Treatment for Recurrent Miscarraiges

CURRICULAM :

C - Circlage operation (shirodkar's and McDonald's operation)

U - Ultrasound

R - Rest

R - Reassurance and tender loving care

I - Inherited thrombophilias treatment (Heparin)

C - chromosomal anamolies detection (amniocentesis)

U - Unexplained causes

L - Luteal phase defect treatment (progesterone and hCG therapy)

A - Antiphospholipid antibody syndrome treatment (aspirin and heparin)

M - medical complications like hemoglobinopathies, cyanotic heart diseases, SLE etc treamtent

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Risk factors for Ectopic pregnancy

CAP2I2T3A

C - Contraceptive failure

A - Abortion (previous)

P - PID (pelvic inflammatory disease)and Salphingitis

P -Previous ectopic pregnancy

I - IUD use

I - Infertility
T - Tubal ligation
T - Tubal reconstructive surgery
T -  Tubal endometriosis
A - ART use

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CANDIDA ALBICANS - virtually all of us play host to it!!!

Facts :
        - Its a yeast infection and predominantly focuses on GI tract invasion
        - People having H-pylori infection also has candida overgrowth (60%-70%)
        - By age of 6 months, about 90% of the babies are positive for candida test
        - And by adulthood virtually we all have become the host of it
        - Our GI bacteria act in part to keep Candida growth in check in our body ecology

Features :
      Medium used :
                - Lownstein-Jensen medium

                - Two tubes of Sabouraud’s dextrose agar, SDA, one incubated at 37°C and the other at 20°C

     Upon culture :
                - After incubating for 48 hours typical creamy pasty colonies appeared on the blood agar and     both tubes of SDA.

                - it was then isolated and identified by the germ tube test

Disease caused by it is called Candidiasis, also called thrush or moniliasis, is a yeast infection

 Clinical pictures : for clinical pictures of candidiasis click on the below highlighted names
               1.    ORAL CANDIDIASIS
               2.   CANDIDIAL ESOPHAGITIS
               3.   YEAST VAGINITIS
               4.   CANDIDA GRANULOMA
               5.   CUTANEOUS CANDIDIASIS 

 

Symptoms : 

            1. Infection of skin : well defined patch of red, itchy skin, often leaking fluid

            2. Vaginal yeast infection : slow leakage of a thick, white, cheese-like substance, itching or burning sensation during urination and intercourse

            3. Infection of fingernail : painful, red, swollen area around the fingernail. In worse cases, the fingernail may separate, revealing a discoloured white or yellow nail bed.

            4. Oral thrush : curd like white patches in mouth, palate, tongue and around the lips

Investigations :

          - Proper diet history

          - History of medication and antibiotics which may weaken the immune system

          - History of diabetes, cancer, HIV, or other chronic disease

          - Microscopic examination after being scraped off the affected area

Treatment :

                 Candidiasis is not normally a dangerous disease except in rare cases when it enters the blood and spreads to vital organs of people with weakened immune systems

                Anti-fungal cream or powder

Precaution :

           - wipe from front to back after going to the toilet - the rectal area is full of yeast

           - take baths not showers - sitting in the bath can clear yeast from the vaginal area

           - dry yourself thoroughly afterwards, especially the pubic hair - use a hair dryer on low setting if you have to

          - don't use soap around the vagina - soap kills the bacteria you want to keep, and has no effect on yeast

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DRACUNCULUS MEDINENSIS - silent killer which remains in body silent upto 1 year !!!!!!

Facts :
          - Also known as guinea worm disease (GWD)
          - These are among the longest nematodes infecting humans.
          - Dracunculus medinensis is one of four filarial nematodes that cause subcutaneous filariasis in humans. The other three filarial nematodes are Loa loa (the African eye worm), Mansonella streptocerca, and Onchocerca volvulus (river blindness)
          - The longest adult female recorded was 800 millimetres (31 in), while the adult male was only 40 mm (1.6 in)
          - Guinea worm has been found in calcified Egyptian mummies
          - An Old Testament description of "fiery serpents" may have been referring to Guinea Worm: "And the Lord sent fiery serpents among the people, and they bit the people; and much people of Israel died."

          - Humans become infected by drinking unfiltered water containing copepods

The disease caused is  Dracunculiasis
 Symptoms include :
           - Pruritus
           - Nausea
           - Vomiting
           - Diarrhea or
           - Asthmatic attacks

 Treatment :
           - There is NO vaccine or medicine to treat or prevent Guinea worm disease
           - Once a Guinea worm begins emerging, the first step is to do a controlled submersion of the affected area in a bucket of water. This causes the worm to discharge many of its larva, making it less infectious
           - To extract the worm, a person must wrap the live worm around a piece of gauze or a stick. The process can be long, taking anywhere from hours to months.
           - Gently massaging the area around the blister can help loosen the worm up a bit.
           - Use of metronidazole or thiabendazole may make extraction easier, but also may lead to migration to other parts of the body

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OSTEOSARCOMA - most common type of bone cancer in childrens and adult !!!

                Osteosarcoma is the most common bone cancer in children and adolescents, and the third most common cancer in adolescence.
                Osteosarcoma is most common between the ages of 10 and 25 when the bones are rapidly growing

Risk factors :
        - Exact cause is unknown associated with random genetic mutations of osteoblasts
        - Transmission of diseases including retinoblastoma, Li Fraumeni syndrome, Rothmund-Thomson syndrome,- Paget's disease, and Werner's syndrome from parents to offspring
        - Only known environmental risk factor is exposure to radiation

Symptoms include :
       - Bone fracture (may occur after what seems like a routine movement)
       - Bone pain
       - Limitation of motion
       - Limping (if the tumor is in the leg)
       - Pain when lifting (if the tumor is in the arm)
       - Tenderness, swelling, or redness at the site of the tumor

Investigations :
       - Biopsy (at time of surgery for diagnosis)
       - Blood tests
       - Bone scan to see if the cancer has spread to other bones
       - CT scan of the chest to see if the cancer has spread to the lungs
       - CT scan and MRI scan
       - PET scan
       - X-ray

Diagnosis :
       - Chemotherapy is the first line of treatment, drugs include
Carboplatin (Paraplatin), Cisplatin, Cyclophosphamide (Cytoxan), Doxorubicin (Adriamycin), Epirubicin, Etoposide, Ifosfamide (Ifex), Methotrexate (high dose) with leucovorin
       - Surgery is used after chemotherapy to remove any remaining tumor. In most cases, surgery can remove the tumor while saving the affected limb (this is called limb-salvage surgery)

Prognosis :
If the tumor has not spread to the lungs (pulmonary metastasis), long-term survival rates are better

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ROUND WORM - infects 1 in every 4 persons in world!!!!!!

Roundworms are one of the most common species of intestinal parasites in the world
Also known as Ascaris lumbricoides

Facts :
            - The World Health Organization (WHO) estimates that about 25% of the world's population are infected with roundworm.
            - Female round worm ranges from 16cm to 33 cm and can grow up to the size of pencil
            - WHO estimates that about 25% of the world's population are infected with roundworm.
            - Medical research studies use roundworms to study human diseases which include illnesses like muscular dystrophy and even Alzheimer's disease. This is because of the fact that human beings and roundworms have similar body organization and similar genetic code

 Clinical features :
      - perianal itching
      - abdominal pain
      - diarrhea
      - melena
      - fatigue and weight loss
      - vomiting
      - cough in case of systemic involvement

Diagnosis :
      - stool examination
      - passing of worms in stool
      - radiolophic/ USG imaging
      - endoscopy

Treatment :
Mebendazole, drug of choice
Piperazine, alternative
Albendazole, levamisole, ivermectic other medications
Diethlycarbamazine with filariasis infection

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ADIPOSE TISSUE - good or bad

Introduction :
In humans, adipose tissue is located beneath the skin (subcutaneous fat), around internal organs (visceral fat), in bone marrow (yellow bone marrow) and in breast tissue. Adipose tissue is found in specific locations, which are referred to as adipose depots. Adipose tissue contains several cell types, with the highest percentage of cells being adipocytes, which contain fat droplets. Other cell types include fibroblasts, macrophages, and endothelial cells.

WHY IT IS GOOD FOR BODY :
      - It functions as the major storage site for fat in the form of triglycerides
      - Important heat insulator in the body (subcutaneous fat)
      - As the major form of energy storage, fat provides a buffer for energy imbalances when energy intake is not equal to energy output
      - The average woman with 20% body fat has about one month of energy stored as fat.
      - In hibernating animals and neonates, brown adipose tissue is important for regulating body temperature via non-shivering thermogenesis.

WHY IT IS BAD FOR BODY :
Physiological amount of adipose tissue is needed for the body if it becomes excess then will lead to one of the most emerging problem in today's life i.e OBESITY leading to complications like
        - Metabolic complications - type 2 diabetes, insulin resistance and hyperinsulinemia, dyslipidemia, gout
        - Abnormalities of hormones - growth hormone, hypothalamic-pituitary-adrenal axis, cytokines, renin-angiotensin system, leptin, ghrelin.
        - Cardiac and vascular diseases - coronary heart disease, hypertension, congestive heart failure, cerebrovascular disease, thromboembolic disease
       - Respiratory system abnormalities - obesity-hypoventilation syndrome, sleep apnea.
       - Digestive system abnormalities - gallbladder disease, hepatic disease.
       - Nervous system - pseudotumor cerebri, adiposis dolorosa, alzheimer's disease.
       - Mechanical complications - arthritis, increased intra-abdominal pressure.
       - Other complications - immune system dysfunction, skin disease, eye disease, cancer, social complications.

Histological Features :
This histology slide shows adipose tissue surrounding the ureter. The adipocytes are shaped like a signet ring. The nucleus is pushed to the periphery of the cell. The staining process leaches the fat out of the cells, so these are just the skeleton of the cell. Some smooth muscle from the ureter is visible in this section as well.

Conclusion : body fat is one one the most useful aspect of the body and when present in excess or not properly regulated will lead to a cascade of diseases.. 

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CHRONIC PYELONEPHRITIS - why 1 out of 7,000 people develop pyelonephritis each year in the US

Introduction :
             One of the most common renal diseases, acute pyelonephritis is a sudden inflammation caused by bacteria.It is characterized by renal inflammation and fibrosis induced by recurrent or persistent renal infection, vesicoureteral reflux, or other causes of urinary tract obstruction.
Occurs almost exclusively in patients with major anatomic anomalies, most commonly in young children with vesicoureteral reflux (VUR)
               Non-obstructive secondary to obstruction or vesiculourethral reflux with recurrent infection (reflex nephropathy, most common). Vesiculourethral reflux due to an incompetent ureterovesical junction is most common in children (males < 1 year, females > 1 year). Obstruction may be due to renal stones, prostatic hyperplasia, or tumors. Hydronephrosis eventually results, with entry of infected urine into the renal medula.

Definition :
            Pyelonephritis is a serious bacterial infection of the kidney that can be acute or chronic

Clinical features :
         - high grade fever with chills
         - flank pain
         - confusion
         - headache
         - renal colic pain
         - other symptoms include hypertension, anemia and renal insufficiency

Investigations :
        - urine analysis
        - urine culture
        - ultrasound study of kidneys

Treatment :
       - broad-spectrum antibiotic therapy
       - hospitalization in severe cases

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SABOURAUD DEXTROSE AGAR - fungi growing agent

         Sabouraud agar medium was developed by the French dermatologist Raymond J. A. Sabouraud in the late 1800’s to support the growth of fungi that cause infection of the skin, hair, or nails, collectively referred to as dermatophytes 

Sabouraud dextrose agar is used for growing fungi. It is recommended for skin and nail fungi, as well as other species that are human pathogens

Ingredients : water, dextrose, agar, peptone, antibiotics
Per liter of medium:                    
          Peptone, 10 g                    
          Glucose, 40 g                    
          Agar, 15 g  


External links for reference :
http://philip-mcintosh.suite101.com/sabouraud-dextrose-agar-a189138 

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ESOPHAGOSCOPE (ENT)

Definition : instrument used for the examination of esophagus

Procedure :  uses an esophagoscope, which is a thin tube with a light and camera on the end that is fed through the mouth to the esophagus, performed with a local anesthetic, although it is virtually painless

Indications :
         - General : for diagnostic observation
                          removal of foreign bodies
                          interference with the function of esophagus
                          biopsy of tumors and endoscopic removal
         - Specific : congenital malformations

Contraindications :
                           uncooperative or moribund patients
                           suspected perforated viscus
                           he non-sterile instrument may aggravate mediastinal or peritoneal contamination

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TCBS CULTURE (microbiology)

Thiosulfate Citrate Bile Sucrose Agar (TCBS) proposed by NAKANISHI (1962), modified by KOBAYASHI et al. (1963).

Use :  isolation and selective cultivation of Vibrio cholera and other enteropahtogenic vibrios

Preparation Suspend 88 g/liter and pour plates. Do not autoclave. pH: 8.6 ± 0.2 at 25°C. The plates are clear and green-blue.

Appearance of colonies                                                                      microorganisms

Flat, 2-3 mm in diameter, yellow	Vibrio cholerae, Vibrio cholerae type El Tor
Small, blue-green centre	Vibrio parahaemolyticus
Large, yellow	Vibrio alginolyticus
Blue	Pseudomonas, Aeromonas and others
Very small, translucent	Enterobacteriaceae and others

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CARCINOMA OF BREAST (pathology)

Types :
        - ductal carcinoma
        - lobular carcinoma

Causes :
        - age :- women more than 50 years
        - sex :- women are 100 times more prone than males
        - family history of breast cancer and genetic influence
        - hormonal replacement therapy, alcohol use
        - menstrual cycle :- early menarche and late menapause
        - radiation

Clinical features :
       - lump in breast
       - change in size, shape or feel of breast and nipple
       - abnormal fluid coming from breast
       - In advanced cancer :- bone pain, breast pain, skin ulcer, swelling in one arm, weight loss

Investigations :
       - MRI, ultrasound of breast
       - biopsy
       - mammography
       - PET scan
       - sentinel lymph node biopsy

Treatment :
        - chemotheraphy
        - radiotherapy
        - surgery includes
                                  lumpectomy :- removal of breast lump
                                  mastectomy :- removal of all or part of breast and nearby structures
        - hormonal therapy ex :- tamoxifen

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RHIZOPUS SPECIES (microbiology)

Disease caused mucormycosis

Clinical presentation :
       - Rhino-cerebral disease :- unilateral, retro-orbital headache, facial pain, numbness, fever, hyposmia, and nasal stuffiness
       - pulmonary disease :- fever, dyspnea, and cough occasionally hemoptysis
cutaneous disease :- progressive black necrotic lesion
       - GI disease :- abdominal pain, distention, nausea, and vomiting
       - CNS disease :- headache, decreasing consciousness, and focal neurologic symptoms/signs, including cranial nerve deficits
        - Disseminated disease :- involve the kidneys, bones, and heart, with symptoms attributed to these organ systems

Investigations :
      - complete blood cell (CBC)
      - arterial blood gases (ABG)
      - CSF examination
      - CSF and blood culture
      - CT scan and MRI
      - chest X ray
      - biospy

Treatment :
     - prompt institution of liposomal amphoterecin B therapy and surgical resection
     - insulin for diabetic ketoacidosis
     - sodium bicarbonate for acidosis and re-hydration therapy
     - Antifungal treatment consists of lipid formulations of amphotericin B, amphotericin B deoxycholate, or posaconazole. First-line treatment is with an amphotericin derivative.

Prognosis :
      - Mucormycosis carries a mortality rate of 50-85%. The mortality rate associated with rhinocerebral disease is 50-70%. Pulmonary and gastrointestinal (GI) diseases carry an even higher mortality rate, because these forms are typically diagnosed late in the disease course. Disseminated disease carries a mortality rate that approaches 100%

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ACUTE GLOMERULONEPHRITIS (pathology)

Definition :
        - disease of kidney characterized by inflammation of glomeruli

Causes :
        - post streptococcal glomerulonephritis
        - tuberculosis, syphilis
        - injecting illegal drugs
        - bacterial endocarditis
        - hepatitis B and C, HIV
        - lupus
        - Good pasture's syndrome , IgA nephropathy
        - polyartheritis, wegener's granulomatosis

clinical features :
       - an elevated body temp (100.4)
       - breathing difficulties
       - edema
       - nausea, vomiting, loss of appetite
       - pallor, vision problems

Investigations :
       - urine test
       - blood test
       - throat swab
       - renal function test
       - kidney biopsy
       - imaging tests (x-ray,  USG, CT)

Treatment :
      - diet and fluid intake
      - treatment for hypertension
      - antibiotic for bacterial infections
      - corticosteroids for lupus and vasculitis
      - kidney dialysis

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CARCINOMA STOMACH (pathology)

    
Risk factors :
        -  helicobactor pylori infection
        - stomach lymphoma
        - age after 50 years
        - more common in males
        - more common in Japan, China, Southern and Eastern Europe, and South and Central America
        - large amounts of smoked foods, salted fish and meat, and pickled vegetables. Nitrates and nitrites are substances commonly found in cured meats
       - tobacco use, obesity, previous stomach surgery
       - type A blood, family history of stomach cancer
       - EBV infection
       - immune deficiency

Clinical symptoms :
        - weight loss
        - persistent abdominal pain
        - dysphagia
        - occasional nausea and intestinal obstruction

Investigations :
        - Check FBC (possible anemia)
        - Rapid-access flexible endoscopy
        - Chromoendoscopy (use of dyes to highlight various aspects of the gastric mucosa), narrow band imaging and auto-fluorescence
        - biopsy

Management :
       - Surgery is the treatment of choice for gastric cancer
       - Distal (antral) tumours should be treated by subtotal gastrectomy and proximal tumors by total gastrectomy
       - Limited gastric resections should presently only be used for palliation or in the very elderly.

      

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