A Simple Guide to Osteomyelitis

A Simple Guide to Osteomyelitis
--------------------------------------


What is Osteomyelitis?
----------------------------

Osteomyelitis is an infection of the bone substance by pyogenic bacteria and fungus.


What causes Osteomyelitis?
----------------------------------

The most causes of Osteomyelitis is

1.Staphylococcus aureus bacteria(80%).

Other bacteria involved are:

2.Streptococci Group A & B

3.Enterobacter species including E.Coli

4.Haemophilus influenzae

5.Pneumococci

6.Serratia marcescens

Systemic mycotic (fungal) infections may also cause osteomyelitis.

1.Blastomyces dermatitidis

2.Coccidioides immitis.

In children,
-------------------
1.the long bones are usually affected in children.

2.Spread of bacteria occurs from the bloodstream from a skin boil, dental abscess, direct injury to the bone.

3.Acute osteomyelitis almost invariably occurs in children.

In adults
---------------

1.injury to the bone is the most common cause.

The bone injury is exposed to local infection in the skin or environment.

Staphylococcus aureus is the most common bacteria in osteomyelitis resulting from bone injury and infection.

Other bacteria such as Pseudomonas aeruginosa, E. coli, and Serratia marcescens, are also common.

2.The vertebrae and the pelvis are the bones most commonly affected in adults.

For osteomyelitis of the vertebral bodies,
50% are due to Staphylococcus aureus,
and the remaining 50%f are due to tuberculosis usually from the lungs.

3.Bone infection in adults are usually due to their lower resistance from

debilitation,
intravenous drug abuse,
infectious root-canal teeth,
other disease or drugs (e.g. immunosuppressive therapy).


What are the symptoms of Osteomyelitis?
-------------------------------------------------

Symptoms:
---------------
1.pain and swelling of the bone

2.fever

3.toxemia

Signs:
-----------

1.Hot tender bones

2.Throbbing pain of bones

3.Abscess and swelling


How do you made the diagnosis of Osteomyelitis?
-------------------------------------------------

Diagnosis of osteomyelitis is often based on:

1.radiologic results showing a translucent center with a ring of sclerosis(hardened bones)

2.Blood and bone cultures are normally required to identify the specific pathogen


What are the complications of Osteomyelitis?
-------------------------------------------------------

The complications of Osteomyelitis are:

1.fractures of the bone

2.amyloidosis

3.endocarditis

4.septicemia


What is the treatment of Osteomyelitis?
----------------------------------------

1.antibiotic therapy - usually as prolonged treatment lasting a matter of weeks or months.

2.Hyperbaric oxygen therapy has helped in the treatment of refractory osteomyelitis.

3.Immobilization of the bone affected(bed rest, plaster casts,splints)

4.Osteomyelitis may also need surgical debridement to remove pus and damaged bone tissues.

5.Severe cases may lead to the loss of a limb.


What is the prognosis of Osteomyelitis?
----------------------------------------

Prognosis depends on the rapidity of onset of treatment.

The faster the treatment the faster thee cure.

Otherwise the condition may become a chronic illness requiring multiple surgical procedures.

A Simple Guide to Glossitis

A Simple Guide to Glossitis
-----------------------------------

What is Glossitis?
---------------------------

Glossitis is an acute or chronic inflammatory disease of the tongue which can cause swelling of the tongue and change of colour of the tongue.

The finger like papilla on the surface of the tongue may be lost as a result leading to a smooth tongue.


What are the causes of Glossitis?
----------------------------------------

Bacterial Infections:
----------------------------

1.Gram positive bacteria such as Streptococcus and Staphphylococcus may be painful and lead to upper respiratory tract infection

2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia

Viral infections:
------------------

Herpes simplex

Non-infectious:
----------------

1.Dryness of the mouth and low saliva in the mouth may allow bacteria to grow more readily.

2.Local dental abnormalities, rough edges of teeth ,ill fitting dental appliances, or other trauma to the tongue

3.Tongue Piercings

4.irritants such as tobacco, alcohol, hot foods, and spicy food.

5.Sensitivity to toothpaste, mouthwash, breath fresheners,and dental material

6.Allergies to dyes in candy or preservatives in food.

7.Drug induced such as anticholinergics (cause dryness of mouth), certain blood-pressure medications (ACE inhibitors).

8.Mouth breathing

Systemic diseases:
--------------------

1.iron deficiency anemia, pernicious anemia and other B-vitamin deficiencies

2.Skin diseases such as oral lichen planus, erythema multiforme, aphthous ulcer, pemphigus vulgaris,

3.Systemic diseases such as syphilis, and others.

Genetic
---------------

Occasionally Glossitis may be inherited


What are Signs and symptoms of Glossitis?
---------------------------------------------


Symptoms:

1.Swelling of the tongue

2.Tongue color changes often dark red

3.Pale if caused by anemia.

4.Fiery red if due to vitamin B deficiency

5.Sore and tender tongue

6.Smooth tongue

7.Aphthous ulcers of the tongue

8. Swollen tongue resulting in difficulty with chewing, swallowing, or speaking.

This may require emergency treatment especially if breathing is compromised.


How is the diagnosis of Glossitis made?
------------------------------------------


1.Symptoms and signs of red, swollen and inflamed tongue

2.blood tests (complete blood count, ESR and blood culture)

3.Biopsy of the tongue in rare cases.


What are the complications of Glossitis?
-----------------------------------------------


1.difficulty in breathing and swallowing

2.cervical lymphadenitis - swelling of the neck lymph nodes

3.upper respiratory tract infection


What is the treatment of Glossitis?
------------------------------------


The Main treatment is to reduce inflammation.

1.Good oral hygiene

2.Attend to dental problems

3.Antibiotics and antifungal treatment depending on the organism found

4.Corticosteroids may be given to reduce inflammation

5.For mild cases, topical applications of steroid mouth rinses or creams that is not swallowed are used

6.Underlying causes such as Anemia and nutritional deficiencies must be treated, often by changes in diet or vitamin supplements

7.Avoid irritants such as hot or spicy foods, alcohol, and tobacco to minimize the discomfort.

8.hospitalization may be required if unless tongue swelling is is affecting breathing or swallowing.

What is the prognosis of Glossitis ?
------------------------------------------

Usually very good.

Recurrences are common

What are the Preventive measures taken for Glossitis ?
--------------------------------------------------------

1.Avoid smoking

2.Healthy lifestyle with balanced diet and exercise.

3.Regular cleaning of gums and teeth by brushing and flossing

4.Gargling of mouth after meals

5.Regular dental checkups

A Simple Guide to Impetigo

A Simple Guide to Impetigo
-----------------------------------

What is Impetigo?
---------------------------

Impetigo is a vesiculopustular skin infection occurring mainly at all ages.


What are the causes of Impetigo?
----------------------------------------

Bacterial Infections:
----------------------------

1.Gram positive bacteria such as Streptococcus and Staphphylococcus are common

2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas,


What are Signs and symptoms of Impetigo?
---------------------------------------------

Symptoms:

1.vesicles that appears rapidly on the face, hands and knee

2.Yellow liquid or pus discharges from vesicles

3.form crusts

Signs:

1.Vesicles rash present on face, hand and knees

2.yellow crusts appeared and spread to surrounding tissues

3.Neighboring lymph nodes may be enlarged


How is the diagnosis of Impetigo made?
------------------------------------------

1.Symptoms and signs of vesiculopustular lesions of the skin.

2.Culture and sensitivity to antibiotics of the discharge or crusts from skin lesions



What are the complications of Impetigo?
-----------------------------------------------

1.cellulitis

2.abscess

3.carbuncle( a group of abscesses which join together to become a large abscess

4.lymphadenitis


What is the treatment of Impetigo?
------------------------------------

1.Removal of crusts with warm saline or liquid paraffin

2.Strong antibiotic cream applied to skin lesions.

3. Strong systemic antibiotics

a.cephalosporin, penicillin, ampicillin, erythromycin, tetracycline, for most streptococci,
staphalococci,
hemophilus

b.cephalosporins, gentamycin for
pseudomonas

4.surgery to drain abscess and carbuncles may be necessary


What is the prognosis of Impetigo ?
------------------------------------------

Generally excellent with good healing


What are the Preventive measures taken for Impetigo ?
--------------------------------------------------------

1.Avoid touching skin with dirty hands

2.Good hand hygiene

3.Healthy lifestyle with balance diet and adequate sleep.

4.Proper skin care

A Simple Guide to Blepharitis

A Simple Guide to Blepharitis
-----------------------------------

What is Blepharitis?
---------------------------

Blepharitis is a disease which causes inflammation and infection of the margins of the eyelids.


What are the causes of Blepharitis?
----------------------------------------

Bacterial Infections:
----------------------------

1.Gram positive bacteria such as Streptococcus and Staphphylococcus are common

2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas,

Parasitic Infections:
----------------------------

Deodex folliculorum rare cause

Non-infectious:
------------------

blocked oil glands of eyelashes


What are the types of Blepharitis?
----------------------------------------

Squamous:
--------------

typically scales on lashes- usually non-infectious

Ulcerative:
----------------

yellow crusts on eyelids which causes small bleeding ulcers when removed -
usually due to infections.


What are Signs and symptoms of Blepharitis?
---------------------------------------------

Symptoms:

1.Irritation and discomfort of eyelids

2.tearing of eyes

3.photophobia (fear of bright lights and sunlight)

4.Yellow discharge or crusts on eyelashes

Signs:

1.White scales on eyelashes in squamous blepharitis

2.yellow crusts on eyelashes in infectious blepharitis

3.small bleeding ulcers on eyelids where crusts have dropped.

4.Conjuctivitis


How is the diagnosis of Blepharitis made?
------------------------------------------

1.Symptoms and signs of scales, yellow crusts on eyelids

2.Culture and sensitivity to antibiotics of the discharge from eyedlids

3.Microscopic examination of eyelashes

What are the complications of Blepharitis?
-----------------------------------------------

1.Stye or chalazion of eyelid

2.Conjuctivitis

3.Scarring of eyelids


What is the treatment of Blepharitis?
------------------------------------

Squamous Blepharitis
-----------------------

1.Treatment of underlying cause such as seborrhoeic dermatitis

2.Application of antiseptic or antibiotic cream to eyelashes

Ulcerative Blepharitis
--------------------------

1.Rest in dark room

2.Painkiller for pain

3.Removal of crusts and diseased eyelashes by washing warm water or saline

4.Strong antibiotic eyedrops and cream applied to eyelashes:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus

b.cephalosporins, gentamycin for pseudomonas

5.Treat associated conjunctivitis

What is the prognosis of Blepharitis ?
------------------------------------------

Squamous Blepharitis
-----------------------

Generally good.

May vary with response to underlying cause.

Recurrence is common.

Ulcerative Blepharitis
--------------------------

Most cases recovered well.

Rarely there may serious sequalae such as
loss of eyelashes,
scarring of eyelashes
conjuctival ulcers


What are the Preventive measures taken for Blepharitis ?
--------------------------------------------------------

1.Avoid rubbing of eyes with dirty hands

2.Good hand hygiene

3.Healthy lifestyle with balanced diet and adequate sleep.

4.Reducing watching of TV and computer monitors

5.Regular eye checkups

A Simple Guide to Cervicitis

A Simple Guide to Cervicitis
----------------------------------------------------

What is Cervicitis?
---------------------------------------

Cervicitis is non-specific infection of the cervix.

It is most common on the posterior cervix but may be anterior or concentric.


Who is affected by Cervicitis?
---------------------------------------------------

1.Congeital cervical erosions or cervicitis can occur in virgins.

2.sexually active females

3.dilatation in labor or during abortion

What are the types of Cervicitis?
-------------------------------------------

1.Simple:

Erosion surface is smooth

2.Papillary:

Erosion surface is rough

3.Follicular:

Erosion surface is cystic

What are the Causes of Cervicitis?
-----------------------------------------------------

Bacterial infections:
---------------------------

1.Gonorrhea

2.Chlamydia

3.staphylococcus aureus

4.Streptococcus

5.Mycobacterium tuberculosis.

6.E.coli

Viral infections:
--------------------------

1.Genital herpes

2.Human Papilloma Virus

Other causes:
--------------------

1.Cervical cap

2.Device to support the uterus (pessary)

3.Diaphragm

4.allergy to spermicides

5.Exposure to a chemical

What are the complications of Cervicitis?
---------------------------------------------------

1.Pelvic inflammatory disease

2.Urethritis and cystitis

3.rarely malignant changes in cervix

4.inguinal lymphadenitis

5.Cervical cancer

What are the Symptoms and signs of Cervicitis?
-----------------------------------------------------------

1.Mucopurulent vaginal discharge (Gray, white, or yellow color) with odor

2.Blood in the vaginal discharge
a.After intercourse
b.After menopause
c.Between periods

3.Urinary infection symptoms - frequency and pain

3.hematuria (blood in the urine)

4.Pelvic pain

5.Backache

6.Painful sexual intercourse

7.Pain in the vagina

8.Pressure or heaviness in the pelvis

Signs:

1.reddened area of cervix

2.erosion of cervical wall

3.Vaginal surface of cervix may be affected

4.pus discharge from the cervix

5.Swelling (inflammation) of the walls of the vagina

How is diagnosis of Cervicitis made?
-----------------------------------------------

1.Vaginal examination with Pap's smear of cervical cells

2.Cervical swab for culture and sensitivity to antibiotics

3.Blood tests( white cell count , blood culture, chlamydia, gonorrhea)

4.Biopsy of cervical erosions.

What is the treatment of Cervicitis?
---------------------------------------------------

1. Antibiotics is given according to the sensitivity of bacteria in the culture.

2.Pelvic pain and backache may be treated with paracetamol

3.Local application of sulphonamide, tetracycline or other antibiotic cream to affected cervical area

4.Electro-Cauterisation of the affected cervical area

5.Cryosurgery of cervical erosions

6.Cone biopsy if necessary of affected cervix area.

7.Hormonal therapy (especially in postmenopausal women)

8.Laser therapy of cervical erosions

What is the prognosis of Cervicitis?
-------------------------------------------------------------

Prognosis with appropriate treatment and antibiotics is generally good.

Recurrence is common.

Cervicitis may last for months to years.

Cervicitis may lead to pain with intercourse (dyspareunia).

What are Preventive measures for Cervicitis?
-------------------------------------------------------------------

Avoid sexual intercourse with multiple partners.

Use condoms during sexual intercourse.

Vaccination against human papilloma virus

Avoid chemical irritants such as douches and deodorant tampons.

Avoid using spermicidal contraceptives

Make sure that any foreign objects that inserted into the vagina is clean or sterile

A Simple Guide to Epididymitis and Orchitis

A Simple Guide to Epididymitis and Orchitis
----------------------------------------------------

What is Epididymitis and Orchitis?
---------------------------------------

Epididymitis and orchitis is acute bacterial or viral infection of the epididymis and testis.

The epididymis is the small organ on top of the testis.


Who is affected by Epididymitis and Orchitis?
---------------------------------------------------

1.childhood, usually related to mumps infection

2.sexually active males

3.Epididymitis is more common than Orchitis


What are the Causes of Epididymitis and Orchitis?
-----------------------------------------------------

Bacterial infections:

1.Gonorrhea

2.Chlamydia

3.staphylococcus aureus

4.Streptococcus

5.Mycobacterium tuberculosis.

6.E.coli

Viral infections:

1.mumps in childhood

2.measles


What are the complications of Epididymitis and Orchitis?
---------------------------------------------------

1.Orchitis or infection of the testis following epididymitis

2.Abscess formation of the epididymis

3.gangrene of the testis if blood flow is affected.

4.inguinal lymphadenitis


What are the Symptoms and signs of Epididymitis and Orchitis?
-----------------------------------------------------------

1.Pain in scrotum

2.ejaculation of blood

3.hematuria (blood in the urine)

4.Fever

Signs:

1.Scrotal swelling

2.Induration of scrotum wall

3.tenderness of epididymis

4.tenderness of the testis if orchitis is present


How is diagnosis of Epididymitis and Orchitis made?
-----------------------------------------------

1.pain and tenderness of the epididymis and testis

2.Mid stream urine for culture

3.Blood tests( white cell count , blood culture)

4.Ultrasound of the testis


What is the treatment of Epididymitis and Orchitis?
---------------------------------------------------

Acute Epididymitis and Orchitis

1. Antibiotics may be commenced if fever is high or the culture showed bacterial infections.

2.Fever and pain may be treated with paracetamol

3.Scrotal support

4.Ice packs for scrotum

5.Bed rest and Fluids

6.Surgical drainage if there is abscess formation.


What is the prognosis of Epididymitis and Orchitis?
-------------------------------------------------------------

Prognosis with appropriate treatment and antibiotics is generally good.

There is a risk of sterility and decreased male hormone production if treatment is inadequate.


What are Preventive measures for Epididymitis and Orchitis?
-------------------------------------------------------------------

Avoid sexual partners with multiple partners.

Use condoms during sexual intercourse.

A Simple Guide to Gingivitis

A Simple Guide to Gingivitis
-----------------------------------

What is Gingivitis?
---------------------------

Gingivitis is an acute disease which causes inflammation and infection of the gums with redness, swelling and bleeding.


What are the causes of Gingivitis?
----------------------------------------

Bacterial Infections:
----------------------------

1.Gram positive bacteria such as Streptococcus and Staphphylococcus may be painful and lead to upper respiratory tract infection

2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia

Non-infectious:
------------------

1.malocclusion

2.food impaction

3.dental calculus

4.dental procedures

5.exposure to heavy metals

6.long term phenytoin treatment

7.Oral contraceptive pills

Systemic diseases:
--------------------

1.diabetes mellitus

2.leukemia

3.Debilitating diseases

4.autoimmune diseases


What are Signs and symptoms of Gingivitis?
---------------------------------------------

Symptoms:

1.Pain in the gums

2.Red swollen inflamed gums

3.bleeding in between the gums

4.Fever may be present

Signs:

1.Red swollen inflamed gums around neck of teeth

2.Swelling of papilla between teeth

3.Gum boils or abscess in the gums

4.Gum ulcers


How is the diagnosis of Gingivitis made?
------------------------------------------

1.Symptoms and signs of red, swollen and inflamed gums

2.blood tests (complete blood count, ESR and blood culture)

3.X-rays of teeth


What are the complications of Gingivitis?
-----------------------------------------------

1.damage to root canals

2.cavity in the teeth

3.upper respiratory tract infection


What is the treatment of Gingivitis?
------------------------------------

1.Rest & fluids

2.Painkiller for pain

3.Antibiotics depending on the organism found:

a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus

b.cephalosporins, gentamycin for pseudomonas

4.Oral application of oral antibiotic cream

What is the prognosis of Gingivitis ?
------------------------------------------

Usually very good.

Surgery for abscess and other gum or tooth problem very rarely needed.


What are the Preventive measures taken for Gingivitis ?
--------------------------------------------------------

1.Avoid smoking

2.Healthy lifestyle with balanced diet and exercise.

3.Regular cleaning of gums and teeth by brushing and flossing

4.Gargling of mouth after meals

5.Regular dental checkups

A Simple Guide to Otitis media

A Simple Guide to Otitis media
----------------------------------------------------

What is Otitis media?
---------------------------------------

Otitis media is acute or chronic inflammation of the middle ear.

Otitis media occurs in the area between the ear drum (the end of the outer ear) and the inner ear, including a duct known as the Eustachian tube.

Who is affected by Otitis media?
---------------------------------------------------

1.childhood, usually related to viral upper respiratory tract infection

2.family history of middle ear disease.

What are the Causes of Otitis media?
-----------------------------------------------------

Bacterial infections:

1.Streptococcus pneumoniae

2.Haemophilus influenzae

3.staphylococcus aureus

4.Moraxella catarrhalis, a gram-negative diplococcus.

5.Mycobacterium tuberculosis.

6.E.coli

Viral infections:

1.common cold.

2.measles

What is the Types of Otitis Media?
-----------------------------------------------------

1. Acute otitis media

Acute otitis media ia an acute infection of the middle ear which usually occurs as a result of viral upper respiratory tract infection that can occur at least twice a year

2.Chronic otitis media

Chronic otitis media occurs following acute otitis media with chronic infection of the middle ear and ear perforation.

3.Otitis media with effusion:

Otitis media with effusion occurs when fluid occurs in the middle ear due to blockage of the eustachian tube.

What are the complications of Otitis media?
---------------------------------------------------

1.mastoiditis

2.labrynthitis

3.facial nerve palsy

4.meningitis,

5.brain abscess,

6.febrile seizures.

7.death if a severe infection goes untreated long enough


What are the Symptoms and signs of Otitis media?
-----------------------------------------------------------

1. cold: stuffy nose

2. earache - The pain lasts a day or two.

3. high fever - may cause seizures if very high

4. discharging pus from the ruptured eardrum
Usually the ruptured drum will usually heal spontaneously

5.Eustachian tube becomes blocked resulting in hearing loss

Signs:

1.Ear drum (tympanic membrane) inflamed and bulging with loss of normal outline

2.Decreased or displaced light reflex of ear drum

3.perforation of ear drum

4.mucopurulent discharge from ear after perforation

How is diagnosis of Otitis media made?
-----------------------------------------------

1.Inflamed ear drum with loss of normal outline, decreased light reflex, bulging and perforation and purulent discharge.

2.Culture and sensitivity of pus swab

3.Nasal and pharyngeal swabs my also be done

4.X-rays or MRI of the mastoid air cells

5.Audiogram for hearing loss

What is the treatment of Otitis media?
---------------------------------------------------

Acute otitis media

1. Antibiotics may be commenced if fever is high or the culture showed bacterial infections.

2.Fever and pain may be treated with paracetamol

3.Antihistamines may be given for rhinitis or runny nose.

4.Decogestants may be necessary for blockage of eustachian tube

5.Bed rest and Fluids

6.Myringoplasty -Puncture of bulging ear drum if painful and aspiration of pus or fluid in the middle ear.

7.Tympanoplasty for eardrum whose perforation does not heal.

8.Mastoidectomy to remove cholesteatoma(growing of skin into middle ear cavity) in chronic otitis media with mastoiditis.


What is the prognosis of Otitis media?
-----------------------------------------

Prognosis with appropriate treatment is generally good.

Ear drum perforation usually heal spontaneously in most cases.

What are Preventive measures for Otitis media?
----------------------------------------------------

Avoid swimming and diving.

Proper ear hygiene.

A Simple guide to Anal Fistula

A Simple guide to Anal Fistula
-------------------------------------

What is Anal Fistula?
----------------------------

Anal Fistula (or fistula-in-ano) is a chronic granulous track which communicate between the anorectal canal and the perianal skin.

There may be several external openings but only one internal opening

What is the cause of Anal Fistula?
------------------------------------------

Anal Fistula usually result from :
1.breakdown of anorectal abscesses

2.follows surgery for anal fissure

3.Less common causes are:
lymphogranuloma

carcinoma of rectum

ulcerative colitis,

regional ileitis

tuberculosis

What are the symptoms of Anal Fistula?
------------------------------------------------

1.pain especially on sitting down

2.purulent painless discharge(pus) near the anus

3.Recurrent perianal abscesses(pockets of pus around the anus)

4.pruritis ani(itch in anus)

How are Anal Fistula diagnosed?
-----------------------------------------

1.thorough examination of the perianal region

2.Rectal examination and palpation of the fistula track

3.Pass a probe through the perianal opening to determine the length of the track

4.Sigmoidoscopy and colonoscopy to detect internal opening and other lesions in the rectum and large intestine

5.Barium enema to exclude any ulcerative colitis and regional ileitis


What is the treatment of Anal Fistula?
------------------------------------------

There are 2 types of anal fistula:
1.High level fistulas penetrate the levator ani-muscle of the anal sphlinter

2.Low level fistulas are below the levator ani and are more common.

Treatment of lowlevel fistula:
1.lay open the track and curette(scrape the lining and debris in the track out)

Treatment of high level fistula:
1.open the track from within the ischiorectal fossa

2.colostomy may be necessary for multiple fistulas or very high internal opening

General treatment:
1.Treatment of associated diseases like diabetes, ulcerative colitis, regional ilitis, carcinoma

2.Antibiotics - a full course of at least 2 weeks of antibiotics is needed

3.toilet and dressing of the wounds, with application of antibiotic creams

4.tub baths of the anal region several times a day in plain, warm water for about 10 minutes

What is the prognosis of Anal Fistula?
----------------------------------------

Good with surgery.

Rarely there may undesirable complication like rectal incontinence.

A Simple Guide to Adenoiditis

A Simple Guide to Adenoiditis
----------------------------------------------

What is Adenoiditis?
-------------------------------

Adenoiditis is inflammation (swelling) of the Adenoids.

The adenoids are lymph nodes in the back of the nose and above the throat.

They normally help to filter out bacteria and other microorganisms to prevent infection in the nose and throat area.

They may become so overwhelmed by bacterial or viral infection that they swell and become inflamed, causing Adenoiditis.

Enlarged adenoids can cause blockage of the eustachian tubes and posterior openings of the nose.

What causes Adenoiditis?
-------------------------------

1.Viral or bacterial infections
---------------------------------

Bacteria cause 15-30 percent of Adenoiditis cases.
Streptococcus pyogenes is the most common bacteria causing acute Adenoiditis.

The herpes simplex virus, Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute Adenoiditis.


2.low immunity factors
-----------------------

Unbalanced or insufficient food diet,

Unhygienic lifestyle

Inadequate rest or sleep

3. Allergy
---------------

dustmites,

pollens

Who gets Adenoiditis?
---------------------

Adenoiditis most often occurs in children but rarely occurs in children younger than two years.

It is occasionally found in young adults.

What are the symptoms of Adenoiditis?
-------------------------------------

The Symptoms of Adenoiditis are:

1,Blocked nose

2.mouth breathing

3.nasal speech

4.rhinorhoea(runny nose)

5.Snoring at night

6.Ear blockage(eustachian tube blockage)

7.Ear pain(otitis media)

8.Pain in the cheeks(maxillary sinusitis) or above the eye(frontal sinusitis)

9.Headache

10.Fever, chills

11.Lethargy and malaise are common.

These symptoms usually resolve in three to four days but may last up to two weeks despite therapy.

What are the signs of Adenoiditis?
---------------------------------

An ear nose and throat specialist will be able to put a endoscope through the nasal passage to see the enlarged and inflamed adenoids.

What are the Complications of Adenoiditis?
------------------------------------------

1.Complications of untreated streptococcus Adenoiditis with tonsillitis may be severe:

Rheumatic fever and subsequent cardiovascular disorders
Post-streptococcal glomerulonephritis followed by kidney failure

2.Ear pain from otitis media

3.Blocked airway from enlarged Adenoids

What is the treatment of Adenoiditis?
------------------------------------

1.If the cause of the Adenoiditis is bacteria such as streptococcus, antibiotics are given to cure the infection.

The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.

2.Rest to allow the body to heal.

3. Fluids especially warm (not hot), bland fluids or very cold fluids may soothe the nose and throat.

4.Hospitalization may be required in severe cases, particularly when there is airway obstruction.

5.When the condition is chronic or recurrent, a surgical procedure to remove the Adenoids(Adenoidectomy) is often recommended.

What is the Prognosis of Adenoiditis?
------------------------------------

Adenoiditis symptoms usually lessen in 2 or 3 days after treatment starts.

The infection usually is cured by then, but may require more than one course of antibiotics.

Adenoidectomy may be recommended if Adenoiditis is severe, recurrent, or does not respond to antibiotics.

A Simple Guide to Stomatitis

A Simple Guide to Stomatitis
-----------------------------------

What is Stomatitis?
--------------------------

Stomatitis means inflammation of the mouth

What are the Causes of Stomatitis?
---------------------------------------------

There are many many disorders which can cause Stomatitis:

1.Bacteria, viruses, fungus

2.avitaminosis

3.leukemia,agranulocytosis

4.Dental problems,poor fitting denture, poor dental hygience

5.smoking

6.medicines: phenytoin, iodides, barbiturates

7.stress

What are the Symptoms of Stomatitis?
----------------------------------------------

Stomatitis usually appear on the inner surface of the cheeks and lips, tongue, soft palate, and the base of the gums.

It may begin with a tingling or burning sensation, followed by a red hyperemia of the inside of the lining of the cheek, gums or tongues.

The inflamed surfaces may develop into ulcers

Occasionally, a severe occurrence may be accompanied by fever,lymphadenopathy and lethargy.

Most mouth inflammation is not infectious except bacterial,fungal and viral infections.

Oral mucosal smears may be necessary to determine those with bacterial or fungal infections.

What is the Treatment of Stomatitis?
-------------------------------------------

The exact treatment will depend on the cause of the Stomatitis.
Sometimes all that is required is to remove the cause of the Stomatitis such as an ill fitting denture.

The following measures may help to reduce pain from Stomatitis:
Proper oral hygience:
---------------------

1.keep your mouth clean at all times,

2.avoid foods that are spicy, acidic, salty or particularly hot or cold, which can make the symptoms worse,

3.eat a healthy diet that includes fresh fruit and vegetables,

4.gargle with warm salt water,

5.use a diluted chlorhexidine mouthwash once a day to help reduce the length of time the stomatitis last.

6.sprays and rinses are also available for pain relief.

Medical treatment:
-------------------

The main treatment of the Stomatitis is application of topical corticosteroids (Kenalog in orabase or Oracorte E), or other soothing preparations.

Where bacteria are present the appropriate antibiotic will treat the Stomatitis.

Antifungal agents are used to treat fungal infection.

Vitamin B replacements are important in cases due to deficiency of the vitamins.

Underlying condition:
-------------------

Treatment of systemic condition causing the Stomatitis such as leukemia,

What are the Prevention measures in Stomatitis?
---------------------------------------------------------

Good oral hygiene may help in the prevention of some types of stomatitis or complications from stomatitis.

This includes brushing the teeth at least twice per day, flossing at least daily, and going for regular dental checkup and cleaning.

Try to avoid getting run down by making sure you eat a balanced diet, take regular exercise and learn to manage stress.

What is the prognosis of the Stomatitis?
---------------------------------------------

The outlook for most stomatitis is good.

Those with underlying condition such as leukemia will improve with treatment of the illness.

A Simple Guide to Typhoid Fever

A Simple Guide to Typhoid Fever
---------------------------------------

What is Typhoid Fever?
---------------------------

Typhoid Fever is an acute febrile illness caused by the Salmonella typhi bacteria.

What is the cause of Typhoid Fever?
-------------------------------------------

The bacteria which causes Typhoid Fever is the Salmonella typhi which is an extremely hardy bacteria able to live in polluted water, contaminated food and soiled clothes.
Oral ingestion of the bacteria leads to penetration of the small bowel mucosa and rapid spread to lymphatics, lymph nodes and blood stream.
Once it entered the bloodstream, fever occur.
It then enters the spleen, liver and gallbladder and penetrates into the mucosa of the rest of the intestine, causing thinning of the walls of the bowels.
Incubation period is 5-10 days.

What are symptoms of Typhoid Fever?
----------------------------------------------

The main symptoms of Typhoid Fever are
1. Fever which becomes higher and higher like a step ladder

2. headache

3. abdominal pain

4. green pea soup type of diarrhea

5. enlarged spleen and liver

6. delirium and disorientation from high fever and dehydration

7. lassitude and tiredness

8. rose spots rash on the body

Symptoms usually appear within 5-10 days after exposure to the germ and last for 3-4 weeks.

How is Typhoid Fever transmitted?
------------------------------------------

Typhoid Fever can be highly contagious.
The germs are commonly transmitted by food handlers who are typhoid carriers.
People can get the germs from contaminated food and drinks.

How is the diagnosis of Typhoid Fever made?
-----------------------------------------------------

Doctors generally diagnose Typhoid Fever based on the symptoms and a physical examination.
Confirmation is by blood tests(Widal test), blood and stool cultures.

What are the complications of Typhoid Fever?
-------------------------------------------------------

Typhoid Fever is a disease which can kill especially through its complications:
1.Intestinal hemorrhage

2.Intestinal perforation

3.Cholecystitis

4.dehydration especially in young children and the very old patients

How is Typhoid Fever treated?
-------------------------------------

Thypoid is an infectious disease which can spread to other people through soiled clothes, contaminated food.
It is therefore advisable to quarantine the patient in hospitals.

Antibiotics is the main treatment against typhoid.
The best antibiotic is chloramphenicol but because of its side effects of aplastic anemia it should be avoided especially in pregnant women and young children.
Other antibiotics used are septrin(co-timoxazole) and ampicillin.
Antibiotics should be continued for at least 2 weeks.

Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
Aspirin is to be avoided to prevent intestinal bleeding.

2.antispasmodic drug to stop abdominal cramps

3.medicine to harden the stools such as kaolin

4.slow down the intestinal movement (lomotil or loperamide).

Prompt treatment may be needed to prevent dehydration:
Dehydration can be caused by diarrhea, excessive sweating from the high fever, or by not drinking enough fluids because of loss of appetite.
Mild dehydration can be treated by drinking liquids.
Severe dehydration may require intravenous fluids.
Untreated severe dehydration can be life threatening especially in babies, young children and the elderly.

Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
Get plenty of rest.

Complications such as intestinal perforation may require surgical treatment.

How is Typhoid Fever prevented?
----------------------------------------

Prevention of typhoid is usually by vaccination of all food handlers and staff working in restaurants.

Food handlers should always wash their hands after going to the toilets and before cooking food.
They should always wear gloves when handling or cooking food.

Treatment of chronic typhoid carriers with antibiotics such as ampicillin for 6 months and removal of gallbladder which may harboured the bacteria.

You can avoid infection by:
Avoid eating or drinking foods or liquids that might be contaminated

Good food hygience

A Simple Guide to Syphilis

A Simple Guide to Syphilis
--------------------------------

What is Syphilis?
----------------------

Syphilis is a infectious sexually transmitted disease caused by the bacterium Treponema pallidum.
It can be acute, subacute or chronic depending on the stage.

How is Syphilis spread?
----------------------------

Syphilis is passed from a infected person through sexual contact with a infected sore which occur mainly on the external genitals, anus, or rectum.
The lips and the mouth may also have sores.

The bacteria can penetrate through normal mucous membrane and minor abrasions of the epithelium.
Transmission of the organism usually occurs during sexual contact.
Pregnant women with the disease can pass it to the babies they are carrying.

What are the symptoms of Syphilis?
--------------------------------------------

The signs and symptoms of syphilis may occur in four stages:

Primary
----------
These signs may occur from 10 to 90 days after exposure:

1.A small, firm, painless sore (chancre) appears on the body where the syphilis enter the body, usually the genitals, rectum, or lips.
A single chancre is typical, but there may be multiple sores.

2.Enlarged lymph nodes in your groin.

The chancre lasts 3 to 6 weeks, and it heals without treatment.
However, if untreated, the infection progresses to the secondary stage.

Secondary
----------
The signs and symptoms of secondary syphilis may begin two to 10 weeks after the chancre appears, and may include:

1.Rash marked by red or reddish-brown sores over any area of the body especially the palms and soles. The rash usually does not cause itching.

2.Fever

3.Fatigue and a vague feeling of discomfort

4.swollen lymph glands,

5.sore throat,

6.weight loss,

7.Soreness and aching

The signs and symptoms of secondary syphilis will resolve with or without treatment.
Without treatment, the infection will progress to the latent and late stages of disease.

Latent
--------

A period called latent syphilis in which no symptoms are present may follow the secondary stage.
Signs and symptoms may not appear until the disease may progress to the tertiary stage.

Tertiary
----------

Without treatment, syphilis bacteria may spread, leading to serious internal organ damage including the brain, nerves, eyes, heart, blood vessels, liver, bones,joints and finally death years after the original infection.

1.Neurological problems. These may include stroke; infection and inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis); poor muscle coordination; numbness; paralysis; deafness or visual problems; personality changes; and dementia.

2.Cardiovascular problems. These may include bulging (aneurysm) and inflammation of the aorta and of other blood vessels.
Syphilis may also cause valvular heart disease, such as aortic valve insufficiency.

Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated.

What is the danger of Syphilis during pregnancy?
----------------------------------------------------------

The syphilis bacterium can infect the baby of a woman during her pregnancy. Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth or of giving birth to a baby who dies shortly after birth.
An infected baby may be born without signs or symptoms of disease.
Untreated babies may become developmentally delayed, have seizures, or die.

How do you diagnose Syphilis?
---------------------------------------

1. dark-field microscope: examining material from a chancre using this microscope.
If syphilis bacteria are present in the sore, they will show up when observed through the microscope.

2.A blood test for syphilis antibodies is accurate, safe, and inexpensive. There will be some antibodies in the blood for months even when the disease has been successfully treated.

Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.

What is the treatment of Syphilis?
-----------------------------------------

Syphilis is easy to cure in its early stages.

Treatment with intramuscular injection of penicillin can kill the organism that causes syphilis.
If you're allergic to penicillin, other antibiotics such as erythromycin will kill the syphilis bacterium.
Treatment however will not repair damage already done.
Left untreated, the disease can lead to serious complications or death.

Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed.
Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.

Even if you were treated for syphilis during your pregnancy, your newborn child should receive antibiotic treatment.

To make sure you're responding to the usual dosage of penicillin, the doctor likely will want you to have periodic blood tests.
Blood test may remain positive up to 18 months even after successful treatment of syphilis.

Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection.

How do you prevent Syphilis?
---------------------------

The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to 1.abstain from sexual contact

2.in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

3.Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior.

4.Correct and consistent use of latex condoms can reduce the risk of syphilis only when the infected area or site of potential exposure is protected.

5.Complications from syphilis such as neurosyphilis are rare because of better diagnosis and treatment

A Simple Guide to Chlamydia

A Simple Guide to Chlamydia
-----------------------------------

What is Chlamydia?
------------------------

Chlamydia is a bacterial infection which is one of the most common sexually transmitted diseases.
It used to be called Lymphogranuloma venereum because of the typically enlarged lymph nodes at the groins.
It can lead to pelvic inflammatory disease (PID), as well as sterility and pregnancy problems.

How do you get Chlamydia?
--------------------------------

Chlamydia is highly contagious.
It spreads by sexual contact with an infected partner.

It can also be transmitted from mother to child during birth.
This may lead to an infection of the eyes and lungs in the infant.

It is also be transmitted through casual sexual contact with other people.

What are the signs & symptoms of Chlamydia?
------------------------------------------------------

About 80% of women and 10% of men display no symptoms.

For the rest the symptoms often appear 7-14 days after transmission in the following ways:

For men:

1.Discharge from a papule on the penis

2.Burning pain and itching when urinating.

3.lymph nodes enlargement at inguinal regions

4. Anal infections in homosexuals

Symptoms present early a few days after exposure, go away, only to return.
Advanced Chlamydia infection may lead to inflammation of the sperm duct (epididymitis), proctitis (anal region) and sterility.

For women:

1.Vaginal itching or discharge.

2.Abdominal pain,

3.Bleeding between menstrual periods

4.Low grade fever

5.Anal infections

The disease can also cause cervicitis, endometritis and pelvic inflammatory disease which can result in sterility.

For infants:

1.Fever

2.Pneumonia

3.Conjunctivitis

Symptoms usually show up one week to one month after exposure.

Besides the above symptoms, headache, conjunctivitis, skin rashes, nausea and vomiting can be present.

How can Chlamydia be detected?
---------------------------------------

Women may be tested through the insertion of a swab into the cervix during a pelvic exam.

Men can be examined by inserting a swab into the urethra to take a specimen.

Urine testing can also be done for both sexes.

Blood test for chlamydia can also be done.

What is the Treatment of Chlamydia?
--------------------------------------------

Early treatment is important as it can protect against problems like pelvic inflammatory disease as well as sterility and pregnancy problems.

Patients typically undergo antibiotic treatment (usually tetracycline or sulphonamides) for a week.
The medication can be taken orally.
This treatment must be followed through even when symptoms of Chlamydia disappear.

Alcohol should be avoided when taking antibiotics, as well as milk and other dairy products.

Where Chlamydia has been transmitted through sexual contact, it is essential that both sexual partners are treated for the disease.

It is recommended that both partners abstain from sexual activity from the time of diagnosis until they have completed treatment.

Follow-up treatment is also important, as doctors need to make sure the infection has been cured.

How can I avoid contracting Chlamydia?
------------------------------------------------

The best way to prevent Chlamydia is through improved hygiene standards and lifestyle changes.

Sexually active persons should use condoms.

Abstinence is recommended for those infected and on antibiotic treatment.

One's risk for Chlamydia, or any other sexually transmitted disease, increases with the number of sexual partners.
Prevention is always better than cure!

A Simple Guide to Ear Infections

A Simple Guide to Ear Infections
--------------------------------------

What are Ear Infections?
------------------------------

Otitis Externa

-----------------
The most common infections of the ear is in the external ear.
Wax in the ear over time can cause blockage to the external canal.
Digging for wax in the ear irritates the lining of the external canal and allows bacteria to infect the external ear and the eardrum.
Foreign bodies such as cotton from cotton buds used to clean the ear, beads in children, may be stucked in the ear causing bacterial or fungal infection. Other foreign body are insects which flew into the ear and cannot get out, leaving the dead insect in the ear.
Trauma or injury to the ear may also cause bacteria to enter the injured tissue of the ear.

Otitis Media

---------------
Infection or inflammation of the middle ear (Otitis Media) is another common cause of earaches.
It is common for ear infections to develop when a person suffers a cold, flu or another type of respiratory infection. This is because the middle ear is connected to the upper respiratory tract by a pair of tiny conduits known as Eustachian tubes.

Ear infections occur more frequently in infants and children but can also affect adults.

What are the Symptoms of Ear Infections?

--------------------------------------------------

In adults:
Earache (this may be felt as a sharp, sudden pain or a dull, continuous pain)
Fever and chills
Nasal congestion
Feeling of fullness in the ear
Muffled hearing

In Children:
Tugging at the ear
Poor sleep
Fever
Irritability or restlessness
Ear discharge
Nasal discharge
Diminished appetite
Crying at night when lying down

What is theTreatment for Ear infections?
-------------------------------------------------

Ear infections caused by viral infections are treated with decongestants to reduce the swelling in the Eustachian tubes.

Ear infections caused by bacteria are treated with antibiotics.

Wax and foreign bodies are usually removed by aural toilet(washing of external ear canal with warm water)

What are complications of ear infections?
--------------------------------------------------

Most external ear infections can be treated easily and resolved without any damage to the surrouding tissues.

In Otitis Media, there is danger of spread of the infections to the surounding bone tissue, labrynth, facial nerve, meninges and brain.
Acute mastoiditis
labrynthitis
Meningitis
Brain abscess
Facial palsy
Deafness