Oh, yes, I do. After a long, well, hiatus in my tutorial, my students are coming back and I’m kind of hoping that more are yet to come. Since the beginning of this year, only one of my students, has come to sessions regularly. So, I actually stopped printing worksheets, then I began to feel that I was getting nowhere with my plans. But, as I mentioned, some of them came back recently, and even more were inquiring whether I could accommodate them for summer tutorial. Well, that is just so exciting!
I guess I’m back to business and I would need to print letterhead to make it look more official. Well, I guess I have to get busy very soon.
Honestly, I haven’t, but my daughter, Candid, has and she’s been praising Kojie-San ever since.
Basically, her pimples started to disappear leaving her face smooth and soft. As far as I can remember, she’s been using it for a year now and it seems like she’s still satisfied with the result. And since she only uses it on her face, I buy only a pack of two which only costs P50 and it is good for a month.
You may want to try it and find out if it would work for you that way it does to her..
No, I don’t have it right now, but I had it a few years ago and it felt very very uncomfortable. So, I’m being very careful not to have it again. So, what is constipation?
Constipation is a common problem. It means either going to the toilet less often than usual to empty the bowels, or passing hard or painful poo (also called faeces, stools or motions). Constipation may be caused by not eating enough fibre, or not drinking enough fluids. It can also be a side-effect of certain medicines, or related to an underlying medical condition. In many cases, the cause is not clear. Laxatives are a group of medicines that can treat constipation. Ideally, laxatives should only be used for short periods of time until symptoms ease.
What is constipation?
Constipation is common. If you are constipated it causes one or more of the following:
- Poo (faeces, stools or motions) becomes hard, and difficult or painful to pass.
- The time between toilet trips increases compared with your usual pattern. (Note: there is a large range of normal bowel habit. Some people normally go to the toilet to pass stools 2-3 times per day. For others, 2-3 times per week is normal. It is a change from your usual pattern that may mean that you are constipated.)
- Sometimes, crampy pains occur in the lower part of your tummy (abdomen) You may also feel bloated and feel sick if you have severe constipation.
What are the causes of constipation?
Known causes include the following:
- Not eating enough fibre (roughage) is a common cause. The average person in the UK eats about 12 grams of fibre each day. But, 18 grams per day is recommended by the British Nutrition Foundation. Fibre is the part of plant food that is not digested. It remains in your gut. It adds bulk to the poo (faeces, stools or motions), and helps your bowels to work well. Foods high in fibre include: fruit, vegetables, cereals and wholemeal bread.
- Not drinking much may make constipation worse. Stools are usually soft and easily passed if you eat enough fibre, and drink enough fluid. However, some people need more fibre and/or fluid than others in order to avoid constipation.
- Some special slimming diets are low in fibre, and may cause constipation.
- Some medicines can cause constipation as a side-effect. Examples are painkillers(particularly those with codeine, such as co-codamol, or very strong painkillers, such as morphine), some antacids, some antidepressants (including amitriptyline) and iron tablets, but there are many others. See the list of possible side-effects on the leaflet that comes with any medicine that you may be taking. Tell a doctor if you suspect a medicine is making you constipated. A change of medication may be possible.
- Various medical conditions can cause constipation. For example, an underactive thyroid, irritable bowel syndrome, some gut disorders, and conditions that cause poor mobility, particularly in the elderly.
- Pregnancy. About 1 in 5 pregnant women will become constipated. It is due to the hormonal changes of pregnancy that slow down the gut movements. In later pregnancy, it can simply be due to the baby taking up a lot of room in the tummy and the bowels being pushed to one side.
Unknown cause (idiopathic)
Some people have a good diet, drink a lot of fluid, do not have a disease or take any medication that can cause constipation, but still become constipated. Their bowels are said to be underactive. This is quite common and is sometimes called functional constipation or primary constipation. Most cases occur in women. This condition tends to start in childhood or in early adulthood, and persists throughout life.
Do I need any tests?
Tests are not usually needed to diagnose constipation, because symptoms are often typical.
However, tests may be advised if you have any of the following:
- If regular constipation is a new symptom, and there is no apparent cause, such as a change in diet, lifestyle, or medication. This is known as a ‘change in bowel habit’ and should be investigated if it lasts for more than about six weeks.
- If symptoms are very severe and not helped with laxative medication.
- If other symptoms develop. More worrying symptoms include passing blood from your bowel; weight loss; bouts of diarrhoea; night-time symptoms; a family history of colon cancer or inflammatory bowel disease (Crohn’s disease or ulcerative colitis); or other unexplained symptoms in addition to constipation.
What can I do to ease and to prevent constipation?
These measures are often grouped together and called lifestyle advice.
Eat foods that contain plenty of fibre
Fibre (roughage) is the part of plant food that is not digested. It stays in your gut and is passed in the poo (faeces, stools or motions). Fibre adds bulk and some softness to the stools. High-fibre foods include the following:
- Wholemeal or whole-wheat bread, biscuits and flour.
- Fruit and vegetables. Aim to eat at least five portions of a variety of fruit and vegetables each day. One portion is: one large fruit such as an apple, pear, banana, orange, or a large slice of melon or pineapple; OR two smaller fruits such as plums, satsumas, etc; OR one cup of small fruits such as grapes, strawberries, raspberries, cherries, etc; OR one tablespoon of dried fruit; OR a normal portion of any vegetable (about two tablespoons); OR one dessert bowl of salad.
- Wholegrain breakfast cereals such as All-Bran®, Bran Flakes®, Weetabix®, Shredded Wheat® and muesli. A simple thing like changing your regular breakfast cereal can make a big difference to the amount of fibre you eat each day.
- Brown rice, and wholemeal spaghetti and other wholemeal pasta.
Although the effects of a high-fibre diet may be seen in a few days, it may take as long as four weeks. You may find that if you eat more fibre (or take fibre supplements – see below), you may have some bloating and wind at first. This is often temporary. As your gut becomes used to extra fibre, the bloating or wind tends to settle over a few weeks. Therefore, if you are not used to a high-fibre diet, it is best to increase the amount of fibre gradually.
Note: have lots to drink when you eat a high-fibre diet or fibre supplements. Drink at least two litres (about 8-10 cups) per day. This is to prevent a blockage of the gut, which is a rare complication of eating a lot of fibre without adequate fluid. See below in the section ‘Bulk-forming laxatives’ for an explanation.
A separate leaflet in this series, called Fibre and Fibre Supplements, gives more details on high-fibre foods.
Have plenty to drink
Aim to drink at least two litres (about 8-10 cups) of fluid per day. You will pass much of the fluid as urine, but some is passed out in the gut and softens the stools. Most sorts of drink will do, but alcoholic drinks can be dehydrating and may not be so good. As a start, try just drinking a glass of water 3-4 times a day in addition to what you normally drink.
Sorbitol is a naturally occurring sugar. It is not digested very well and draws water into the gut, which has an effect of softening the stools. In effect, it acts like a natural osmotic laxative (osmotic laxatives are explained later). So, you may wish to include some foods that contain sorbitol in your diet. Fruits (and their juices) that have a high sorbitol content include apples, apricots, gooseberries, grapes (and raisins), peaches, pears, plums, prunes, raspberries and strawberries. The concentration of sorbitol is about 5-10 times higher in dried fruit. Dried or semi-dried fruits make good snacks and are easily packed for transport – for example, in a packed lunch.
Exercise regularly, if possible
Keeping your body active helps to keep your gut moving. It is well known that disabled people, and bed-bound people (even if just temporarily whilst admitted to hospital) are more likely to get constipated.
Do not ignore the feeling of needing the toilet. Some people suppress this feeling if they are busy. It may result in a backlog of stools which is difficult to pass later. When you go to the toilet, it should be unhurried, with enough time to ensure that you can empty your bowel.
When mobility is limited – for example, in people who are frail or who have dementia – it is important for carers to see that they have sufficient help to get to the toilet at the time they need to go; also, that they have a regular, unhurried toilet routine, with privacy. As a rule, it is best to try going to the toilet first thing in the morning or about 30 minutes after a meal. This is because the movement (propulsion) of stools through the lower bowel is greatest in the mornings and after meals (due to the gastrocolic reflex).
Positioning on the toilet is also important, especially for elderly people with constipation. Western-style toilets actually make things more difficult – squatting is probably the best position in which to pass stools. Putting a small footstool under your feet is a simple way to change your toilet position to aid the passage of stools. Relax, lean forward and rest your elbows on your thighs. You should not strain and hold your breath to pass stools.
What are the treatments for constipation?
Treatment with a laxative is needed only if the lifestyle measures above do not work well. It is still worth persisting with these methods, even if you end up needing to use laxatives.
For short-term uncomplicated constipation, you may even choose to treat yourself (without visiting the GP), by buying laxatives in the pharmacy or supermarket. In short-term constipation, laxatives can be stopped once the poo (faeces, stools or motions) becomes soft and easily passed again. You should probably visit your GP if you are struggling to manage short-term constipation yourself, or if you have longer-term (chronic, or persistent) constipation. All the different types of laxative are available on prescription.
Chronic (persistent) constipation can be more difficult to treat. Laxatives are usually needed for longer periods (sometimes even indefinitely) and they should not be stopped abruptly. Chronic constipation is sometimes complicated by a backlog of hard faeces building up in the bowel (faecal loading) or even partially blocking it (impaction). If loading and impaction occur they need to be treated first, often with much higher doses of laxatives. Then a normal maintenance dose of laxatives is used to keep the bowels moving.
There are four main groups of laxatives that work in different ways:
- Bulk-forming laxatives.
- Stimulant laxatives.
- Osmotic laxatives.
- Faecal (stool) softener laxatives.
Sometimes these are known as fibre supplements. These increase the bulk of your stools in a similar way to fibre. They can have some effect within 12-24 hours but their full effect may take several days to develop.
- Unprocessed bran is a cheap fibre supplement. If you take bran, it is best to build up the amount gradually. Start with two teaspoons a day, and double the amount every five days until you reach about about 1-3 tablespoons per day. You can sprinkle bran on breakfast cereals, or mix it with fruit juices, milk, stews, soups, crumbles, pastries, scones, etc.
- Other fibre supplements include ispaghula (psyllium), methylcellulose, sterculia, wheat dextrin, inulin fibre, and whole linseeds (soaked in water).
There are various branded products that contain these ingredients. Examples are:
- Fibrelief®, Fybogel®, Isogel®, Ispagel® Orange and Regulan® – these all contain ispaghula.
- Celevac® – contains methylcellulose.
- Normacol® and Normacol Plus® – both contain sterculia.
A note of caution: fibre and bulk-forming laxatives partly work by absorbing water (a bit like blotting paper). The combination of bulk-forming laxatives and fluid usually produces soft, bulky stools which should be easy to pass out. When you eat a high-fibre diet or take bulk-forming laxatives:
- You should have plenty to drink. At least two litres per day (8-10 cups). The stools may become dry and difficult to pass if you do not have enough to drink. Very rarely, lots of fibre or bulk-forming laxatives and not enough fluid can cause an obstruction in the gut.
- You may notice an increase in wind (flatulence) and tummy (abdominal) bloating. This is normal and tends to settle down after a few weeks as the gut becomes used to the increase in fibre (or bulk-forming laxative).
Occasionally, bulk-forming laxatives can make symptoms worse if you have very severe constipation. This is because they may cause abdominal bloating and discomfort without doing much to clear a lot of faeces which are stuck further down the gut. See a doctor if you feel that bulk-forming laxatives are making your symptoms worse.
These stimulate the nerves in the large bowel (the colon and rectum, sometimes also called the large intestine). This then causes the muscle in the wall of the large bowel to squeeze harder than usual. This pushes the stools along and out. Their effect is usually within 8-12 hours. A bedtime dose is recommended so you are likely to feel the urge to go to the toilet sometime the following morning. Stimulant laxative suppositories act more quickly (within 20-60 minutes). Possible side-effects from stimulant laxatives include abdominal cramps, and long-term use can lead to a bowel that is less active on its own (without laxatives). This can be thought of as a ‘lazy bowel’.
Stimulant laxatives include bisacodyl, dantron, docusate, glycerol, senna and sodium picosulfate. These medicines can be prescribed on a prescription in the unbranded (generic) form. Commercially branded versions (proprietary brands) contain the same ingredients, but are generally only available for purchase over-the-counter. Examples include:
- Dulcolax® – contains bisacodyl.
- Dioctyl®, Docusol® and Norgalax Micro-enema® – all contain docusate.
- Manevac® and Senokot® – are both brands that contain senna. Senokot® tablets are not available on prescription. Manevac® also contains the bulk-forming laxative ispaghula.
- Dulcolax Perles® – contain sodium picosulfate.
These work by retaining fluid in the large bowel by osmosis (so less fluid is absorbed into the bloodstream from the large bowel). There are two types – lactulose and a group called macrogols (also called polyethylene glycols). Lactulose can be bought over-the-counter as Duphalac®, Lactugal® and Regulose®. Movicol®, Movicol®-Half and Movicol® Paediatric Plain all contain macrogols and are available on prescription.
Lactulose can take up to two days to have any effect so it is not suitable for the rapid relief of constipation. Possible side-effects of lactulose include abdominal pain and bloating. Some people find the taste of lactulose unpleasant. Macrogols act much faster, and can also be used in high doses to clear faecal loading or impaction. Stronger osmotic laxatives (such as magnesium salts and phosphate enemas) can be used to clear the bowel quickly and in situations such as before bowel surgery.
These work by wetting and softening the faeces. The most commonly used is docusate sodium (which also has a weak stimulant action too). Bulk-forming laxatives also have some faecal-softening properties. Arachis (peanut) oil enemas are occasionally used to soften impacted faeces in the rectum (the lowest part of the colon, just before the back passage (anus)).
Liquid paraffin used to be commonly used as a faecal softener. However, it is now not recommended, as it may cause side-effects such as seeping from the anus and irritation of the skin, and it can interfere with the absorption of some vitamins from the gut.
Which laxative should I use and for how long?
The one recommended by your doctor or pharmacist will depend on factors such as your own preference, the symptoms of constipation that you have, possible unwanted effects, your other medical conditions, and cost. However, as a general rule:
- Treatment with a bulk-forming laxative is usually tried first.
- If poo (faeces, stools or motions) remains hard despite using a bulk-forming laxative, then an osmotic laxative tends to be tried, or used in addition to a bulk-forming laxative.
- If stools are soft but you still find them difficult to pass then a stimulant laxative may be added in.
- High doses of the macrogol osmotic laxatives are used to treat faecal loading and impaction – this should be under the supervision and advice of a doctor.
You should use a laxative only for a short time, when necessary, to get over a bout of constipation. Once the constipation eases, you should normally stop the laxative. Some people get into the habit of taking a laxative each day ‘to keep the bowels regular’ or to prevent constipation. This is not advised, especially for laxatives which are not bulk-forming.
Constipation is usually helped by the above treatments. Mostly, laxatives are taken by mouth (orally). In some cases, it is preferable also to treat constipation by giving medication via the back passage (anus).
Suppositories are pellet-shaped laxatives that are inserted into the the lowest part of the colon (the rectum), via the anus. Glycerol suppositories act as a stimulant within the rectum, encouraging the passing of poo (faeces, stools or motions). Sometimes, an enema is needed in severe constipation. An enema is a liquid that is inserted into the rectum and lower colon, via the anus. Enemas can be used to clear out the rectum in severe constipation.
Other treatments may be advised by a specialist for people with severe constipation who have not been helped by the treatments listed above.
Are there any complications of long-term (chronic) constipation?
Short-term constipation or intermittent bouts of constipation are unlikely to cause any long-term problems. Sometimes a split or tear in the anal skin (an anal fissure) can occur with the passage of particularly big or hard poo (faeces, stools or motions). This is very painful, and there may be a small amount of fresh red blood on the toilet paper. Treatment of an anal fissure involves lifestyle measures (mentioned earlier) to keep the stools soft, and perhaps laxatives too, to keep the stools really easy to pass. Local anaesthetic ointment or glyceryl trinitrate (GTN) ointment can be prescribed by your GP to ease the pain and help relax the muscles around the back passage (anus), to help the fissure to heal.
Chronic constipation and long-term use of laxatives can mean that your bowel becomes sluggish and ‘lazy’. This means that the bowel doesn’t work very well on its own, without medication. Constipation then becomes a vicious cycle and even more chronic. Try to avoid getting into this situation in the first place, and consult your GP for advice. Some people with persistent and severe constipation do require regular laxatives.
Severe chronic constipation can result in faecal impaction. This is something that is more likely in the elderly and infirm. Basically, a large mass of hard faeces blocks the rectum. The mass is too big to pass and the rectum is stretched and enlarged, so the muscles within it don’t work so well to push faeces out. Sometimes people with this problem think that they have diarrhoea. This is because liquid faeces, from above the blockage, leak round the big lump of faeces, and out of the anus. This is known as overflow diarrhoea. In this situation, you may also have faecal incontinence – that is, you have no control over this liquid faeces leaking out. Faecal impaction with overflow diarrhoea is likely if you have been getting progressively more constipated, and then get liquid faeces, possibly explosive, and without much control. If a doctor or nurse examines the anus, the hard faeces can often be felt, confirming the diagnosis. The diagram below shows this process:
Natural treatments for constipation
Prunes (dried plums) have long been thought of as effective for constipation. However, up until recently, there had been little scientific proof of this. But, a research trial published in 2011 (cited at the end) lends support to the belief that prunes are good for treating constipation.
In the trial, 40 adults with persistent constipation were studied as to the effect of prunes versus ispaghula (psyllium) – a commonly used treatment for constipation. Briefly, on average, 50 g of prunes (about six prunes) twice daily seemed to be better at easing constipation than 11 g of ispaghula taken twice daily. This is just one small trial, but does seem to confirm many people’s belief that prunes are good for easing constipation.
The Beverley-Travis natural laxative mixture
This recipe (detailed below) was studied in a research trial that involved older people in a care home. A treatment group was compared to a non-treatment group. The conclusion of the study stated that “the Beverley-Travis natural laxative mixture, given at a dosage of 2 tablespoons twice daily, is easy to use, cost-effective, and more effective than daily prescribed laxatives at producing normal bowel movements”. So, it may be worth a try.
- Recipe ingredients – one cup each of: raisins; pitted prunes; figs; dates; currants; prune juice concentrate.
- Directions – combine contents together in grinder or blender to a thickened consistency. Store in refrigerator between uses.
- Dose – two tablespoons twice a day. Increase or decrease dose according to consistency and frequency of bowel movements.
The Philippines is a tropical country, and though I love my country, with the climate and all, I sometimes complain about the weather. It can get too hot that sometimes it’s almost unbearable. It’s as if you’ll die of heatstroke anytime.
So, when it got cold in January, it was kind of shock for us. Basically because we’re not used to icy cold mornings. It made my morning walks a little uncomfortable. It felt like my chest was going to burst because of the cold wind that enters my nostrils. And my face felt like cracking into several pieces. But thanks to Nivea Creme I didn’t happen.
It isn’t just me but my two daughters use it also. Several years back, I tried other moisturizing cream. It worked for, probably, a year, but eventually I felt that it wasn’t working anymore so I had to try a new one.
It’s one of the things I don’t like about aging, getting all dried up..
I used to have long straight black shiny hair.
Well.. that was many many years ago. And though I’m basically not a vain person, I feel, somehow, sad to see my crowning glory once shiny black turn to bronze and silver.
I dyed it twice already using the expensive kind but I developed irritating headaches. The headaches lasted for a few days, four to my estimation, and the color stayed for only a month because my hair grew long right away and the white hairs stood up so soon.
I can’t stand another dye job at the moment, so, I settled for the next best thing. Cream Silk Black.
I don’t know and I’m not really sure but I guess it works, or maybe I very much wanted to believe that it works and so it does.
Well, I guess I’m going to use this for now. Will dye my hair much later.. or not at all if possible.
Five years ago, a friend of mine came home from abroad for a week-long vacation. She was a close friend so I filed a leave from work just so we could meet. It was a grand get-together. My friend had a whole pig roasted for us and she had a lot of food prepared. We had the best time of our lives.
Then, we planned another date here in Manila. But.. I wasn’t able to come. I was down with loose bowel movement and fever. After several trips to the toilet, I went to the doctor and my fear was confirmed. I had amoebiasis.
Amoebiasis is caused by the protozoan Entamoeba histolytica. Amoebiasis is often asymptomatic but may cause dysentery and invasive extra-intestinal disease. Entamoeba dispar, another species, has been thought in the past to be non-pathological but in vitro and in vivo experiments suggest it is capable of causing liver damage.
- Humans are the only reservoir, and infection occurs by ingestion of mature cysts in food or water, or on hands contaminated by faeces.
- The cysts of E. histolytica enter the small intestine and release active amoebic parasites (trophozoites), which invade the epithelial cells of the large intestines, causing flask-shaped ulcers. Infection can then spread from the intestines to other organs – eg, the liver, lungs and brain, via the venous system.
- Asymptomatic carriers pass cysts in the faeces and the asymptomatic carriage state can persist indefinitely. E. dispar is the parasite most commonly found in such carriers, Cysts remain viable for up to two months.
- Invasive amoebiasis most often causes an amoebic liver abscess but may affect the lung, heart, brain, urinary tract and skin.
- E. histolytica infects approximately 50 million people worldwide, of which approximately 100,000 die annually.
- It is the third most common cause of death (after schistosomiasis and malaria) from parasitic infections.
- It is very common in South and Central America, West Africa and Southeast Asia. It is rare in temperate climates.
- Increasing prevalence is seen in men who have sex with men who engage in oral-anal sex.
- Travellers and immigrants and residents of institutions are also at risk.
- About 90% of infections are asymptomatic and the remaining 10% produce a spectrum of disease varying from dysentery to amoebic liver abscess.
The incubation period may be as short as seven days and tissue invasion mostly occurs during first four months of infection.
- The most common type of amoebic infection is the asymptomatic passage of cysts, found to be mainly associated with E. dispar infection.
- Symptomatic patients initially have lower abdominal pain and diarrhoea and later develop dysentery (with blood and mucus in stool).
- Amoebic colitis with dysentery: loose stools with fresh blood. The patient is usually generally well with mild or moderate abdominal pain. Symptoms often fluctuate over weeks or even months with the patient becoming debilitated.
- Abdominal tenderness in one or both iliac fossae but may be generalised. There is palpably thickened gut, and low fever. There is abdominal distension in more severely ill patients passing relatively small amounts of stool sometimes.
- Amoebic colitis without dysentery: a change in bowel habit, bloodstained stools, flatulence and colicky pain, tenderness in the right iliac fossa or other places over the colon. This may disappear or progress to dysentery.
- Rectal bleeding: this may occasionally be the only sign, with or without tenesmus (common in children).
- Abdominal mass, which is usually in the right iliac fossa.
- May be painful and tender.
- Fever, altered bowel habit and there may be intermittent dysentery.
- May be symptoms of partial or intermittent bowel obstruction.
- Fulminant colitis: this is more likely in children and in patients taking steroids; high-grade fever, severe abdominal pain, increasing distension of the abdomen with vomiting plus watery diarrhoea. Absent bowel sounds. X-ray may show free peritoneal gas with acute gaseous dilatation of the colon.
- Localised perforation and appendicitis: deep ulcer may cause sudden perforation with peritonitis or may leak causing pericolic abscess or retroperitoneal infection. May also resemble simple appendicitis, often with signs of dysentery.
- There is usually no current, and often no history of, dysentery.
- It usually occurs within eight weeks to one year of infection.
- It presents with sweating and pyrexia, a painful liver or diaphragm, together with weight loss often appearing insidiously, but pain may appear abruptly.
- Fever is typically remitting with a prominent evening rise with brief rigors and profuse sweating.
- Often there is anaemia and dry painful cough.
- There is liver enlargement with localised tenderness in the right hypochondrium, epigastrium and intercostal spaces overlying the liver.
- An epigastric mass from a left-lobe lesion may be found.
- Upward enlargement may cause bulging of the right chest wall with raised upper level of liver dullness on percussion. Reduced breath sounds or crepitations at the right lung base may be heard.
- Abscess may extend into adjacent structures, usually the right chest, peritoneum and pericardium. If it extends into the lung, it produces hepatobronchial fistula with expectoration of brownish, necrotic liver tissue. May also cause peritonitis, pericarditis, brain abscess or genitourinary disease.
- Other causes of infective colitis, ulcerative colitis, colorectal cancer.
- In chronic infection, other possible diagnoses include Crohn’s disease, ileocaecal tuberculosis, diverticulitis, anorectal lymphogranuloma venereum.
- Amoebic liver abscess has to be differentiated from pyogenic abscess which may occur particularly in older patients with underlying bowel disease or after surgery.
- FBC (leukocytosis), raised ESR, abnormal LFTs (raised alkaline phosphatase and transaminases).
- Stool examination:
- Microscopic stool examination for trophozoites should be performed in patients with diarrhoea..Examination of 3 to 6 stool samples and concentration techniques may be required due to low specificity.
- E. histolytica should be differentiated from other Entamoeba spp. The World Health Organization now recommends that intestinal amoebiasis should be diagnosed with specific stool E. histolytica testing (eg, cultures, antigen testing or PCR) rather than examining stool for ova and parasites.
- Serology: antibody testing is positive in nearly 100% of cases of liver abscess, 89-100% of invasive bowel disease and nearly 100% of patients with amoeboma.
- PCR tests (faeces, abscess aspirate or other tissues).
- Barium studies are contra-indicated in acute amoebic colitis because of the risk of perforation.
- Ultrasound, CT and MRI scans of the abdomen can be useful in diagnosing hepatic amoebiasis.
- Ultrasound- or CT-guided liver abscess aspiration.
- Proctoscopy, sigmoidoscopy or colonoscopy: mucosal scrapings for biopsy and E. histolytica testing.
- Abscesses resolve slowly and may increase in size during treatment and so clinical response, rather than repeated scans, is more important in monitoring progress.
- Fluid and electrolyte replacement, gastric suction and blood transfusion may be required.
- Diloxanide furoate is the drug of choice for asymptomatic patients with E. histolyticacysts in the faeces (metronidazole and tinidazole are relatively ineffective).
- Metronidazole is the first choice for treatment of acute invasive amoebic dysentery. Tinidazole is also effective.
- Treatment with metronidazole or tinidazole is followed by a 10-day course of diloxanide furoate to destroy any amoebae in the gut.
- Diloxanide furoate is also given as a 10-day course for chronic infections.
- Amoebic abscesses of the liver:
- Metronidazole and tinidazole are effective for amoebic abscesses of the liver.
- Diloxanide furoate is ineffective against hepatic amoebiasis but a 10-day course should be given at the completion of metronidazole or tinidazole treatment to destroy any amoebae in the gut.
- Surgical drainage of an uncomplicated amoebic liver abscess is unnecessary and should be avoided.
- However, the abscess should be drained if there is a risk that it may rupture or if metronidazole leads to no improvement after 72 hours of treatment.
- Aspiration is largely being replaced by percutaneous catheter drainage.
- In patients unsuitable for percutaneous drainage (elderly, frail, septic shock, multilocular cysts) laparoscopy is the preferred option.
- Laparotomy is usually required for rupture of a liver abscess but can occasionally be managed by ultrasound-guided percutaneous catheter drainage.
- Amoebic colitis may lead to fulminant or necrotising colitis, toxic megacolon, amoeboma or a rectovaginal fistula.
- Amoebic liver abscess: may extend and/or rupture into the abdomen or chest, or disseminate and cause a brain abscess.
- In uncomplicated disease, the mortality rate is less than 1% but is much higher in complicated severe disease – eg, fulminant amoebic colitis, chest involvement or cerebral amoebiasis.
- More severe illness occurs in children (especially neonates), the immunosuppressed, malnourished, pregnancy and postpartum.
- Recurrence is common if amoebae are not completely eradicated.
- The bowel heals rapidly and completely; hepatic abscesses usually disappear within 8 months to 2 years.
- Successful control of amoebiasis depends on prevention of infection through adequate sanitation, safe food and water and good personal hygiene of the population.
- No vaccine is yet available but progress has been made in the identification of possible candidates, the route of application and the understanding of the immune response. It is hoped that this will lead to a vaccine being developed within the next few years.
This is just so exciting!
With the success of Laur Music Festival 2013 in our hometown, LMF 2014 is being proposed. Facebook is teeming with posts and comments about the upcoming event. Old time musicians are being invited to perform and any one who has talent for music can participate.
Though I would like to see my brother perform, I’m not sure if he would be enthusiastic with the idea Besides, he might need a new epiphone flying v guitar at guitar center to perform well. His old acoustic guitar may do, but of course, something this big needs something just as big.
The festival might be held in April.
No, that is not my score, that is my daughter, Candid’s. And no, I don’t play it myself. I tried, yes, but I decided that I didn’t like it so, I stop. But to make the record straight, I have nothing against Flappy Bird.
First and foremost, it’s a game. Anybody has a choice whether to play it or not. There is absolutely no one forcing anybody to play it and get addicted to it.
Personally, I don’t like the idea of this game. It isn’t something that uses strategy or technique. Expertise, maybe. It doesn’t require you to be smart or cunning. You just need a steady hand and pulse. It also requires infinite patience which may or may not be rewarded in the end.
I also don’t like the overall effect of this game. You have this burning urge to beat your highest score. When you do, you feel wonderful but the urge to beat it yet again is born. And if you don’t, you have to play again and again hoping that you’ll be lucky enough to make it this time. But if that doesn’t happen, you feel irrationally frustrated and if you’re unluckier than the others, it would make you feel bad the whole day. You can’t wait to play again to give it another try.
Generally speaking, I stay away from things that make me feel frustrated, that’s why the first chance I got, I uninstalled the game. BUT, as I said, I have nothing against Flappy Bird nor to its creator, in fact, I find him really smart.
My daughter Candid still plays the game and I could say she enjoys it. She said it makes her feel relaxed, though I have no idea how that could be. And so, for this new and very controversial game..
Keep flying Flappy Bird!
As my 8th grade daughter came home this afternoon, she was having trouble figuring out some steps in their Science experiment. As a mother, I wanted so much to help her, however, I know as well that I could only guide her but she has to solve the problem herself which I know she would, eventually.
Well, I wonder how it is nowadays. When I was a student, I remember bringing some materials to school for laboratory experiments while the teachers supervised the use of chemicals.
I hope it is still like that these days. It will make me feel better knowing that there is someone who knows how to handle things. I assume also that the school has a reliable chemical supplier for its needs. It may sound meddling, but I think it’s just natural for mothers to concern themselves with these.