Common allergies that bring on wheezing, sneezing and watery eyes could be next to join the list of factors linked to heart disease, suggests a large new study.

However, the researchers stress that the findings do not prove that allergies actually cause heart disease, the leading cause of death in the U.S.

To look for ties between common allergic symptoms and heart disease, Dr. Jongoh Kim of Albert Einstein Medical Center in Philadelphia, Pennsylvania and colleagues analyzed data on more than 8,600 adults aged 20 or older who participated in the National Health and Nutrition Examination Survey conducted between 1988 and 1994.

They found that common allergies and heart disease frequently paired up.

Eighteen percent of the adults reported wheezing and 46 percent suffered bouts of a stuffy nose or itchy and watery eyes -- a combination of allergic symptoms known as rhinoconjunctivitis.

Heart disease was present in 6 percent of the adults overall. It was found in 13 percent of wheezing cases, 5 percent of rhinoconjunctivitis cases and 4 percent of people without any allergic symptoms.

After adjusting for other related factors, such as age and asthma, there was a 2.6-fold increased risk of heart disease with wheezing and a 40 percent increased risk with rhinoconjunctivitis, compared to no allergies. The association was mainly seen in women younger than age of 50.

Kim suggests that the intermittent inflammation that comes with allergies may lead to the thickening of artery walls, and eventually heart disease. It could also be that some people simply carry genes that are linked to the development of both allergies and heart disease, Kim added.

But given the nature of the study, the researchers are not yet able to say if allergies truly have a role to play in the development of heart disease.

Much more study is needed to "clearly see" whether there is a cause and effect relationship, Kim said. "And even if there is a cause and effect, it is not clear whether treating allergic disease can reduce the risk," Kim noted.

Dr. Carlos Iribarren, a research scientist at Kaiser Permanente in Oakland, California, who was not involved in the study, said: "Because common allergic symptoms are highly prevalent in asthma, these findings are consistent with prior research conducted at Kaiser Permanente showing a significant association between self-report of asthma and future risk of coronary disease, particularly among women."

But he cautioned, in an email to Reuters Health, against jumping to any "premature conclusion, consumer-level advice or public health recommendation based on these findings."

Iribarren also noted that study subjects with allergy (particularly wheezing) had a greater burden of heart disease risk factors (for example, smoking, obesity, high blood pressure), compared with allergy-free subjects. Therefore, "allergists, internists and cardiologists should be made aware of this link and intensify cardiovascular risk profile assessment and modification among patients presenting with allergy."

Dr. Viola Vaccarino, of the Rollins School of Public Health at Emory University School of Medicine in Atlanta, told Reuters Health that the current findings also fit with studies she and her colleagues have done, "finding of an association of chronic inflammatory conditions such as asthma and other allergic conditions with coronary disease in women but not in men."

"Young women may have a stronger inflammatory response due to allergic conditions than men, perhaps due to estrogens," explained Vaccarino, who was also not involved in the current study.

It's also possible, she said, that "people with history of coronary heart disease are sicker with respiratory symptoms just because they have coronary heart disease and not vice-versa."

"I really wouldn't draw any strong message from this study," said Vaccarino. "I would not alarm the public with the news that common allergic symptoms (other than asthma) increase the risk of coronary heart disease in women, based on this study."

                                                                                                                                                                      2010-09-01

Subfertility is defined by involuntary failure to conceive after a couple having unprotected intercourse for a year. Infertility can be either primary or secondary. The incidence of primary infertility affected at least 12% of couples.  For diagnosis of infertility, coital history is essential and both partners should be investigated.

Primary infertility refers to a couple that never become pregnant after a year of unprotected sexual intercourse.

Secondary infertility means a couple have been pregnant at least once in their lifetime however have difficulty to become pregnant again.

Causes of infertility:

Infertility factor Type Percentage
Female factor Tubal problemAnovulationOther 15%20%10%
Male factor Ejaculation and erection dysfunction and reduce sperm quality 40%
Unknown IdiopathicSexual problem 25%5%

The total of causes are more than 100% because most of the time there is more than one factor that cause the infertility. Management of infertility is different for each problem. In severe case, assisted reproduction will be necessary.

Infertility – female factor

Female factor infertility is the inability to conceive or carry a pregnancy to term due to one or more problems specific to females. For example, if a couple is struggling to achieve pregnancy and the male has adequate sperm count, motility, and shape, but the woman has polycystic ovarian syndrome, then their inability to conceive is likely due to female factor infertility.

There are several conditions that contribute to female factor infertility, including uterine and pelvic abnormalities, secondary infertility, polycystic ovarian syndrome, and hostile cervical mucus.

It is important to understand, however, that infertility, whether male infertility or female infertility, is not the same thing as sterility - conception and successful pregnancy are possible in many cases. Likewise, secondary infertility (the inability of a couple to conceive after having already achieved a successful pregnancy or pregnancies) can often be treated.

Infertility – male factor

Approximately 15% of couples attempting their first pregnancy meet with failure. Most authorities define these patients as primarily infertile if they have been unable to achieve a pregnancy after one year of unprotected intercourse. Conception normally is achieved within twelve months in 80-85% of couples who use no contraceptive measures, and persons presenting after this time should therefore be regarded as possibly infertile and should be evaluated. Data available over the past twenty years reveal that in approximately 30% of cases pathology is found in the man alone, and in another 20% both the man and woman are abnormal. Therefore, the male factor is at least partly responsible in about 50% of infertile couples.
 
Important issues related to the evaluation of the male factor include the most appropriate time for the male evaluation, the most efficient format for a comprehensive male exam, and definition of rationale and effective medical and surgical regimens in the treatment of these disorders. It is extremely important in the evaluation of infertility to consider the couple as a unit in evaluation and treatment and to proceed in a parallel investigative manner until a problem is uncovered. It has been shown that the longer a couple remains subfertile, the worse their chance for an effective cure. Many couples experience significant apprehension and anxiety after only a few months of failure to conceive. Unduly prolonged unprotected intercourse should not be advocated before a workup of the man is instituted. Initial screening of the man should be considered whenever the patient presents with the chief complaint of infertility. This initial evaluation should be rapid, non-invasive and cost effective. Of interest is the fact that pregnancy rates of up to 50% have been reported when only the woman has been investigated and treated even when the man was found to have moderately severe abnormalities of semen quality.

                                                                                                                                                         2010-08-31

What doctors think they are telling hospital patients, and what those patients actually hear, may be very different, a small study suggests.

The findings, from a study of 89 patients at one U.S. hospital, add to research showing that doctors and patients are often not on the same page when discussing diagnoses and treatment.

In interviews with the patients on the day of their discharge, researchers found that only 18 percent even knew the name of the main physician in charge of their hospital care. Meanwhile, just 57 percent left the hospital knowing what their diagnosis was.

In contrast, two-thirds of the 43 physicians interviewed thought their patients knew their name, and 77 percent believed their patients were aware of their diagnosis.

Drs. Douglas P. Olson and Donna M. Windish of Yale University School of Medicine in New Haven, Connecticut, report the results in the Archives of Internal Medicine.

The finding that many patients were unsure of their diagnosis or their doctor's name may sound surprising, but it is not new, according to Olson. Past studies have found that the majority of hospital patients cannot name their main physician, and frequently cannot name their medical problem.

However, the current study also shows that many doctors mistakenly believe their patients know more than they do.

"What's new here is the discrepancy between doctors and patients," Olson told Reuters Health. "Patients aren't really getting the take-home message."

The communication gaps go beyond names and diagnoses, the study found. Of patients in this study who were prescribed a new medication during their hospital stay, one-quarter said their doctor never told them about it. And very few -- 10 percent -- said their doctor discussed the drug's potential side effects with them.

In contrast, all physicians in the study said they at least sometimes told patients about any new prescriptions, and 81 percent said they described the possible side effects at least some of the time.

In recent years, the medical community has increasingly focused on improving doctor-patient communication. In residency programs at academic hospitals, for instance, doctors-in-training are taught to include patients in discussions rather than talking amongst themselves in front of patients, Olson pointed out.

"But there's still a disconnect," he said, adding that even when patients say they understand, that often turns out not to be the case.

One explanation, according to Olson, may be that many hospitalized patients are elderly and have complex medical problems -- not just one diagnosis, but several co-existing health conditions -- and the information they receive during their stay "could understandably be overwhelming."

And compared with 30 or 40 years ago, Olson noted, patients' hospital stays are now typically much shorter; that leaves them with less time to absorb and fully understand information about their condition and any treatment changes.

One potential way to address the communication gaps would be to give patients and families written information, in addition to spoken explanations, during the hospital stay -- and not only at discharge, Olson said.

"It's important for us to take a step back and see how some system changes might improve communication," he said.

Steps patients and their family members can take include writing down any questions as they come up so they can raise them with the doctor later, according to Olson.

Family involvement is important, he noted, particularly for older patients with more complex medical problems and multiple medications.

"How is my life going to be different when I leave the hospital?" is a good general question that patients can ask their doctors, Olson recommends. It can help start a discussion about a range of concerns, including any lifestyle adjustments and medication changes that need to be made, he said.

Olson also advised that patients lacking a primary care doctor get the number of someone at the hospital whom they can call with any questions after they are discharged.

                                                                                                                                                               2010-08-31