Patient name:

Date admitted:

Address:

Time:

Gender:

Room: MSW

Birth place: Occupation:

Viatal sign BP 120/70 CR- 70 RR- 21 T 36.6

Case NO: 009175

Chief complain Body pain Body weakness

Physical examination:

tentative diagnosis: -Prostate cancer -Parkinson desease Present illness:

Diet: -Low fat -Low fat diet

Medication:

Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing;.[1] however, there are cases of aggressive prostate cancers.[2] The cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse, orerectile dysfunction. Other symptoms can potentially develop during later stages of the disease.

Signs and symptoms

Early prostate cancer usually causes no symptoms. Sometimes, however, prostate cancer does cause symptoms, often similar to those of diseases such as benign prostatic hyperplasia. These include frequent urination, nocturia (increased urination at night), difficulty starting and maintaining a steady stream of urine, hematuria (blood in the urine), and dysuria (painful urination). About a third of patients diagnosed with prostate cancer have one or more such symptoms, while two thirds have no symptoms.[7] Prostate cancer is associated with urinary dysfunction as the prostate gland surrounds the prostatic urethra. Changes within the gland, therefore, directly affect urinary function. Because the vas deferens deposits seminal fluid into the prostatic urethra, and secretions from the prostate gland itself are included in semen content, prostate cancer may also cause problems with sexual function and performance, such as difficulty achieving erection or painful ejaculation.[7]

Advanced prostate cancer can spread to other parts of the body, possibly causing additional symptoms. The most common symptom is bone pain, often in the vertebrae (bones of the spine),pelvis, or ribs. Spread of cancer into other bones such as the femur is usually to the proximal part of the bone. Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and fecal incontinence.[8] [edit]Causes A complete understanding of the causes of prostate cancer remains elusive.[9] The primary risk factors are obesity, age and family history. Prostate cancer is very uncommon in men younger than 45, but becomes more common with advancing age. The average age at the time of diagnosis is 70.[10] However, many men never know they have prostate cancer. Autopsy studies of Chinese, German, Israeli, Jamaican, Swedish, and Ugandan men who died of other causes have found prostate cancer in thirty percent of men in their 50s, and in eighty percent of men in their 70s.[11] Men who have first-degree family members with prostate cancer appear to have double the risk of getting the disease compared to men without prostate cancer in the family.[12] This risk appears to be greater for men with an affected brother than for men with an affected father. In the United States in 2005, there were an estimated 230,000 new cases of prostate cancer and 30,000 deaths due to prostate cancer.[13] Men with high blood pressure are more likely to develop prostate cancer.[14] There is a small increased risk of prostate cancer associated with lack of exercise.[15] A 2010 study found that prostate basal cells were the most common site of origin for prostate cancers.[16] [edit]Genetic Genetic background may contribute to prostate cancer risk, as suggested by associations with race, family, and specific gene variants. Men who have a first-degree relative (father or brother) with prostate cancer have twice the risk of developing prostate cancer, and those with two first-degree relatives affected have a fivefold greater risk compared with men with no family history.[17] In the United States, prostate cancer more commonly affects black men than white or Hispanic men, and is also more deadly in black men.[18] [19] In contrast, the incidence and mortality rates for Hispanic men are one third lower than for non-Hispanic whites. Studies of twins in Scandinavia suggest that forty percent of prostate cancer risk can be explained by inherited factors.[20] No single gene is responsible for prostate cancer; many different genes have been implicated. Mutations in BRCA1 and BRCA2, important risk factors for ovarian cancer and breast cancer in women, have also been implicated in prostate cancer.[21] Other linked genes include the Hereditary Prostate cancer gene 1 (HPC1), the androgen receptor, and the vitamin D receptor.[18]TMPRSS2-

ETS gene family fusion, specifically TMPRSS2-ERG or TMPRSS2-ETV1/4 promotes cancer cell growth.[22] Loss of cancer suppressor genes, early in the prostatic carcinogenesis, have been localized to chromosomes 8p, 10q, 13q,and 16q. P53 mutations in the primary prostate cancer are relatively low and are more frequently seen in metastatic settings, hence, p53 mutations are late event in pathology of prostate cancer. Other tumor suppressor genes that are thought to play a role in prostate cancer include PTEN (gene) and KAI1. "Up to 70 percent of men with prostate cancer have lost one copy of the PTEN gene at the time of diagnosis"[23] Relative frequency of loss of Ecadherin and CD44 has also been observed. [edit]Dietary While a number of dietary factors have been linked to prostate cancer the evidence is still tentative.[24] Evidence supports little role for dietary fruits and vegetables in prostate cancer occurrence.[25] Red meat and processed meat also appear to have little effect.[26] Lower blood levels of vitamin D may increase the risk of developing prostate cancer.[27] This may be linked to lower exposure to ultraviolet (UV) light, since UV light exposure can increase vitamin D in the body.[28] Green tea may be protective (due to its catechins content),[29] although the most comprehensive clinical study indicates that it has no protective effect.[30] Other holistic methods are also studied.[31] Taking multivitamins more than seven times a week may increase the risks of contracting the disease.[32][33] This research was unable to highlight the exact vitamins responsible for this increase (almost double), although they suggest that vitamin A, vitamin E and beta-carotene may lie at its heart. It is advised that those taking multivitamins never exceed the stated daily dose on the label. Folic acid supplements have recently been linked to an increase in risk of developing prostate cancer.[34] A ten-year study led by University of Southern California researchers showed that men who took daily folic acid supplements of 1 mg were three times more likely to be diagnosed with prostate cancer than men who took a placebo.[34] High alcohol intake may increase the risk of prostate cancer and interfere with folate metabolism.[35] Low folate intake and high alcohol intake may increase the risk of prostate cancer to a greater extent than the sole effect of either one by itself.[35] A case control study consisting of 137 veterans addressed this hypothesis and the results were that high folate intake was related to a 79% lower risk of developing prostate cancer and there was no association between alcohol consumption by itself and prostate cancer risk.[35] Folate's effect however was only significant when coupled with low alcohol intake.[35] There is a significant decrease in risk of prostate cancer with increasing dietary folate intake but this association only remains in individuals with low levels of alcohol

consumption.[35] There was no association found in this study between folic acid supplements and risk of prostate cancer.[35] [edit]Medication

exposure

There are also some links between prostate cancer and medications, medical procedures, and medical conditions.[36] Use of the cholesterol-lowering drugs known as the statins may also decrease prostate cancer risk.[37] Infection or inflammation of the prostate (prostatitis) may increase the chance for prostate cancer while another study shows infection may help prevent prostate cancer by increasing blood to the area. In particular, infection with the sexually transmitted infections chlamydia, gonorrhea, or syphilis seems to increase risk.[38] Finally, obesity[39] and elevated blood levels of testosterone[40]may increase the risk for prostate cancer. There is an association between vasectomy and prostate cancer however more research is needed to determine if this is a causative relationship.[41] Research released in May 2007, found that US war veterans who had been exposed to Agent Orange had a 48% increased risk of prostate cancer recurrence following surgery.[

Screening
Main article: Prostate cancer screening Prostate cancer screening is an attempt to find unsuspected cancers, and may lead to more invasive follow-up tests such as a biopsy, with cell samples taken for closer study. Options include the digital rectal exam (DRE) and the prostate-specific antigen (PSA) blood test. Such screening is controversial and, in some people, may lead to unnecessary, even harmful, consequences.[72]Routine screening with either a DRE or PSA is not supported by the evidence as there is no mortality benefit from screening.[

Screening
Main article: Prostate cancer screening Prostate cancer screening is an attempt to find unsuspected cancers, and may lead to more invasive follow-up tests such as a biopsy, with cell samples taken for closer study. Options include the digital rectal exam (DRE) and the prostate-specific antigen (PSA) blood test. Such screening is controversial and, in some people, may lead to unnecessary, even harmful,

consequences.[72]Routine screening with either a DRE or PSA is not supported by the evidence as there is no mortality benefit from screening.[

Medications
Two medications which block the conversion of testosterone to dihydrotestosterone, finasteride[78] and dutasteride,[79] have also shown some promise. The use of these medications for primary prevention is still in the testing phase, and they are not widely used for this purpose. A 2008 study found that finasteride reduces the incidence of prostate cancer by 30%, without any increase in the risk of High-Grade prostate cancer.[80] In the original study it turns out that the smaller prostate caused by finasteride means that a doctor is more likely to hit upon cancer nests and more likely to find aggressive-looking cells.

Parkinson disease is recognized as one of the most common neurologic disorders, affecting approximately 1% of individuals older than 60 years. There are 2 major neuropathologic findings: the loss of pigmented dopaminergic neurons in the substantia nigra pars compacta (SNpc) and the presence of Lewy bodies (see the following image). Most cases of Parkinson disease (idiopathic Parkinson disease [IPD]) are hypothesized to be due to a combination of genetic and environmental factors. However, no environmental cause of Parkinson disease has yet been proven. A known genetic cause can be identified in approximately 10% of cases, and these are more common in younger-onset patients.

Symptoms of Parkinson's disease typically begin appearing between the ages 50 and 60. They develop slowly and often go unnoticed by family, friends, and even the person who has them. A small number of people have symptoms on only one side of the body that never progress to the other side. The most common symptoms include:
Recommended Related to Parkinson's
10 Questions to Ask Your Doctor About Parkinson's Disease It's always a good idea to know what to ask beforehand and to take notes during a doctor visit. For patients newly diagnosed with Parkinson's disease, some of the questions below may be worth asking. Print out this page and take it with you to your next appointment. 1. What stage do you think my illness is in now? 2. How quickly do you think my disease will progress? 3. What treatments do you suggest for now? Later on? ... Read the 10 Questions to Ask Your Doctor About Parkinson's Disease article > >

Tremor, or shaking, often in a hand, arm, or leg. Tremor caused by Parkinson's diseaseoccurs when the person is awake and sitting or standing still (resting tremor) and subsides when the person moves the affected body part. Stiff muscles (rigidity) and aching muscles. One of the most common early signs of Parkinson's disease is a reduced arm swing on one side when the person is walking that is caused by rigid muscles. Rigidity can also affect the muscles of the legs, face, neck, or other parts of the body and may cause muscles to feel tired and achy.

Slow, limited movement (bradykinesia), especially when the person tries to move from a resting position. For instance, it may be difficult to get out of a chair or turn over in bed. Weakness of face and throat muscles. Talking and swallowing may become more difficult, and the person may choke, cough, or drool. Speech becomes softer and monotonous. Loss of movement in the muscles in the face can cause a fixed, vacant facial expression, often called the "Parkinson's mask." Difficulty with walking (gait disturbance) and balance (postural instability). A person with Parkinson's disease is likely to take small steps and shuffle with his or her feet close together, bend forward slightly at the waist (stooped posture), and have trouble turning around. Balance and posture problems may result in frequent falls. But these problems usually do not develop until later in the course of the disease. Tremor is often the first symptom that people with Parkinson's disease or their family members notice. Initially, the tremor may appear in just one arm or leg or only on one side of the body. The tremor also may affect the chin, lips, and tongue. As the disease progresses, the tremor may spread to both sides of the body. But in some cases the tremor remains on just one side. Emotional and physical stress tend to make the tremor more noticeable. Sleep, complete relaxation, and intentional movement or action usually reduce or stop the tremor. Although tremor is one of the most common signs of Parkinson's disease, not everyone with tremor has Parkinson's disease. Unlike tremor caused by Parkinson's disease, tremor caused by other conditions gets better when your arm or hand is not moving and gets worse when you try to move it. The most common cause of non-Parkinson's tremor is essential tremor, a treatable condition that is often wrongly diagnosed as Parkinson's disease

Symptoms of Parkinson's disease typically begin appearing between the ages 50 and 60. They develop slowly and often go unnoticed by family, friends, and even the person who has them. A small number of people have symptoms on only one side of the body that never progress to the other side. The most common symptoms include

Tremor, or shaking, often in a hand, arm, or leg. Tremor caused by Parkinson's diseaseoccurs when the person is awake and sitting or standing still (resting tremor) and subsides when the person moves the affected body part. Stiff muscles (rigidity) and aching muscles. One of the most common early signs of Parkinson's disease is a reduced arm swing on one side when the person is walking that is caused by rigid muscles. Rigidity can also affect the muscles of the legs, face, neck, or other parts of the body and may cause muscles to feel tired and achy. Slow, limited movement (bradykinesia), especially when the person tries to move from a resting position. For instance, it may be difficult to get out of a chair or turn over in bed. Weakness of face and throat muscles. Talking and swallowing may become more difficult, and the person may choke, cough, or drool. Speech becomes softer and monotonous. Loss of movement in the muscles in the face can cause a fixed, vacant facial expression, often called the "Parkinson's mask." Difficulty with walking (gait disturbance) and balance (postural instability). A person with Parkinson's disease is likely to take small steps and shuffle with his or her feet close together, bend forward slightly at the waist (stooped posture), and have trouble turning around. Balance and posture problems may result in frequent falls. But these problems usually do not develop until later in the course of the disease.

Tremor is often the first symptom that people with Parkinson's disease or their family members notice. Initially, the tremor may appear in just one arm or leg or only on one side of the body. The tremor also may affect the chin, lips, and tongue. As the disease progresses, the tremor may spread to both sides of the body. But in some cases the tremor remains on just one side. Emotional and physical stress tend to make the tremor more noticeable. Sleep, complete relaxation, and intentional movement or action usually reduce or stop the tremor. Although tremor is one of the most common signs of Parkinson's disease, not everyone with tremor has Parkinson's disease. Unlike tremor caused by Parkinson's disease, tremor caused by other conditions gets better when your arm or hand is not moving and gets worse when you try to move it. The most common cause of non-Parkinson's tremor is essential tremo

What is the treatment for Parkinson's disease?

There is currently no treatment to cure Parkinson's disease. Several therapies are available to delay the onset of motor symptoms and to ameliorate motor symptoms. All of these therapies are designed to increase the amount of dopamine in the brain either by replacing dopamine, mimicking dopamine, or prolonging the effect of dopamine by inhibiting its breakdown. Studies have shown that early therapy in the non-motor stage can delay the onset of motor symptoms, thereby extending quality of life. The most effective therapy for Parkinson's disease is levodopa (Sinemet), which is converted to dopamine in the brain. However, because long-term treatment with levodopa can lead to unpleasant side effects (a shortened response to each dose, painful cramps, and involuntary movements), its use is often delayed until motor impairment is more severe. Levodopa is frequently prescribed together with carbidopa (Sinemet), which prevents levodopa from being broken down before it reaches the brain. Co-treatment with carbidopa allows for a lower levodopa dose, thereby reducing side effects. In earlier stages of Parkinson's disease, substances that mimic the action of dopamine (dopamine agonists), and substances that reduce the breakdown of dopamine (monoamine oxidase type B (MAO-B) inhibitors) can be very efficacious in relieving motor symptoms. Unpleasant side effects of these preparations are quite common, including swelling caused by fluid accumulation in body tissues, drowsiness, constipation, dizziness, hallucinations, and nausea. For some individuals with advanced, virtually unmanageable motor symptoms, surgery may be an option. In deep brain stimulation (DBS), the surgeon implants electrodes to stimulate areas of the brain involved in movement. In another type of surgery, specific areas in the brain that cause Parkinson's symptoms are destroyed.

An alternative approach currently being explored is the use of dopamine-producing cells derived from stem cells. While stem cell therapy has great potential, more research is required before such cells can become of therapeutic value in the treatment of Parkinson's disease. In addition to medication and surgery, general lifestyle changes (rest andexercise), physical therapy, occupational therapy, and speech therapy may be beneficial.

What are the symptoms of Parkinson's disease?

The primary symptoms of Parkinson's disease are all related to voluntary and involuntary motor function and usually start on one side of the body. Symptoms are mild at first and will progress over time. Some individuals are more affected than others. Studies have shown that by the time that primary symptoms appear, individuals with Parkinson's disease will have lost 60% to 80% or more of the dopamine-producing cells in the brain. Characteristic motor symptoms include the following: Tremors: Trembling in fingers, hands, arms, feet, legs, jaw, or head. Tremorsmost often occur while the individual is resting, but not while involved in a task. Tremors may worsen when an individual is excited, tired, or stressed. Rigidity: Stiffness of the limbs and trunk, which may increase during movement. Rigidity may produce muscle aches and pain. Loss of fine hand movements can lead to cramped handwriting (micrographia) and may make eating difficult. Bradykinesia: Slowness of voluntary movement. Over time, it may become difficult to initiate movement and to complete movement. Bradykinesia together with stiffness can also affect the facial muscles and result in an expressionless, "mask-like" appearance. Postural instability: Impaired or lost reflexes can make it difficult to adjust posture to maintain balance. Postural instability may lead to falls. Parkinsonian gait: Individuals with more progressive Parkinson's disease develop a distinctive shuffling walk with a stooped position and a diminished or absent arm swing. It may become difficult to startwalking and to make turns. Individuals may freeze in mid-stride and appear to fall forward while walking. Secondary symptoms of Parkinson's disease While the main symptoms of Parkinson's disease are movement-related, progressive loss of muscle control and continued damage to the brain can lead to secondary symptoms. These vary in severity, and not every individual will experience all of them. Some of the secondary symptoms include:

anxiety, insecurity, and stress confusion, memory loss, and dementia (more common in elderly individuals)

constipation depression difficulty swallowing and excessive salivation diminished sense of smell increased sweating male erectile dysfunction skin problems slowed, quieter speech, and monotone voice urinary frequency/urgency

What is Parkinson's disease?

Parkinson's disease is the second most common neurodegenerative disorder and the most common movement disorder. It is characterized by progressive loss of muscle control, which leads to trembling of the limbs and head while at rest, stiffness, slowness, and impaired balance. As symptoms worsen, it may become difficult to walk, talk, and complete simple tasks. The progression of Parkinson's disease and the degree of impairment vary from individual to individual. Many people with Parkinson's disease live long productive lives, whereas others become disabled much more quickly. Premature death is usually due to complications such as falling-related injuries or pneumonia. In the United States, about 1 million people are affected by Parkinson's disease and worldwide about 5 million. Most individuals who develop Parkinson's disease are 60 years of age or older. Parkinson's disease occurs in approximately 1% of individuals aged 60 years and in about 4% of those aged 80 years. Since overall life expectancy is rising, the number of individuals with Parkinson's disease will increase in the future. Adult-onset Parkinson's disease is most common, but early-onset Parkinson's disease (onset between 21-40 years), and juvenile-onset Parkinson's disease (onset before age 21) also exist. Descriptions of Parkinson's disease date back as far as 5000 BC. Around that time, an ancient Indian civilization called the disorder Kampavata and treated it with the seeds of a plant containing therapeutic levels of what is today known as levodopa. Parkinson's disease was

named after the British doctor James Parkinson, who in 1817 first described the disorder in great detail as "shaking palsy."

Tramadol hydrochloride (trademarked as Conzip, Ryzolt, Ultracet, Ultram in the USA, Ralivia and Zytram XL in Canada) is a centrally-acting synthetic analgesic used to treat moderate to moderatelysevere pain. The drug has a wide range of applications, including treatment of rheumatoid arthritis, restless legs syndrome and fibromyalgia. It was launched and marketed as Tramal by the German pharmaceutical company Grnenthal GmbH in 1977.[1][2] Tramadol is a very weak -opioid receptor agonist, induces serotonin release, and inhibits the reuptake of norepinephrine.[3][4]Tramadol is converted to O-desmethyltramadol, a significantly more potent -opioid agonist. The opioid agonistic effect of tramadol and its major metabolite(s) is almost exclusively mediated by such -opioid receptors. This further distinguishes tramadol from opioids in general (including morphine), which do not possess tramadol's degree of receptor subtype selectivity and which are much stronger opiate-receptor agonists. Similarly, the habituating properties of tramadol (such as they are) are arguably mainly due to -opioid agonism with contributions from serotonergic and noradrenergic effects.

GENERIC NAME: bicalutamide

BRAND NAME: Casodex

DRUG CLASS AND MECHANISM: Bicalutamide is an oral medication that is used for treating cancer of the prostate. It belongs to a class of drugs called anti-androgens which includes flutamide (Eulexin) and nilutamide (Nilandron). Androgens (an example of which is testosterone) are hormones that are produced and released by the adrenal glands. They are responsible for supporting (stimulating) tissues that primarily are thought of as male, for example, the male prostate gland. Male traits that also are influenced by androgens include facial and body hair and small breasts. Anti-androgens prevent the action of androgens by blocking the receptors for androgens on the cells of tissues, for example, the cells of the prostate gland. In addition to normal prostate cells, androgens also have been shown to stimulate the growth of cancer cells within the prostate. Bicalutamide is thought to prevent the growth of prostate cancer by blocking the effects of androgens on the cancer cells. Bicalutamide was approved by the FDA i
Losartan (rINN) ( /losrtn/) is an angiotensin II receptor antagonist drug used mainly to treat

high blood pressure (hypertension). Losartan was the first angiotensin II receptor antagonist to be marketed. Losartan potassium is marketed by Merck & Co. Inc. under the trade name Cozaar. As of 2009, losartan is available in generic form.

As with all angiotensin II type 1 receptor (AT1) antagonists, losartan is indicated for the treatment of hypertension. It may also delay progression ofdiabetic nephropathy, and is also indicated for the reduction of renal disease progression in patients with type 2 diabetes, hypertension and microalbuminuria (>30 mg/24 hours) or proteinuria (>900 mg/24 hours).[citation needed] Although clinical evidence shows calcium channel blockers and thiazide-type diuretics are preferred first-line treatments for most patients (from both efficacy and cost points of view), an angiotensin II receptor antagonist such as losartan is recommended as first-line treatment in patients under the age of 55 who cannot tolerate an ACE inhibitor.[1] The LIFE study demonstrated losartan was significantly superior to atenolol in the primary prevention of adverse cardiovascular events (myocardial infarction or stroke), with a significant reduction in cardiovascular morbidity and mortality for a comparable reduction in blood pressure. A study hints that losartan has a beneficial effect on mitochondria by reversing age related dysfunction in maintaining normal blood pressure and cellular energy usage.[2][3] The maximal effects on blood pressure usually occur within 3-6 weeks upon starting losartan.[4] Losartan is also available as hydrochlorothiazide/losartan, a combination drug with a low dose thiazide diuretic to achieve an additive antihypertensive effect.