Diagnostic laboratory of Dalimed medical center

Esophageal reflux is a condition where stomach contents, including acid, digestive juices, or sometimes food remnants, rise up into the esophagus. The esophagus connects the mouth to the stomach, and normally, there is a special circular muscle at the lower end of the esophagus, known as the lower esophageal sphincter, which opens only during swallowing and then closes to prevent stomach contents from returning. When this muscle weakens or does not close fully for any reason, stomach acid can rise upward, causing irritation, heartburn, pain, or other discomforting sensations. Main Causes of Reflux 1. Weakening of the lower esophageal sphincter, which is the most common cause. 2. High stomach pressure, caused by excess weight, pregnancy, or consuming heavy food. 3. Certain foods and drinks, including coffee, alcohol, carbonated beverages, chocolate, fatty, and fried foods, that can increase the likelihood of reflux. 4. Smoking and alcohol, which weaken the sphincter. 5. Medications, such as certain anti-inflammatory drugs or blood pressure medications. 6. Stress and anxiety, which affect the digestive system and can contribute to the development of reflux. Main Symptoms • Chest burning, especially after eating or when lying down. • Bitter or sour taste in the mouth. • Itching or pain in the throat. • Hoarse voice or cough, especially in the morning. • Bloating or gas, nausea. • Rarely, difficulty breathing or throat pain that does not go away. If left untreated, the acid can damage the esophageal lining, leading to esophagitis, ulcers, and bleeding, Barrett’s esophagus, or even respiratory problems, such as asthma flare-ups and chronic cough. Diet and Lifestyle • Avoid overly spicy, fatty, and sour foods. • Do not eat before bedtime, as it can lead to excessive acid in the stomach. • Eat smaller portions more frequently, as consuming less food reduces the likelihood of reflux. • Reduce coffee, chocolate, and carbonated beverages. • Eat lighter foods, such as oats, bananas, vegetables, boiled meats, and soups with plain water. • Avoid eating before lying down to reduce the chances of acid rising. • Raise the head of the bed while sleeping, to help the sphincter stay closed and prevent stomach contents from rising. • Lose weight gradually if overweight, as excess weight can contribute to reflux. • Avoid tight clothing that can put pressure on the stomach. • Do not smoke or drink alcohol, as both weaken the lower esophageal sphincter. Treatment Esophageal reflux is a common but manageable condition. It requires a consistent treatment approach, which may involve medications and lifestyle changes. The treatment may include proton pump inhibitors, eliminating alcohol and smoking, as well as a reflux-friendly diet. If symptoms persist or frequently return, it is essential to consult a doctor for appropriate treatment options.

The knee joint is subjected to heavy daily stress. It is a fairly large joint, surrounded inside and outside by ligaments and tendons that ensure its stability. In fact, the articular cartilage itself has no nerve supply. With age, as cartilage wears down and body weight increases, the strain on the ligamentous apparatus also increases, leading to inflammation and destructive joint processes. At this stage, the patient feels pain in the knee joint. According to global statistics, every 10th person over the age of 55 suffers from gonarthritis, and one in four of them becomes disabled and requires knee joint endoprosthesis surgery. Causes of knee pain: • Osteoarthritis, mainly caused by cartilage wear, • Arthritis or joint inflammation, which can occur in rheumatoid arthritis, reactive arthritis, psoriatic arthritis, septic or infectious arthritis, periodic disease, gout, and other inflammatory joint conditions, • Excess weight or obesity, which increases the load on the knees, • Vitamin D deficiency, • Impaired blood circulation in the lower limbs, for example due to varicose veins, pronounced lymphostasis, or obliterating arterial diseases of the legs, • Certain types of anemia, • Excessive physical exertion. When to see a doctor: • if the pain is persistent and gradually worsening, with only temporary relief from painkillers, • if there is redness and localized warmth, • if movement in the knees becomes difficult, especially when climbing up or down stairs, • if a cracking or grinding sound (known as crepitus) is heard or felt in the knees, • if there has been a wound or insect bite on the skin over the knee, followed by inflammation with redness and warmth. Patients with gonarthritis (inflammation of the knee joint) may also have anemia. This may be a manifestation of the main disease or, in some cases, anemia itself may provoke joint inflammation. For example, in rheumatoid arthritis, blood tests may show anemia, thrombocytosis, and elevated ESR — indicators of disease activity. In such cases, it is not necessary to treat anemia with iron supplements; rather, proper anti-inflammatory therapy to control disease activity and flare-ups is sufficient, and laboratory markers will normalize on their own. Anemia during inflammatory joint diseases may also be caused by prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, ibuprofen, aertal, or indomethacin, which can lead to gastritis or peptic ulcers. One possible manifestation of these complications is anemia. Knee pain can also be occupational. For example, knee injuries are very common among football players, since football involves fast running, sudden stops and turns, jumping, and kicking. Players may stretch or tear cruciate ligaments, damage the menisci, dislocate the kneecap, or develop inflammation or muscle strain. A deficiency of vitamin D and magnesium can also cause knee and muscle pain. It is particularly important to replenish magnesium deficiency, as all enzymes involved in vitamin D metabolism require magnesium as a cofactor. Even when magnesium levels in bone tissue decrease, its concentration in the blood may remain within the normal range — this is known as chronic latent magnesium deficiency.

Subacute thyroiditis is an inflammatory disease of the thyroid gland. Women are affected much more often than men. It usually occurs between the ages of 30 and 50. Causes The disease may develop after viral infections such as coxsackie virus, influenza, or adenoviral infections. General Symptoms • Fatigue • Weakness • Headache • Muscle pain • Joint pain Stages of the Disease Subacute thyroiditis generally progresses through three stages. Stage 1 – Hyperthyroidism During this phase, the following symptoms are observed: • Palpitations • Weight loss • Nervousness • Tremor • Enlargement of the thyroid gland • Pain in the thyroid area radiating to the neck, occiput, ears, or lower jaw • Sometimes difficulty swallowing • Enlargement of lymph nodes • Fever Over time, hyperthyroidism is replaced by the second (euthyroid) stage, during which the clinical symptoms subside. A third (hypothyroid) stage may also occur, which is usually temporary. The course of the disease lasts from several weeks to a few months. Diagnosis Diagnosis includes: • Laboratory tests – complete blood count, C-reactive protein level, and thyroid hormone tests. • Thyroid ultrasound (US) – the gland appears heterogeneous and hypoechoic. • Thyroid scintigraphy – damaged areas may appear as “cold nodules.” • Fine-needle aspiration biopsy – performed for histological examination. Treatment Subacute thyroiditis usually resolves spontaneously within up to 12 months. • For mild pain symptoms, nonsteroidal anti-inflammatory drugs (NSAIDs) are used. • In more severe cases, glucocorticoids are prescribed and must be taken only according to a medical regimen. • During the hyperthyroid phase, beta-adrenergic blockers are indicated. • In the hypothyroid phase, replacement therapy with thyroid hormones is rarely necessary. Conclusion The course of the disease is generally favorable. Only in 2–5% of cases can persistent hypothyroidism develop. If such symptoms appear, it is necessary to consult an endocrinologist at Dalimed Medical Center.

Adrenocorticotropic hormone (ACTH), or corticotropin, is a peptide hormone composed of 39 amino acids. It is produced in the anterior pituitary gland as part of the precursor molecule proopiomelanocortin (POMC). Through tissue cleavage, ACTH and several other related peptides are formed. ACTH stimulates the synthesis and secretion of glucocorticoids (especially cortisol) by the adrenal cortex. The production of glucocorticoids is regulated by various factors. After stimulation (for example, by physical activity or internal biological mechanisms), the hypothalamus secretes corticotropin-releasing hormone (CRH, corticoliberin). CRH acts on the pituitary gland, which in turn synthesizes and secretes ACTH. ACTH stimulates the adrenal glands to secrete glucocorticoids. Elevated glucocorticoid concentrations in the blood inhibit the synthesis of CRH and ACTH through negative feedback. Clinical significance of ACTH testing 1) Measuring ACTH levels in plasma helps assess adrenal and pituitary function in cases of cortisol production disorders. 2) A high ACTH level with high cortisol suggests Cushing’s disease (an ACTH-producing pituitary adenoma). 3) A high ACTH level with low cortisol suggests primary adrenal insufficiency (Addison’s disease). 4) A low or normal ACTH level with low cortisol suggests secondary or tertiary adrenal insufficiency due to pituitary or hypothalamic dysfunction. ACTH that is not produced by the pituitary gland is known as ectopic ACTH. This condition is often associated with small-cell lung carcinoma. In rare cases, ectopic ACTH may arise from thymic tumors, pancreatic adenocarcinomas, or bronchial tumors. These tumors often secrete ACTH precursors (POMC and pro-ACTH).