be diagnosed with sarcopenia. This suggests that there could be other reasons for the development of the disease.

Researchers currently believe that other causes of sarcopenia could include:

A reduction in the nerve cells that send signals from your brain to tell your muscles to move
A lowering of your hormone levels
A decline in your body’s ability to convert protein to energy
Not consuming enough daily calories and protein in order to maintain your muscle mass
Symptoms
Symptoms of sarcopenia may vary depending on how much muscle mass a person has lost. Symptoms include:

A decrease in muscle size
Weakness
Loss of endurance
Poor balance
Trouble climbing stairs
A decline in muscle mass may not seem like a big concern for most people. However, muscle loss can be significant enough to cause weakness, increase fall risk, and limit a person’s independence.

Sarcopenia may also cause a person to reduce their participation in physical activities. This decrease in activity causes even further muscle loss, which can adversely affect a person’s quality of life.

Complications
Sarcopenia has been linked to metabolic problems like type 2 diabetes, high blood pressure, and obesity. These conditions put you at greater risk of developing coronary heart disease, stroke, and other conditions that affect the blood vessels.

Sarcopenia has a pervasive, negative impact on patients’ quality of life and often leads to:

Increased inpatient length of stay
A decline in daily activities and ambulatory function
Reduced day-to-day activities
Increased risk of illness and infection
Reduced recovery from surgery, illness, and injury
Poor wound healing
Increased mortality
Diagnosis and Test
Sarcopenia should be diagnosed in three criteria:

i) Muscle mass:

Computed Tomography scan (CT scan).
Magnetic Resonance Imagery (MRI).
Dual Energy X-ray Absorptiometry (DXA).
Bioimpedance analysis (BIA).
ii) Muscle strength:

Handgrip strength.
iii) Physical performance:

Short Physical Performance Battery (SPPB).
Gait speed.
Grip strength.
Thigh muscle thickness ratio.
Treatment and Medications
Hormone replacement therapy (HRT)
HRT can help to raise lean body mass, decrease abdominal fat, and prevent bone deterioration in women whose hormone levels decrease with menopause. However, the use of HRT is debated because of an increased risk of some cancers and other severe health conditions.

Some other treatments that are under investigation include:
Growth hormone supplements
Testosterone supplements
hydroxymethyl butyrate
Angiotensin-converting enzyme inhibitors
Vitamin D
Medications for the treatment of metabolic syndromes
Although drug therapy is not the preferred treatment for sarcopenia, a few medications are under investigation. They include:

Urocortin II. This has been shown to stimulate the release of a hormone called adrenocorticotropic hormone (ACTH) from your pituitary gland. Given through an IV, this can prevent muscle atrophy that can happen when you’re in a cast or taking certain medicines. Its use for building muscle mass in humans has not been studied and isn’t recommended.

Other treatments under investigation for sarcopenia include:

Testosterone supplements
Growth hormone supplements
Medication for the treatment of metabolic syndrome includes insulin resistance, obesity, and hypertension).
Home remedies
Instead of medication or hormone therapy, management of sarcopenia focuses on lifestyle changes to prevent muscle loss. These usually include:

Exercise
Strength training or resistance training can improve muscle size, strength, and tone. It can also strengthen bones, ligaments, and tendons, which is good for a person’s overall health. Strength training involves using resistance to cause muscle contraction. The muscle contraction builds muscle size and increases strength. Strength training may involve using weights, resistance bands, or exercise machines. A person’s own body weight can also be used for resistance.

Nutrition
Proper nutrition is essential to treat sarcopenia, and may even prevent or delay the condition. Healthy protein. Healthy sources of protein, such as fish, nuts, lentils, and quinoa, can help to build up and sustain normal muscle mass levels.

Eating enough protein is an important dietary consideration in preventing sarcopenia. The IOF recommend that adults eat 1.0-1.2 grams of protein per kilogram of body weight daily.

Dietary supplements
Taking certain dietary supplements may be another way to improve sarcopenia or help prevent the condition. For example, taking creatine supplements may increase strength and lean muscle mass in adults of any age. Similarly, maintaining adequate levels of vitamin D, either through diet or supplements, may help older adults maintain muscle strength.

Prevention
Lack of activity is the most common reason behind this condition. Therefore, being physically active may lessen your chances of getting sarcopenia. Just half an hour of moderate exercise each day, like walking or jogging, will help keep your system working and fit.

In order for exercise to be effective, proper nutrition is also important. Research has shown that consuming more protein may help older adults reduce their chance of sarcopenia. Supplements have also proven useful in the prevention of sarcopenia. Some include:

Creatine, for increasing and maintaining muscle mass
Vitamin D, for maintaining bone and muscle tissues
Whey protein, to help preserve body mass