September 2017



Eosinophilia is an abnormal increase in the eosinophils (type of white blood cell) in blood or body tissues. Eosinophils are produced in the bone marrow existing normally in the bloodstream and gut lining, which helps the body fight infection from parasitic organisms. On an average around 5% to 7% of white blood cells constitute eosinophils but if you have a higher count then it means that you either have borderline eosinophilia or actual progressing eosinophilia that can cause significant health hazards.

Emphasis is placed on the number of eosinophils circulating in the peripheral blood, although an increase in eosinophils can be observed in other body fluids (eg, cerebrospinal fluid, urine) and many body tissues (eg, skin, lung, heart, liver, intestine, bladder, bone marrow, muscle, nerve).

Eosinophils are derived from hematopoietic stem cells initially committed to the myeloid line and then to the basophil-eosinophil granulocyte lineage. Tissues of the pulmonary and gastrointestinal systems are the normal residence for eosinophils, but peripheral, or blood, eosinophilia (absolute eosinophil count more than 600 per cubic millimeter) indicates an eosinophilic disorder. Eosinophilia can be categorized as mild (less than 1500 eosinophils per cubic millimeter), moderate (1500 to 5000 per cubic millimeter), or severe (more than 5000 per cubic millimeter). An increase in tissue eosinophilia may be seen with or without concurrent peripheral eosinophilia.

In general eosinophilia occurs as a response to parasites (such as filaria or helminths), or from allergy as occurs with asthma and allergic rhinitis, or in some gastrointestinal disorders that may be associated with food allergy. A few drugs or inhaled allergens can cause inflammatory tissue changes accompanied by eosinophilia in susceptible people.

Parasites are a common cause of eosinophilia, and there is often an association with asthma. In occasional patients, an idiopathic hypereosinophilic syndrome occurs, with an eosinophil count in excess of 1500 cells per cubic millimeter of blood, and the heart or nervous system may be affected. Other causes that may be responsible for eosinophilia include collagen-vascular diseases or skin diseases such as pemphigus. Thus, there are numerous rare causes of eosinophilia to consider, although sometimes there is no obvious disease in some people who have prolonged persistence of the high eosinophil count. It is not unusual for the abnormality to eventually clear up without treatment.


What’re the symptoms and signs of bacteremia?
Usually, bacteremia that results from ordinary events such as dental procedures causes no symptoms. People with bacteremia from other causes sometimes have fever. If people with bacteremia have a fever, a rapid heart rate, rapid breathing, and multiple organ failures, sepsis is likely.

The list of signs and symptoms mentioned in various sources for Bacteremia includes some symptoms listed below:

fever over 38.3°C
abdominal pain
shortness of breath
How is bacteremia diagnosed?
The diagnosis of bacteremia is made from a blood culture, in which a sample of blood is allowed to incubate with a medium that promotes bacterial growth. This test requires 24 to 48 hours for the results to come back. Since blood is normally sterile, this process does not normally lead to the isolation of bacteria. If, however, bacteria are present in the bloodstream at the time the sample is obtained, the bacteria will multiply and can thereby be detected. Any bacteria that incidentally find their way to the culture medium will also multiply. For this reason, blood cultures must be drawn with great attention to sterile process. Occasionally, blood cultures will reveal the presence of bacteria that represent contamination from the skin through which the culture was obtained. Blood analysis may also reveal an elevated number of white blood cells. Blood pressure is monitored closely; a decline in blood pressure may indicate the onset of septic shock.


What is symptoms of anaphylactic shock?
An anaphylactic shock reaction is most likely to occur in susceptible people who’ve been stung by an insect, eaten something they’re allergic to, or taken a medication that they are sensitive to. Even if you’ve only had a mild allergic reaction in the past, you still may be at risk of anaphylaxis. The symptoms of anaphylaxis can vary. In some people, the reaction begins very slowly, but in most the symptoms appear rapidly and abruptly.

1. The most severe and life-threatening symptoms are difficulty breathing and loss of consciousness.

Difficulty breathing is due to swelling and/or spasm in the airways (which can include swelling of the tongue or the airways). In very rare cases, breathing can stop altogether.
Loss of consciousness is due to dangerously low blood pressure, which is called “shock.”
In the most serious cases, the heart can stop pumping altogether.
These events can lead to death from anaphylaxis.
2. While some symptoms are life threatening, others are merely uncomfortable. Generally, a reaction must involve at least two different body systems, such as skin and heart, to be considered anaphylaxis.

Tingling or sensation of warmth – Often the first symptom ;
Difficulty swallowing ;
Nausea, vomiting ;
Diarrhea, abdominal cramping, bloating ;
Anxiety, fear, feeling that you are going to die ;
Skin: Most anaphylactic reactions involve the skin.
Hives, welts, or wheals (raised bumps): Hives can cause severe itching ;
Generalized erythema (redness) ;
Swelling in the face, eyelids, lips, tongue, throat, hands, and feet.
Breathing: Swelling of the surrounding tissues narrows the airways.
Difficulty breathing, wheezing, chest tightness ;
Coughing, hoarseness ;
Nasal congestion, sneezing.
Cardiovascular: Blood pressure may drop to dangerously low levels.
Rapid or irregular heart beat ;
Dizziness, faintness ;
Loss of consciousness, collapse.
What is signs of anaphylactic shock?

Abnormal heart rhythm (arrhythmia)
Fluid in the lungs (pulmonary edema)
Low blood pressure
Mental confusion
Rapid pulse
Skin that is blue from lack of oxygen or pale from shock
Swelling (angioedema) in the throat that may be severe enough to block the airway
Swelling of the eyes or face

Amenorrhea is condition that absence of menstruation, stop menstruation after already menstrual cycle. Amenorrhea is a common gynecological disease, divided into two types: primary Amenorrhea and secondary Amenorrhea. primary amenorrhea is that over 14 years of girl had yet to come menstruation, it often is caused by congenital anomalies, including ovarian or mullerian dysplasia. Secondary amenorrhea is that Menstrual period has stopped for over 6 months (except for pregnancy or breast-feeding), and often caused by secondary diseases. True amenorrhea is absence of menstruation that can be caused by the spirit of factors, malnutrition, anemia, tuberculosis, excessive curettage, endocrine disorders. Recessive amenorrhea is a result in congenital hypogenesis or acquired injure to cause reproductive tract adhesions or close, and lead to menstrual discharges.

Amenorrhea causes include functional and organic. The hypothalamus – pituitary – ovarian axis dysfunction induced amenorrhea is a functional amenorrhea; organic factors such as genital hypoplasia, cancer, trauma, chronic wasting disease. According to different anatomical, can divided into amenorrhea uterine, ovarian amenorrhea, pituitary and hypothalamic amenorrhea.

The diagnosis of Amenorrhea need physical examination. Endocrine inspection include the following: basal body temperature, vaginal smears, the crystallization of cervical mucus, endometrial biopsy. Determination of blood hormone levels, including: prolactin, luteinizing hormone and follicle-stimulating hormone, therapeutic check artificial such as progesterone withdrawal test and menstruation cycle test, if necessary, also the determination of adrenal and thyroid function.

If occur amenorrhea, it should be timely to found the cause and symptomatic treatment, generally have better effects. Otherwise, the long term amenorrhea, will be more severe uterine atrophy, treatment effects will be worse. The girl can or can’t cure amenorrhea the depends on the causes of amenorrhea. For example, adolescent secondary amenorrhea, often due to environmental, mood and weight changes, through remove these causes, menstruation can be cured. If amenorrhea that caused by illness, such as polycystic ovary syndrome, thyroid dysfunction, tuberculosis bacteria, through treatment, also can return menstruation period. But some amenorrhea can not be cured, which are the condition such as the birth is not the uterus, uterine endometrium is too small or has been damaged due to disease.


Treatment for primary disorder which cause amenorrhea:
can uterine expansion for intrauterine adhesions, separation of adhesions, intrauterine device placed in order to prevent adhesion again, and use estrogen and progesterone to promote endometrial hyperplasia and peel off. For ovarian or pituitary tumor, can surgery treatment after confirmed diagnosis. Patients with the reproductive tract tuberculosis, should give anti-tuberculosis treatment.

Estrogen and progesterone replacement therapy:
ovarian congenital dysplasia or suppressed ovarian function resulting in failure or damage, and can be treated by exogenous ovarian hormone replacement therapy. These patients because of the lack of normal follicles and oocytes, not secretion of sex hormones, treatment is estrogen and progesterone artificial cycle therapy, can correct the lack of estrogen in patients, and promote reproductive organs development, to improve the sex life.

Induced ovulation:
for patients with no loss of ovarian function, could be treated by hormone analogue-induced ovulation:
1. Dysfunction of the pituitary, treatment is use follicle-stimulating hormone to promote follicular development, secretion of estrogen and human chorionic gonadotropin (hCG) treatment, high success rate of ovulation;

2. Normal pituitary and ovarian function, but hypothalamic insufficiency, can treated by chlorine phenol amine in order to correct the hypothalamic-pituitary – ovarian axis function and ovulation induction;

3. Due to lack of endogenous LHRH induced amenorrhea, treatment should use pulsed micro-injection of LHRH to induced ovulation, it have good effects;

4. For high blood prolactin patients, should use bromocriptine to inhibit prolactin, restoration of gonadotropin secretion, and induce ovulation.

Medication and usage:
1. Oral B phenol, 0.25 ~ 0.5 mg per time, 1 time evenings, and even served 20 days, reapply 3 consecutive cycles after stopping 8 ~ 10 days.

2. intramuscular injection for progesterone, 20 mg each, 1 per day, three days straight injection. Discontinuation within 3 ~ 7 days, can occur withdrawal bleeding. If still absence of menstruation in the next Menstrual period, may repeat injection 1 ~ 3 cycles.

3. Oral B phenol per 0.25 ~ 0.5 mg, 1 daily, and even served 20 days, 16 days after stopping, can injection of progesterone 10 to 20 mg, 1 time per day, continuous injection for 5 days. After stopping 3 ~ 7 days, may occur vaginal bleeding, could application for three cycle, but should pay attention to dosage and time, in order to avoid menstrual disorders, affect the outcomes.

4. Can also take Nylestriol oral, 5 mg each, 1 time per month, after symptoms improved, to maintain the volume for each 1 to 2 mg, 1 or 2 times a month. But should be used with caution in patients with asthma, heart and kidney dysfunction, mental depression, migraine, diabetes, abnormal liver function, thyroid disease, uterine myoma, etc.

How to prevent Amenorrhea?

1. Hypomenorrhea or the later Menstrual period can cause amenorrhea, actively cured hypomenorrhea, can reduce the incidence of amenorrhea.

2. Make clear the cause and locations of amenorrhea, can help to treatment and prognosis of amenorrhea. If Hypothalamic amenorrhea, or amenorrhea that caused by the spirit of factors, environmental changes, malnutrition, medication would have better prognosis. If amenorrhea that caused by Mycobacterium tuberculosis and uterine endometrium has been destroyed, so less possibility of the resumption of menstruation. If amenorrhea with positive progesterone test, would have a better prognosis.

3, Amenorrhea and infertility because of families, environment cause the spirit of depression, clinical examination and laboratory tests have no significant abnormal, for these patients use drugs, and at the same time give spirit comfort and encouragement, once relieve the cerebral cortex inhibition, can resume Menstrual period and pregnancy.

5, Some women take weight loss pillsand and cause amenorrhea, or due obesity to go on a diet, leading to anorexia and amenorrhea. In addition many times pedestrian flow can cause amenorrhea, the above amenorrhea can be prevented.

6, Can drug treatment for intractable amenorrhea.

Diagnosis for Amenorrhea need to inquire about medical history and perform many tests. Patients with primary amenorrhea, doctor would ask about the process of growth and development, childhood has been suffering from viral infection or tuberculous peritonitis. Patients with secondary amenorrhea, doctor would ask age of menarche, duration of amenorrhea, Menstrual period before amenorrhea and whether or not the spirit; whether take contraceptives, whether had hormone therapy; whether cyclical pain in the lower abdomen. If had pregnancy, inquire about the history of abortion, curettage, postpartum hemorrhage.

Some tests use to amenorrhea diagnosis include Cervical screening, Ovarian function tests, Pituitary function tests.

1. Cervical screening:

1) Hysteroscopy: shows whether the deformity of bureaucratic depth, width, shape, with or without adhesive, check the pathological changes of endometrium.
2) laparoscopy: shows the uterus and gonadal appearance, except for congenital dysplasia, if necessary, take ovarian biopsy.
3) uterine fallopian tube axis Lipiodol angiography: Understanding cavity shape, with or without deformity, whether tubal patency, except for tuberculosis.
4) drug test: progesterone and estrogen tests, to observe whether the response of endometrium.

2. Ovarian function tests:
1) vaginal mucus crystallization inspection: understanding the level of estrogen.
2) the crystallization of cervical mucus examination: understanding the level of estrogen and whether progesterone affects.
3) Determination of basal body temperature: understanding whether ovulation and luteal function.
4) Determination of estrogen and progesterone levels: understanding ovarian function.

3. Pituitary function tests:
1) Determination of blood PSH, LH concentration: if the higher than normal that prompts ovarian dysfunction; if lower than normal that indicate pituitary function lower.
2) pituitary stimulation test: 15-30 minutes after administration in general, LH values higher than 2-4 times before use drug, that is pituitary function better, if do not increase or increased very little that may be in pituitary disease.
3) serum prolactin (PRL) determination: If PRL <50ug/ml, should be further PRL. Excitement or inhibition test to identify the increased PRL secretion and pituitary adenoma.
4) sellar x-ray film, magnetic resonance imaging examination: to except for pituitary tumor.

The normal Menstrual period is specific performance for normal function of hypothalamic-pituitary ovarian axis. For the patients with amenorrhea, except for organ pathological changes, examination of endocrine function can help to diagnosis for Amenorrhea.

1. Progestin trial: It is detection of endogenous estrogen levels, to evaluate the in vivo estrogen levels and the integrity of the reproductive tract. Progesterone alone for test: Progesterone 20mg, once daily intramuscular injection for 5 days; or oral medroxyprogesterone acetate 10mg, once a day, and even served five days to observe whether or not withdrawal bleeding properties. Use 2 to 7 days after the emergence of drug withdrawal bleeding were positive, that development of normal reproductive tract, the existence of endometrial function has been subject to the full the role of estrogen, progesterone and thus can produce changes in secretory phase. At the same time that “gonadal axis” function basically, but without ovulation may not be perfect. Can not be negative except for the uterus and reproductive tract abnormalities, need for estrogen – progestin trial to further clarify the diagnosis of Amenorrhea.

In addition to determination of serum lactogen, if normal, may be preliminary except for pituitary tumors. If higher than normal, especially when lactation, should be held in sellar X-ray film layer to remove the tumor may be. Necessary and possible, can be used for CT examination to detect small pituitary tumor.

2. Estrogen – progesterone test: progesterone test shows negative, maybe lack of endogenous estrogen due to insufficiented endometrial stimulation and growth by estrogen. Can oral stilbestrol 1mg daily, continuous for 21 days; estradiol benzoate can also be used, every three days intramuscular injection 2mg, continuous 7 times, the last 5 days the daily intramuscular injection of progesterone 20mg. If bleeding after drug withdrawal, shows lack of estrogen levels in vivo, pathological changes site is possible in over of the ovary. No bleeding after drug withdrawal showed that in endometrial lesions.

3. Determination of pituitary gonadotropin: Estrogen withdrawal bleeding test showed positive to express low levels of estrogen in vivo, should further distinguish itself cause that due to ovarian or due to the hypothalamus – pituitary dysfunction. RIA can be used or biological determination of gonadotropin (FSH, LN) level. LH low (<5IU / L) or lack of gonadotropin synthesis and secretion, the cause may be in the pituitary or hypothalamus. FSH increased (> 40IU / L) were more interrelated with the decline of ovarian function. FSH values in the 5 ~ 30IU / L, indicate the existence of ovarian follicular.

4. Pituitary stimulation test: If gonadotropin is lower than normal, should identify lesions in the hypothalamus or pituitary. Can use gonadotropin-releasing hormone (GnRH) for Pituitary stimulation test to distinguished. Methods: Test LH, and then intravenous LHRH100µg4 hours, 15,30,60 and 120 minutes for each of the measured blood LH. Hypothalamic dysfunction, in 30 ~ 45 minutes infusion of LH increased, 60 decreased to 90 minutes, 2 to 4 hours can be increased a second time, and for about four hours. Defects of pituitary function, LH although the first rise, but it can not last long, even to continue to use, nor increase in the phenomenon of the emergence of a second meeting on the function of pituitary LH synthesis is limited. If condition that damage to the hypothalamus and pituitary are inert, the beginning of instillation had no reaction, but can occur delayed reaction about two hours.

1) Wasting disease, such as severe tuberculosis, severe anemia, malnutrition, endocrine diseases; adrenal gland disorder, pancreas dysfunction. These can cause menstruation. If only these disease are cured, then have a natural menstrual period.

2) Lower reproductive tract atresia. Such as the cervix, vagina, hymen, labia, etc., some congenital atresia, or acquired injury resulted in adhesion of atresia, although menstruation, but blood can not drain. This is recessive amenorrhea. Lower reproductive tract atresia, it is completely curable.

3) Genital dysplasia. Some people with congenital non-ovarian or ovarian dysplasia, can not produce estrogen and progesterone, the endometrium can not produce cyclical changes, so causes amenorrhea. Some congenital absence of uterus, or endometrial dysplasia, or endometrial injury, even if healthy ovarian function, estrogen and progesterone secretion is normal, also cause absence of menstruation.

4) Tuberculosis endometritis. This is due to invasive endometrial tuberculosis, cause endometrial inflammation, to varying degrees of damage, and finally scar tissue there, and cause amenorrhea.

5) Pituitary or hypothalamic abnormal. Pituitary can secrete gonadotropin. Gonadotropin have regulation of ovarian and maintain menstruation. If pituitary disorders, will affect gonadotropin secretion, lead to the side effects of ovarian function, ovarian abnormal would cause amenorrhea. In addition, hypothalamic abnormal can cause amenorrhea. Hypothalamic dysfunction are caused by many reasons, such as the spirit of excitement, sadness anxiety, fear, anxiety, tension fatigue, as well as environmental changes, cold stimulus. The hypothalamic abnormal is most common causes of amenorrhea.