Holistic Health Articles and Research Related to Herbal Medicines, Foods and Phytochemicals

Monday, 2 December 2013

Trigeminal neuralgia - Treatments in conventional medicine perspective

Trigeminal neuralgia is defined as a condition of episodes of intense facial pain as a result of the affect of trigeminal nerve, containing 3 branches. The first (upper) branch includes the eye, eyebrow, and forehead. The second (middle) branch corresponds to the upper lip, upper teeth, upper gum, cheek, lower eyelid, and side of the nose. The third (lower) branch involves the lower lip, lower teeth, lower gum, and one side of the tongue. It also includes a narrow area that extends from the lower jaw in front of the ear to the side of the head(1). The pain is nearly always unilateral, and it may occur repeatedly throughout the day(2).
Treatment
V.1. Treatment in conventional medicine perspective
A. Medication
1. Carbamazepine
Carbamazepine is currently the drug of first choice in the treatment of trigeminal neuralgia. However, it is reported as efficacious in only 70-80% of patients, and can be associated with adverse effects such as drowsiness, confusion, nausea, ataxia, nystagmus and hypersensitivity, which may necessitate discontinuation of medication(19).

2. Topiramate
In the trials comparing topiramate with carbamazepine are all poor in methodological quality. A meta-analysis of these studies showed that the overall effectiveness and tolerability of topiramate did not seem to differ from carbamazepine in the treatment of classical trigeminal neuralgia. However, the meta-analysis yielded a favourable effect of topiramate compared with carbamazepine after a treatment duration of 2 months. Results were limited due to the poor methodological quality and the geographic localization of the randomized controlled trials identified. Therefore, large, international, well conducted, randomized controlled trials are needed to further assess the relative efficacy and tolerability of topiramate and carbamazepine in this indication(20)
Side effects include Loss of appetite, dizziness, and tingling sensations, etc.

3. Lamotrigine
In the study of 21e patients with TN administered with LTG in comparison to CBZ. in the clinical trials comprised two phases of 40 days each, with an intervening three-day washout period, showed that oth on VAS and VRS assessments, in terms of proportion of patients, CBZ benefitted 90.5% (19/21) of the patients with pain relief (p < 0.05), in contrast to 62% (13/21) from LTG. On VAS assessment, of the 13 patients who gained pain relief from LTG and 19 from CBZ, 77% (10/13) obtained a "complete" degree of pain relief from LTG, as compared with 21% (4/19) from CBZ. On VRS assessment, with LTG, 84% (11/13) of the patients accomplished "much better" degree of pain relief, as compared with 26% (5/19) with CBZ. On LTG, 67% (14/21) of patients endured general pharmacological side effects, as compared with 57% (12/21) of patients on CBZ (p > 0.05). Meanwhile, LTG inflicted 14% (3/21) of the patients with haematological, hepatic and renal derangements, as compared with 48% (10/21) on CBZ(21).
Side effects include nausea, dizziness, headaches, coordination problems, etc.

4. Etc.

B. Surgical treatments
1. Peripheral neurectomies, a minimally invasive treatment for trigeminal neuralgia
In the study to investigate the efficacy of peripheral neurectomy as a surgical procedure in the treatment of trigeminal neuralgia and to evaluate the results obtained by this procedure and their recurrences in a period of three years followup, researchers at the Modern Dental Collage & Research Centre, showed that peripheral neurectomy is one of the oldest, minimal invasive forms of surgery, well tolerated by the patient and can be done under local anesthesia(22)
Others suggested that peripheral neurectomy is thus a safe and effective procedure for elderly patients, for those patients living in remote and rural places that cannot avail major neurosurgical facilities, and for those patients who are reluctant for major neurosurgical procedures(23).
According to the study by Dr. Freemont AJ, and DR. Millac P. Of 49 patients ultimately maintained pain-free by non-medical means, 26 underwent peripheral neurectomy. Twenty of these achieved excellent pain control in the longer term and 5 of the remaining 6 became more responsive to carbamazepine after operation. Seven patients required repeat neurectomies(24).

2. Trigeminal Root Compression of trigeminal nerve
In the study of the Efficacy and safety of root compression of trigeminal nerve for trigeminal neuralgia with out evidence of vascular compression, found that all patients were pain free after the procedure; there was a 27% relapse in a mean time of 10 months, but 83% of these patients were adequately controled by medical treatment, and only 17% needed a complementary procedure for pain relief. Also we found that 63% of the patients complained of a partial loss of facial sensitivity, but only one patient presented with a corneal ulcer. There were a 6.7% rate of significant complications. We concluded that Trigeminal Root Compression is a safe and effective option for patients with primary trigeminal neuralgia without vascular compression(25).
TN is frequently associated with nerve root entry zone demyelination in MS and patients with nerve root vascular compression. The characteristics of the TN and response to PSR are similar in both groups. Persistent vascular compression increases the risk of recurrent TN after PSR(26).

3. Microvascular decompression (MVD)
In the study to evaluate the long-term efficacy of microvascular decompression (MVD) and to identify the factors affecting outcome in patients treated for primary trigeminal neuralgia (TN), researchers at the
Hôpital Neurologique Pierre Wertheimer, University of Lyon, found that Pure MVD can offer patients affected by a primary TN a 73.38% probability of long-term (15 years) cure of neuralgia. The presence of a clear-cut and marked vascular compression at surgery (and possibly-although not yet reliably--on preoperative magnetic resonance imaging) is the guarantee of a higher than 90% success rate(27).
In Microvascular decompression (MVD), the Complete pain relief (off medication) achieved in 71% of patients at 10 years. Overall 84% of responders to questionnaires expressed satisfaction with the operative outcome, the mean duration of TGN was 80 months and mean post-operative follow-up of 7 years. No mortality reported in this series(28).

4. Gamma Knife surgery
In the comparison of data across previous reports hampered by differences in treatment protocols, lengths of follow-up, and outcome criteria, researchers at the Sint Elisabeth Hospital, Tilburg found that
in the idiopathic TN group, rates of adequate pain relief, defined as BNI Pain Scores I-IIIB, were 75%, 60%, and 58% at 1, 3, and 5 years, respectively. In the multiple sclerosis (MS)-related TN group the rates of adequate pain relief were 56%, 30%, and 20% at 1, 3, and 5 years, respectively. Repeated GKS was as successful as the first. An analysis of our treatment strategy of repeated GKS showed rates of adequate pain relief of 75% at 5 years in the idiopathic TN and 46% in the MS-related TN group. Somewhat bothersome numbness was reported by 6% of patients after the first treatment and by 24% after repeated GKS. Very bothersome numbness was reported in 0.5% after the first GKS and in 2% after the second treatment(29).
During the radiosurgical procedure, 19 patients (2%) suffered anxiety or syncopal episodes, and 2 patients suffered acute coronary events. Treatments were incompletely administered in 12 patients (1.2%). Severe pain was a delayed complication: 8 patients suffered unexpected headaches, and 9 patients developed severe facial pain. New motor deficits developed in 11 patients, including edema-induced ataxia in 4 and one case of facial weakness after treatment of a vestibular schwannoma. Four patients required shunt placement for symptomatic hydrocephalus, and 16 patients suffered delayed seizures(30).

5. Radiofrequency

Only Patients with a good to excellent pain relief with a diagnostic trigeminal ganglion block and if the pain relief is of a short duration may be suitable candidates for percutaneous RF rhizotomy. It is performed by destruction of the trigeminal ganglion or roots using RF. RF is the most common percutaneous procedure used to treat TN, especially in elderly patients(31).

According to the study of an analysis of 16 346 treated nodules in 13 283 patients, between January 1999 and November 2010. Five patients (0.038%) died: two from intraperitoneal hemorrhage, and one each from hemothorax, severe acute pancreatitis and perforation of the colon. In 16 346 treated nodules, 579 complications (3.54%) were observed, including 78 hemorrhages (0.477%), 276 hepatic injuries (1.69%), 113 extrahepatic organ injuries (0.691%) and 27 tumor progressions (0.17%). The centers that treated a large number of nodules and performed RFA modifications, such as use of artificial ascites, artificial pleural effusion and bile duct cooling, had low complication rates(32).

6. Balloon compression
In the retrospective study of 121 patients treated with balloon compression of the rootlets behind the Gasser ganglion from 1995 to 2007 showed that balloon compression is considered in the literature to be a safer procedure than other percutaneous surgeries, especially for postoperative sensitive disorders. The best indications seem to be trigeminal neuralgia in older patients or pain due to multiple sclerosis and neuralgia involving the V1 territory(33).
According to researches at the University Clinical Centre Maribor, pain relief was reported in 25 (93%) patients. In two patients, the pain remained the same. The pain free period ranged from 2 to 74 months (median 15 months). A mean duration of analgesia was longer in patients with ideal pear shape of balloon at the time of the procedure compared to nonideal shape (P = 0.01). No major complications occurred in our group of patients(34).

7. Glycerol rhizolysis
In the study to examine the pathophysiological mechanisms of trigeminal neuralgia and the mechanisms underlying pain relief after percutaneous retrogasserian glycerol rhizolysis (PRGR), indicated that relief of pain after PRGR depends on the normalization of abnormal temporal summation of pain, which is independent of general impairment of sensory perception. Assessment of the temporal summation of pain may serve as an important tool to record central neuronal hyperexcitability, which may play a key role in the pathophysiological changes in trigeminal neuralgia(35).
According to researchers at the All India Institute of Medical Sciences, seventy-nine patients underwent either PRGR (n = 40) or RF thermocoagulation (n = 39). A total of 23 patients (58.9%) in the PRGR group and 33 patients (84.6%) in the RF group experienced excellent pain relief. The mean duration of excellent pain relief in the PRGR and RF groups was comparable. By the end of the study period, 39.1% patients in the PRGR group and 51.5% patients in the RF group experienced recurrence of pain(36).

8. Radiofrequency rhizotomy
In the reevaluate the results of radiofrequency rhizotomy and review the effectiveness of other surgical procedures for the treatment of trigeminal neuralgia, Dr. Taha JM, and Dr. Tew JM Jr. at the University of Cincinnati College of Medicine, found that
1) percutaneous techniques and posterior fossa exploration offer advantages and disadvantages,
2) radiofrequency rhizotomy is the procedure of choice for most patients undergoing first surgical treatments, and
3) MVD is recommended for healthy patients who have isolated pain in the first ophthalmic trigeminal division or in all three trigeminal divisions and patients who desire no sensory deficit(37)
Fifty-four of the 89 patients underwent 146 RF-TR procedures for both sides and 35 underwent 40 RF-TR procedures for one side. Complete pain relief or partial satisfactory pain relief was achieved on the medically treated side in 35 patients. During follow-up, 36 patients required the second procedure and 7 required the third procedure. Acute pain relief was reported in 86 (96.6%) patients. Early (<6 months) pain recurrence was observed in 11 (12.3%) and late (>6 months) recurrence in 25 (28.0%) patients. Complications included diminished corneal reflex in four (2.1%) patients, keratitis in two (1.1%), masseter dysfunction in four (2.1%), dysesthesia in two (1.1%), and anesthesia dolorosa in one (0.5%), according to the study of Ankara University, Faculty of Medicine(38).

9. Etc.

Unfortunately, all neurosurgical interventions are helpful in relieving pain but with certain side effects. In the study to assess the efficacy of neurosurgical interventions for classical trigeminal neuralgia in terms of pain relief, quality of life and any harms and to determine if there are defined subgroups of patients more likely to benefit, showed that there is very low quality evidence for the efficacy of most neurosurgical procedures for trigeminal neuralgia because of the poor quality of the trials. All procedures produced variable pain relief, but many resulted in sensory side effects. There were no studies of microvascular decompression which observational data suggests gives the longest pain relief. There is little evidence to help comparative decision making about the best surgical procedure. Well designed studies are urgently needed(39) and various surgical procedures have been reported for the treatment of this condition, but there is no agreement on the best management of these patients. There are no differences in the short term results among different procedures for TN in MS patients. Each technique demonstrate advantages and limits in terms of long term pain, recurrence rate and complication rate(40).

Trigeminal neuralgia - Diagnosis and Misdiagnosis

Paroxysmal attacks of pain lasting from a fraction of a second to 2 min, affecting one or more divisions of the trigeminal nerve, and fulfilling criteria B and C
Pain has at least one of the following characteristics:
1. Intense, sharp, superficial, or stabbing
2. Precipitated from trigger zones or by trigger factors
Attacks are sterotyped in the individual patient
There is no clinically evident neurologic deficit
Not attributed to another disorder

Symptomatic

Paroxysmal attacks of pain lasting from a fraction of a second to 2 min, with or without persistence of aching between paroxysms, affecting one or more divisions of the trigeminal nerve, and fulfilling criteria B and C
Pain has at least one of the following characteristics:
1. Intense, sharp, superficial, or stabbing
2. Precipitated from trigger zones or by trigger factors
Attacks are sterotyped in the individual patient
A causative lesion, other than vascular compression, has been demonstrated by special investigations and/or posterior fossa exploration(17)

MRI is particularly useful in planning the management of those conditions where surgical or medical intervention can result in improvement or resolution of symptoms and to exclude the symptomatic TN due to multiple sclerosis and tumors.

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Sources
(1) http://www.neurosurgery.ufl.edu/clinical-specialties/images/trigeminal_neuralgia_brochure_for_web.pdf
(2) http://www.ncbi.nlm.nih.gov/pubmed/18540495
(12) http://www.ncbi.nlm.nih.gov/pubmed/20078705
(13) http://www.ncbi.nlm.nih.gov/pubmed/17147031
(14) http://www.ncbi.nlm.nih.gov/pubmed/9139410
(15) http://www.ncbi.nlm.nih.gov/pubmed/22558614
(16) http://www.ncbi.nlm.nih.gov/pubmed/18540495
(17) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033033/table/t1-jpr-3-249/

Trigeminal neuralgia - Signs, Symptoms, Causes and Risk Factors

Trigeminal neuralgia is defined as a condition of episodes of intense facial pain as a result of the affect of trigeminal nerve, containing 3 branches. The first (upper) branch includes the eye, eyebrow, and forehead. The second (middle) branch corresponds to the upper lip, upper teeth, upper gum, cheek, lower eyelid, and side of the nose. The third (lower) branch involves the lower lip, lower teeth, lower gum, and one side of the tongue. It also includes a narrow area that extends from the lower jaw in front of the ear to the side of the head(1). The pain is nearly always unilateral, and it may occur repeatedly throughout the day(2).

I. Signs and symptoms
The abrupt onset of short pains in the face or in a part of the face, including
1. Stabbing
2. Lightning
3. Electric shocks(3).
4. Autonomic symptoms can occur in association with the facial pain of trigeminal neuralgia (TN).the most common autonomic symptoms were conjunctival injection, ptosis, and excessive tearing (4).

5. In the study to evaluate a total of 30 patients with TN and chronic facial pain (group A, 25 women and 5 men; mean age, 64.2±3.2 years) and 30 with atypical facial pain (group B, 26 women and 4 men; mean age, 64.8±1.9 years, researchers at the Lithuanian University of Health Sciences, showed that patients with TN and chronic facial pain had a significantly higher level of pain perception, and they presented the higher level for anxiety and depression than those with atypical facial pain(5).

6. Etc.

II. Causes and Risk factors
A. Causes
1. Neurovascular compression (NC)
Neurovascular compression (NC) seems to have been confirmed as the major cause of classical trigeminal neuralgia (TN)(6).

2. Tumor in the brain
There are a reprot of three cases of contralateral trigeminal neuralgia as a false localizing sign in intracranial tumors. In all cases, tumors were large and firm. The tumor was supratentorial in two cases. In one case, a cortically mediated mechanism may have caused the neuralgia, whereas in the remaining two cases distortion and displacement of the brain stem and compression of the contralateral Meckel's cave would explain the trigeminal nerve signs(7).

3. Multiple sclerosis
Multiple Sclerosis is an inflammation of central nervous system disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are deteriorated, leading to impair of proper conduction of nerve impulse. In a multicentre controlled study of 130 patients with MS: 50 patients with TN, 30 patients with trigeminal sensory disturbances other than TN (ongoing pain, dysaesthesia, or hypoesthesia), and 50 control patients, found that the most likely cause of MS-related TN is a pontine plaque damaging the primary afferents. Nevertheless, in some patients a neurovascular contact may act as a concurring mechanism. The other sensory disturbances, including ongoing pain and dysaesthesia, may arise from damage to the second-order neurons in the spinal trigeminal complex(8).

4. Shingles
Shingles also known as herpes zoster or zona is defined as a viral disease with condition of a painful, blistering skin rash on one side of the body of that can continue to be painful even after the rash have long disappeared(1), as a result of varicella-zoster viral causes of a nerve and skin inflammation. There is a report of a case of reactivation of herpes zoster along the trigeminal nerve with intractable pain after facial trauma(9).

5. Etc.

B. Risk factors
1. Age
If you are 50 or older, you are at increased risk to develop Trigeminal neuralgia.

2. Sex
If you are female, your risk of develop TN are increased.

3. Familial risks
In the study of familial risks for siblings who were hospitalised for nerve, nerve root and plexus disorders in Sweden, showed that 29,686 patients, 43% men and 57% women, were diagnosed at a mean age of 37.5 years. 191 siblings were hospitalised for these disorders, giving an overall SIR of 2.59 (95% CI 1.58 to 4.22), with no sex difference(10).

3. Certain conditions
a. Hypertension
Increased risk of trigeminal neuralgia after hypertension. In the hypertension group, 121 patients developed TN during follow-up, while, in the nonhypertension group, 167 subjects developed TN. The crude hazard ratio for the hypertension group was 1.52 (95% confidence interval [CI] 1.20-1.92; p = 0.0005), while, after adjustment for demographic characteristics and medical comorbidities, the adjusted hazard ratio was 1.51 (95% CI 1.19-1.90; p = 0.0006)(11).

b. Multiple sclerosis
Multiple sclerosis are associated with the increased risk of Trigeminal neuralgia.

c. Etc.

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Sources
(1) http://www.neurosurgery.ufl.edu/clinical-specialties/images/trigeminal_neuralgia_brochure_for_web.pdf
(2) http://www.ncbi.nlm.nih.gov/pubmed/18540495
(3) http://www.ncbi.nlm.nih.gov/pubmed/9139410
(4) http://www.ncbi.nlm.nih.gov/pubmed/21568653
(5) http://www.ncbi.nlm.nih.gov/pubmed/22112988
(6) http://www.ncbi.nlm.nih.gov/pubmed/16472332
(7) http://www.ncbi.nlm.nih.gov/pubmed/3808248
(8) http://www.ncbi.nlm.nih.gov/pubmed/19171430
(9) http://www.ncbi.nlm.nih.gov/pubmed/21686763
(10) http://www.ncbi.nlm.nih.gov/pubmed/17183020
(11) http://www.ncbi.nlm.nih.gov/pubmed/21998318

Cystitis treatments in Traditional Chinese medicine perspective

Cystitis is defined as a condition of urinary bladder inflammation.

Treatment in traditional Chinese medicine perspective
Traditional Chinese medicine view urinary tract infection including bladder inflammation as a result of the of damp heat accumulation that lead to symptoms of a frequent urination, burning sensation, painful during sexual intercourse; cloudy or yellow-milky urine, etc.
F.1. Damp heat accumulation
1. Long dan cao (Gentian)
Besides it is used to treat liver heat caused by dampness accumulation due to spleen' inability in materials absorption, It also enhances the liver and the gallbladder function in draining damp heat in the body through kidney urinary secretion.

2. Huang qin (Scullcap)
Huang qin is important to enhance the lung function by moistening the qi, thus reducing the risk of fever, irritability, thirst, cough. It also improves the stomach function in absorbing vital vitamins and minerals by clearing the heat caused extreme dampness that causes diarrhea and thirst with no desire to drink.

3. Zhi zi (Gardenia)
It improves the circulatory function by clearing the liver heat due to constrained liver and heat caused by infection or inflammation as a result of fluids accumulated in body for a prolong period of time.

4. Mu tong (Akebia)
Mu tong besides increases the kidney in clearing dampness through urinary secretion, it also enhances the blood function by draining the blood heat caused by blood stagnation.

5. Gan cao (licorice root)
Gan cao reduces damp heat accumulated in the body in many different ways
a) It moistens the lung, thus reducing the lung dryness causing symptoms of coughing and promoting the smooth qi movement.
b) It reduces the heat caused by toxins in the body by eliminating them through urinary secretion.
c) It enhances the heart in regulating the movement of blood by strengthening the blood that stop the irregular pulse.
d) It increases the liver function in regulating the abdominal muscles, thus reducing the menstrual cramps and pain.

F.2. Spleen and kidney deficiency
Spleen is considered as the prenatal organ in traditional Chinese medicine. It means what you have is what you get. depletion of kidney Jing can have a serious effect in your health. Spleen is the organ responsible for distribution of Qi and nutrition to the body organ, including kidney and lung. Deficiency of kidney and spleen may result in the symptoms of urinary tract infection, including dribbling urination; frequent urination during the night; dull pain during urination; sporadic urination, recurrence of infection, lower back pain, etc.
1. Wu Bi Shan Yao Wan (Incomparable Dioscorea Pill)
The pill has been been used in TCM to treat urinary tract infection by nourishing the Yin, enhancing the Yang and the Qi and Strengthening the Kidneys. It is one of the patent formula in a collection of 355 efficient valuable and most famous prescriptions among Chinese patent drugs. according to Chinese Patent Medicines (English Edition) Editor-in-Chief: Chen Keji, MD. Editors: Chen Kai MD, Zhang Qunhao MD, Wang Wei MD, Lin Yuxiong MD, Hsia I-Szu Ph.D. Published by Hunan Science & Technology Press, 1997
2. Ingredients
a. Shan Yao
Main uses; Tonifies Qi Kidney Yin and Spleen,nourishes the Stomach Yin.
b. Rou Cong Rong
Main uses; Tonifies the Kidneys, strengthens the Yang, benefits Kidney Jing and bone marrow
c. Wu Wei Zi
main uses; Tonifies the Kidneys, benefits Jing
d. Du Zhong
Main sues; Tonifies Yang, Kidneys and Liver
e. Niu Xi
main uses; Invigorates the Blood, nourishes the Liver and Kidney Yin
f. Sheng Di Huang
Main uses; Clears Heat, cools Blood, nourishes Yin and generates fluids
g. Ze Xie
Mian uses; Promotes urination, drains Kidney Fire and Dampness
h. Shan Zhu Yu
Main uses; Tonifies Liver and Kidney Yin, benefits Kidney Yang
k. Ba Ji Tian
Main sues; Tonifies Kidneys and strengthens Yang.
l. Chi Shi Zhi
Mian uses; Enhances the Intestines functions and stops diarrhea.
m. Tu Si Zi
main uses; Tonifies the Kidneys and Spleen, strengthens Yang, enhances Yin
n. Fu Shen
Main uses; Nourishes the Heart and calms the Shen

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Cystitis treatments in Herbal medicine perspective

Cystitis is defined as a condition of urinary bladder inflammation.

Treatment in herbal medicine perspective
1. Bearberry
Bearberry also best known as Uva Ursi, has diuretic, astringent and antiseptic properties. and been used as tea in herbal medicine to treat urinary tract infection. In a study of "Natural approaches to prevention and treatment of infections of the lower urinary tract" by Head KA., posted in PubMed, researchers indicated that botanicals that can be effective at the first sign of an infection and for short-term prophylaxis include berberine and uva ursi. Estriol cream and vitamins A and C have also been shown to prevent UTIs, while potassium salts can alkalinize the urine and reduce dysuria.

2. Golden-seal
Gloden-seal is said contains antimicrobial properties of which can be used to treated urinary tract infection, according to the article of "Golden-seal" posted in University of Maryland Medical Center, the author wrote that It (Golden-seal root) is commonly used to treat several skin, eye, and mucous membrane inflammatory and infectious conditions (such as sinusitis, conjunctivitis, and urinary tract infections). It is also available in mouthwashes for sore throats and canker sores.
F. Treatment in traditional Chinese medicine perspective.

3. Green tea
According to the study of "Selective microbiologic effects of tea extract on certain antibiotics against Escherichia coli in vitro" by Neyestani TR, Khalaji N, Gharavi A., posted in PubMed, researchers found that the microbiologic effects of both black tea and green tea extracts on certain antibiotics against E. coli may vary, depending on the type of the tea extract (i.e., black vs. green), the amount of the extract, and the antibiotic being used.

4. Cranberry
Herbalist view cranberry as primary herbs for diuretic and in preventing and treating urinary tract infection by by inhibiting bacterial attachment to the urinary tract lining of the bladder and urethra, according to the article of "How Cranberry Juice Can Prevent Urinary Tract Infections" post in Science daily, writer wrote that Cranberry juice had no discernible effect on E. coli bacteria without fimbriae, suggesting that compounds in the juice may act directly on the molecular structure of the fimbriae themselves.
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Cystitis Diagnosis and treatment in Convention medicine perspective

Cystitis is defined as a condition of urinary bladder inflammation

Diagnosis and treatment in convention medicine perspective
1. Acute uncomplicated cystitis

In the diagnosis and treatment of acute uncomplicated cystitis, researchers at the University of Maryland School of Medicine, Baltimore, showed that Most urinary tract infections are acute uncomplicated cystitis. Identifiers of acute uncomplicated cystitis are frequency and dysuria in an immunocompetent woman of childbearing age who has no comorbidities or urologic abnormalities. Physical examination is typically normal or positive for suprapubic tenderness. A urinalysis, but not urine culture, is recommended in making the diagnosis. Guidelines recommend three options for first-line treatment of acute uncomplicated cystitis: fosfomycin, nitrofurantoin, and trimethoprim/sulfamethoxazole (in regions where the prevalence of Escherichia coli resistance does not exceed 20 percent). Beta-lactam antibiotics, amoxicillin/clavulanate, cefaclor, cefdinir, and cefpodoxime are not recommended for initial treatment because of concerns about resistance. Urine cultures are recommended in women with suspected pyelonephritis, women with symptoms that do not resolve or that recur within two to four weeks after completing treatment, and women who present with atypical symptoms(16).

2. Interstitial cystitis

In the study of Interstitial cystitis/painful bladder syndrome, researchers at the University of Toledo College of Medicine, indicated that tests and tools commonly used to diagnose interstitial cystitis/painful bladder syndrome include specific questionnaires developed to assess the condition, the potassium sensitivity test, the anesthetic bladder challenge, and cystoscopy with hydrodistension. Treatment options include oral medications, intravesical instillations, and dietary changes and supplements. Oral medications include pentosan polysulfate sodium, antihistamines, tricyclic antidepressants, and immune modulators. Intravesical medications include dimethyl sulfoxide, pentosan polysulfate sodium, and heparin. Pentosan polysulfate sodium is the only oral therapy and dimethyl sulfoxide is the only intravesical therapy with U.S. Food and Drug Administration approval for the treatment of interstitial cystitis/painful bladder syndrome(17).
Other researchers also suggested the use of intravesical pentosan polysulfate sodium simultaneously with oral pentosan polysulfate sodium is a safe and effective therapeutic option. It will open a new option for patients with interstitial cystitis to reduce their severely devastating symptoms and to improve their quality of life and well-being(18).
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Sources

(15) http://www.ncbi.nlm.nih.gov/pubmed/9258082
(16) http://www.ncbi.nlm.nih.gov/pubmed/22010614
(17) http://www.ncbi.nlm.nih.gov/pubmed/21568251
(18) http://www.ncbi.nlm.nih.gov/pubmed/18001798

Cystitis Preventions - The Nutritional supplements

Cystitis is defined as a condition of urinary bladder inflammation.

C.3. Nutritional supplements
1. Vitamin A, E, C, D
a. Vitamin A
Vitamin A occurs in the form retinol and is best known for its function in maintaining the health of cell membrane, hair, skin, bone, teeth and eyes. It also plays an important role as an antioxidant as it scavenges free radicals in the lining of the mouth and lungs; prevents its depletion in fighting the increased free radicals activity by radiation; boosts immune system in controlling of free radicals; prevents oxidation of LDL and enhances the productions of insulin pancreas.

b. Vitamin C
Vitamin C beside plays an important role in formation and maintenance of body tissues, it as an antioxidant and water soluble vitamin, vitamin C can be easily carry in blood, operate in much of the part of body. By restoring vitamin E, it helps to fight against forming of free radicals. By enhancing the immune system, it promotes against the microbial and viral and irregular cell growth causes of infection and inflammation.
Vitamin C also is a scavenger in inhibiting pollution cause of oxidation.

c. Vitamin E
Vitamin E is used to refer to a group of fat-soluble compounds that include both tocopherols and tocotrienols discovered by researchers Herbert Evans and Katherine Bishop. It beside is important in protecting muscle weakness, repair damage tissues, lower blood pressure and inducing blood clotting in healing wound, etc, it also is one of powerful antioxidant, by moving into the fatty medium to prevent lipid peroxidation, resulting in lessening the risk of chain reactions by curtailing them before they can starts.

2. Carotenoids
Carotenoids are organic pigments, occurring in the chloroplasts and chromoplasts of plants and some other photosynthetic organisms like algae, some bacteria.
a. Beta-carotene
Beta-Carotene, an organic compound and classified as a terpenoid, a strongly-coloured red-orange pigment in plants and fruits.
a.1. It is not toxic and stored in liver for the production of vitamin A that inhibits cancer cell in experiment. Beta-carotene also neutralize singlet oxygen before giving rise of free radicals which can damage of DNA, leading to improper cell DNA replication, causing cancers.
a.2. Cell communication
Researcher found that beta-carotene enhances the communication between cell can reduce the risk of cancer by making cells division more reliable.
a.3. Immune system
Beta-carotene promotes the immune system in identifying the foreign invasion such as virus and bacteria by increasing the quality of MHC2 protein in maintaining optimal function of white cells.
a.4. Polyunsaturated fat
Researchers found that beta-carotene also inhibits the oxidation of polyunsaturated fat and lipoprotein in the blood that reduce the risk of plaques build up onto the arterial walls, causing heart diseases and stroke.
a.5. There are more benefits of beta-carotene.

3. Flavonoids
Flavonoids also known as Vitamin P and citrin are a yellow pigments having a structure similar to that of flavones occurred in varies plants. it has been in human history for over thousands of years and discovered by A. S. Szent-Gyorgi in 1930. As he used vitamin C and flavonoids to heal the breakage of capillaries, which caused swelling and obstruction of blood flow. Most plants have more than one group or type act as predominate.
Flavonoids process a property as antioxidants. it helps to neutralize many of reactive oxygen species (ROS), including singlet oxygen, hydroxyl and superoxide radicals. Although nitric oxide is considered a free radical produced by immune system to destroy bacteria and cancerous cells, but when it is over produced, it causes the production peroxynitrite which may attack protein, lipid and DNA, Flavonoids inhibit NO production of peroxynitrite due to reduction of enzyme expression.

4. Manganese
Manganese is an essential trace nutrient in all forms of life. It is well known for its role in helping the body to maintain healthy skin and bone structure, but also acts as cofactors for a number of enzymes in higher organisms, where they are essential in detoxification of superoxide (O2−, with one unpaired electron) free radicals.
Although superoxide is biologically quite toxic and is deployed by the immune system to kill invading microorganisms by utilizing the enzyme NADPH oxidase. Any Mutations in the gene coding for the NADPH oxidase cause an immunodeficiency syndrome.

5. Selenium
Selenium , a trace mineral plays an important and indirect role as an antioxidant by fulfilling its function as a necessary constituent of glutathione peroxidase and in production of glutathione, that inhibits the damage caused by oxidation of free radical hydrogen peroxide, leading to aging effects.
a. Immune system
Selenium enhances the immune function that fighting off the attack of AID virus by promoting the function of interleukin 2 and T-cells.
b. Cancer
Study showed that levels pf selenium in blood test is associated with high rate of cancer, including skin cancer.
8. Etc.
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