A Simple Guide to Foot Care

A Simple Guide to Foot Care
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What is Foot Care?
------------------------------------

Typically the foot is furthest from the heart and therefore more easily plagued with problems like poor blood circulation or neurological deficit.

Therefore taking care of the foot is very important especially in diabetic patients.

Foot care is an important tool in prevention of foot problems at all ages.


What is important in Foot care?
--------------------------------------

Footwear:

1.Shoes should fit comfortably.

2.Soft shoes like canvas or soft leather is preferred because they cause less
pressure points.
Foam rubber shoes cause fewer planter calluses

3.The toe box should be wide and high enough to accomodate any exostosis or contractures.

4.Shoes should have anterior as well as a posterior heel.
This protects the metatarsal heads from coming under stress.

5.Wearing sport shoes which are comfortable and has air bubbles at the front and back of the shoes will prevent friction in sports like jogging and brisk walking.

6.Woman's shoes should not have high heels as these increase increased pressure
on the planter surface and the metatarsal bones.
A low heel lace shoe is more comfortable because of the bigger toe box.

7.Specially constructed shoes may be necessary for patients with deformities of the foot.

8. Full length soft molded inlays can be used when pressure sores or painful calluses are present.

Socks:

1.Socks or stocking should fit comfortably and kept dry at all times

2.Tight constricting stocking should not be worn.

3.Loose stockings which can wrinkle should also be avoided

Foot:

1.Inspect and clean foot daily.

2.wash feet daily with bland soap and lukewarm water.

Pat dry gently and thoroughly especially between the toes after wash.

Do not rub the foot vigorously.

3.keep your toe nails short,trimming them straight across to avoid ingrowing toenails

4.moisturise feet daily to prevent dryness and cracking of skin

5.web spaces should be kept dry with powder or small pieces of cotton wool in between toes.

6.examine feet daily for scratches, cuts, blisters and corn

7.use a mirror to check the sole of your feet

8.Avoid going barefoot

9.Seek prompt treatment for cuts and sores

10.annual review for foot ulcers, risk of neuropathy(poor sensation), blood circulation( palpable pulses)

General Measures:

1.Smoking should be avoided as it causes constriction of the blood vessels

2.Avoid extreme temperatures such as excessive heat or cold

3.Home surgery should avoided in diabetes and those with vascular disease.

Avoid cutting calluses or corns yourself.

Also avoid applying strong chemicals to calluses or corn.

Instead try changing the weight bearing stresses on the foot.

4.When ulcers do appear they are most commonly on the weight bearing surface of the foot.

Vigorous local care such as removal of infected tissues and control of infections with antibiotics and antibiotic creams are indicated.

If the foot is warm and the blood flow good(feel pulse), healing of ulcers
usually will occur.

Raise the foot and exercise the foot to improve blood circulation.

5.Any injuries or cuts in the foot should be treated instantly to prevent any complication such as infection

6.Good balanced diet and a healthy lifestyle is important.

A Simple Guide to Pancreatic Cancer

A Simple Guide to Pancreatic Cancer
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What is Pancreatic Cancer?
------------------------------

Pancreatic Cancer is a malignant disease of the exocrine pancreas. 90% are adenocarcinomas.

What are the causes of Pancreatic Cancer?
-----------------------------------------

1.Smoking. cigarettes smoke chemicals has been known to damage the pancreatic cells

2.Diets rich in red meat- high protein tends to stmulate more enzymes frm pancreas and cause dysfunction in the cells

3.Diabetes mellitus -damage to islets in pancreas may contribute to pancreatic cancer

4.Chronic pancreatitis has been found to have some causal effect

5.Helicobacter pylori infection -known to cause stomach cancer and also pancreatic cancer

6.Occupational exposure to certain chemicals including insecticides

7.Family history -there is a family history in 5-10% of pancreatic cancer patients

8.Obesity - the high fat diet may induce more disease of bile system with blockage of its tract

What are the symptoms and signs of Pancreatic Cancer?
-------------------------------------------------------

Symptoms - non-specific and varied.

1.pain in the upper abdomen that typically radiates to the back

2.pain relieved by leaning forward

3.painless jaundice related to bile duct obstruction (carcinoma of the head of the pancreas)

4.depression is sometimes associated with pancreatic cancer


Signs:

1.tenderness in upper abdomen

2.mass in the abdomen

3.Trousseau sign- Spontaneous blood clots in veins of extremities, or the superficial veins may indicate presence of pancreatic cancer.


How do you diagnose Pancreatic Cancer?
----------------------------------------------

Diagnosis can usually be made by :

History
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1.pain in upper abdomen radiating straight to the back, worse on eating

2.Weight loss severe with anorexia, early satiety, diarrhea, or steatorrhea.

3.Jaundice -initially painless, itchy with dark urine.
Painful jaundice occurs later

4.onset of atypical diabetes mellitus

5.unexplained recent thrombophlebitis

6.past history of pancreatitis

Location of cancer
-----------------------

1.Tumors in the pancreatic body or tail usually present with pain and weight loss

2.Tumors in the head of the gland typically present with steatorrhea, weight loss, and jaundice.

Courvoisier sign
-----------------

presence of jaundice and a painlessly distended gallbladder is suggestive of pancreatic cancer

Liver function tests
---------------------

may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels).

CA19-9 (carbohydrate antigen 19.9)
----------------------------------

is a tumor marker that is frequently elevated in pancreatic cancer.

Ultrasound or abdominal CT
------------------------------

may be used to identify tumors.

Endoscopic ultrasound (EUS) is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis.

What is the treatment of Pancreatic Cancer?
------------------------------------------------

Treatment of pancreatic cancer can be surgery or chemotherapy depending on the stage of the cancer.

Surgery
--------------

1.Where the head of the pancreas is involved, the Whipple procedure is the most common surgical treatment for pancreatic cancers.
It is a major surgery involving the the resection of the head of pancreas and requres the patient to be fit for the surgery and the tumor to be localised without metastases. Only in small number of cases can the surgery be done.

2.Cancers of the tail of the pancreas can be removes by a technique called distal pancreatectomy

3.localized tumors of the pancreas have been surgically removed using laparoscopy.

4.Surgery may be performed for relief of symptoms especially if the cancer is invading or pressing on the duodenum or colon.

5.Bypass surgery may prevent the obstruction of the pancreatic ducts and improve quality of life.

Chemotherapy
-----------------

is used for patients not suitable for surgery. It can relieve symptoms and improve quality of life

Gemcitabine was approved by the US FDA after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer

Gemcitabine may used after surgery to remove tumor tissue remaining in the body. As a result 5-year survival rates has improved.

Other drugs such as oxaliplatin and fluorouracil have also beneficial effect.

Radiation therapy
--------------------

The use of additional radiation therapy follwing surgery has been used in USA while rejected by most doctors in Europe.

What is the Prognosis of pancreatic cancer?
-------------------------------------------------

The prognosis of pancreatic cancer is poor

1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.

2.Median survival from diagnosis is around 3-4 months;

3.5-year survival is lower than 5%.

4.Pancreatic cancer has the highest mortality of all the cancers.

5.Pancreatic cancer may sometimes cause diabetes.

How to prevent Pancreatic Cancer?
----------------------------------------

1.a healthy lifesyle

2.increase consumption of fruits, vegetables

3.reduce red meat intake

4.Vitamin D can reduce the risk of pancreatic cancer

5.B vitamins such as B12, B6, and folate in food but not in tablets may reduce the risk of pancreatic cancer

6.Avoid smoking and drinking of alcohol

A Simple Guide to Pancreatitis

A Simple Guide to Pancreatitis
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What is Pancreatitis?
----------------------

Pancreatitis is an acute or chronic inflammation of the pancreas.

What are the causes of Pancreatitis?
-----------------------------------------

Pancreatitis is usually caused by the following:

1. Alcoholism and diseases of the biliary tract

2. bacterial infections from salmonella typhi and streptococcus

3. viral infection especially mumps, coxsackie virus, cytomegalovirus

4. trauma

Chronic disease follows attacks of acute infection.

What are the symptoms and signs of Pancreatitis?
-------------------------------------------------------

Persons who has Acute Pancreatitis has the following symptoms:

1.acute onset of abdominal pain starting from the epigastrium, radiating to the back in 50% of cases.

2.Pain usually very severe occuring a large meal or drinking bout

3.Pain is worse lying supine, therefore patients sit or lean forward

4.mild fever and bodyaches

5.nausea and vomitting

6.hypotension followed by clinical shock

Signs:

1.Tenderness at the epigastrium with muscle spasm

2.Distension and diminished bowel sounds

3.Pleural effusion 10%,abdominal mass 20%, ascites 20%

4. Acute renal failure, respiratory failure following shock.

Chronic Pancreatitis
---------------------
Symptoms:

1.repeated attacks of epigastric abdominal pain

2.Pain worse after eating, radiates to the back

3.weight loss

4.Fever

Signs:

1.abdominal tenderness

2.abdominal mass may suggest swelling and pseudocysts

3.tender subcutaneous masses seen indicating fat necrosis

How do you diagnose Pancreatitis?
--------------------------------

Diagnosis can usually be made by :

1.Physical examination with tenderness in the epigastrium

2.Serum and urine amylase very high after 6 hours

3.White blood cell count high

4.Serum lipase high in 50% patients

5.Blood calcium may be low

6.Blood glucose tolerance test for diabetes

7.Ultrasound may show up the presence of pseudocyst in pancreas

8.CAT scan and MRI may show swelling and pseudocysts in pancreas

What is the complications of Pancreatitis?
-------------------------------------

1.Pseudocysts from damage to pancreatic tissues

2.Hemorrhage - bleeding due to damage to the blood vessels in pancreas

3.peritonitis from rupture of pseudocysts and bleeding

4.diabetes mellitus from damage to the glands in the pancreas producing insulin

What is the treatment of Pancreatitis?
-------------------------------------

Acute Pancreatitis:
----------------------
Admission to hospital

Gastric suction and fluid replacement

Analgesic or antispasmodic medicine usually by injection

Antibiotics for infections

Treat biliary tract diseases and alcoholism

surgical drainage of pseudocysts after acute episode.

Chronic Pancreatitis:
-----------------------

Pancreatic extracts and enzymes together with meals

Sodium bicarbonate and cimetidine to prevent enzymes breakdown

Analgesic or antispasmodic medicine usually by injection

Surgical procedures usually unsuccessful

What is the prognosis of Pancreatitis?
----------------------------------------

Prognosis is usually good after treatment of acute pancreatitis with recovery in 5-7 days.

Hemorhagic Pancreatitis has high mortality of 50-90%

Most trauma cases has complete resolution

Some alcoholic pancreatitis may go on to chronic pancreatitis.

Chronic pancreatitis relapses frequently

Rupture of pseudocysts may result in death

How do you prevent Pancreatitis?
------------------------------------------------

Avoid alcohol and oily food

Take precautions during mumps and other viral infection

Avoid injury to the abdomen especially the mid section below the sternum

A Simple Guide to Obesity

A Simple Guide to Obesity
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What is obesity?
--------------------

Obesity is defined as having a weight 20% above the desirable weight which is having a BMI (Body Mass Index) of 22 or less.
It is a chronic medical condition where fat accumulates in the body due to excess calories.
Obesity is harmful to the person's health and well being.

What causes obesity?
--------------------------

Many factors contributes to obesity:

Genetic factors
-------------------

Obesity runs in the family and is hereditary.
Family members who share the same diet and lifestyle may have the same overweight condition.

Environmental factors
---------------------------

The environment is an important factor in determining obesity.
1.Overeating -
many people have an increased craving for food.
It has found that these people lack a hormone called serotonin in the brain which acts to decreased appetite.

2.low metabolism -
some people has a lower metabolic rate tends to accumulate the excess energy from food as fats in the body.
Classic example is hypothyroidism where the low thyroid hormone reduce the capacity of the body to burn off energy so they become lethargic and fat.

3.lack of exercise -
Exercise helps to burn up calories.
People who tend to have a sedentary life without exercise tends to be overweight

4.Certain medications:
some medications like corticosteroids, female hormones aand antidepressants tends to cause increased appetite and water retention and contributes to weight gain.

Psychological factors
---------------------

Psychological factors may be the cause of tendency to overindulge in food.
Some people eats more out of boredom, sadness, or anger.
Others overeat as a way of dealing with stress or depression.

Rare illnesses:
------------------

Some rare illnesses like hypothyroidism, Cushing's syndrome, depression, and certain neurological problems can lead to overeating.
These conditions are believed to be responsible for only about one percent of all obesity cases.

What is the criteria for diagnosis of Obesity?
------------------------------------------------

The most widely used method is the body mass index (BMI).
BMI is the gauge of the amount of body fat in adults.

BMI = Your Weight (kg)
---------------------
Height (metres) x Height (metres)

The risk of developing heart disease and diabetes begins at BMI values of 23 kg/m2 and above.
BMI (kg/m2) (for adults):
Risk of Heart Disease and Diabetes

27.5 and above
High Risk

23.0 - 27.4
Moderate Risk

18.5 - 22.9
Low Risk (healthy range)

Less than 18.5
Risk of nutritional deficiency diseases and osteoporosis

Knowing your BMI will motivate you to lower your weight.

What are the Complications from obesity?
----------------------------------------

Health hazards
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Obesity is not just a cosmetic problem.
Many serious medical conditions are associated with it:
--------------------------------------------------------------------------

1.High blood pressure

2.High blood cholesterol

3.Diabetes

4.Coronary heart disease

5.Stroke

6.Gallbladder disease

7.Liver disease

8.Degenerative joint disease

9.Cancer (colon, uterine, breast and other cancers).

10.Gout,caused by high levels of uric acid in the blood from the high purine
proteins consumed.

11.Sleep apnoea

Emotional effects:
------------------

1.Feelings of rejection, shame, or depression

2.Feeling undesirable compared with a slim person.

3.Some face prejudice or discrimination.

4.Some may be seen as lazy or lacking in self-control.

Treatment of Obesity will follow in A Simple Guide to Obesity Part 2

A Simple Guide to Coronary Heart Disease Part 2

A Simple Guide to Coronary Heart Disease Part 2
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What is the treatment of Coronary Heart Disease?
-----------------------------------------------------------

Any heart attack is an EMERGENCY!
Immediate treatment is urgent!

While waiting for the ambulance, lie the patient in a slightly inclined position.
Give nitroglycerin tablet under the tongue if available.
Admit to hospital as an emergency.

Severe cases are admitted to Cornary care unit(CCU) for constant monitoring of the heart, blood pressure and abnormal rhythm of heart rate.

Risk factors for Coronary heart disease like hypertension, high cholesterol, diabetes must be treated.

Medicine:
-----------

Anticoagulants such as warfarin, aspirin, Plavix,should be given to
prevent blood clots .

Vasodilators like isorbide are given to help dilate the artery to the heart

Any abnormal rhythm of the heart must also be treated with medications or pacemaker if severe as damage to heart may affect the conduction of the electrical impulse of the heart to the cardiac muscles.

Because of the psychological effect of a heart attack on the patient, sometimes antidepressant or tranquilliser may be necessary.

Interventional Procedures:
--------------------------

Once stable the patient may be requred to have a ballooning of the narrowed artery or a stent inserted in the narrowed artery.
This can be done during the cardiac catheterisation.

1.balloon angioplasty
balloon is inflated to compress fatty matter to the wall of narrowed artery and open the blood vessel

2.Stent:
balloon angioplasty is performed in combination with placement of a stent which is a small, metal mesh tube that provide support inside the coronary artery.

3.Drug eluting stents (DES):
Drug-eluting stents contain a medication that is actively released at the stent implantation site to prevent recurrence of narrowing of the artery

4.Rotablation
The Rotoblation special catheter, with an acorn-shaped, diamond-coated tip, spins around at a high speed and grinds away the heavily calcified plaque on the arterial walls.

5.cutting balloon
The cutting balloon catheter has a balloon tip with small blades which are activated when the ballon is inflated. The small blades remove the plaque and the balloon compresses the fatty matter into the arterial wall.

Surgery :
-------------

If the narrowing involved too many arteries, then a coronary artery bypass graft (CABG) surgery will have to be done.

Stay in Hospital and Rehabilation:
---------------------------------

Usually a heart attack patient stays in hospital for 2-4 weeks depending on the severity of his condition.

Mild exercise is started once his condition is stable.
Exercise is good for the patient because it helps the blood circulation.

However strenous exercise including sexual inercourse should start until at least 4-6 weeks later.

Most patients should be able to drive or fly after 2 months.

What can I do to prevent Coronary Heart Disease?
---------------------------------------------------

Prevention of a heart attack is the same as prevention of a stroke as both involve the avoiding the blockage of a major artery to the brain or heart.

1.Control the Blood Pressure
Have your blood pressure checked at least once a year from the age of 40 years.
If there is high blood pressure, lifelong treatment with monthly checkups will keep it under control.

2.Control the Diabetes
Check for diabetes starting from the age of 40 years. If there are risk factors for diabetes, screening should start earlier.
If there is diabetes, take the medicine or injections regularly.
Monitor the sugar levels daily.
Control the diet.
Check with the doctor regularly.

3.Watch Your Diet
Reduce consumption of fat, high-cholesterol food, sugar and salt.
Take more fruit, vegetables and moderate servings of carbohydrates.
Eat more beancurd, dried peas, dried beans, fish and chicken instead of red meat.
Drink low-fat milk.
Avoid full cream milk.
Avoid alcohol.
Drink less coffee, tea and cola drinks.

4.Don't Smoke
Stop smoking immediately.
Don't start smoking if you are not a smoker.

5.Physical Activity
Regular exercise is good for you.
Do moderate intensity physical activity for 30 minutes such that you sweat and breathe deeply without getting breathless.
Examples include brisk walking, swimming, cycling.

6.Learn To Relax
Have adequate rest especially when you feel tense or tired.
Take up a hobby.
Do relaxation exercises such as yoga or deep breathing exercises.
Time management is important.

What is the prognosis of Coronary Heart Disease?
---------------------------------------------------

The outlook following a coronary heart attack is generally good.
About 80% of patients are alive after 3 years and 70% after 6 years.

The outlook varies depending on the age of the patient and severity of the heart attack.

However with new treatment and a healthy lifestyle, the prognosis has improved tremendously.

Medication such as Aspirin or warfarin may have to be taken permanently to prevent a recurrent attack.

A Simple Guide to Stroke 2

A Simple Guide to Stroke 2
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What is the treatment of Stroke?
--------------------------------

Stroke is an emergency.

Purpose of treatment is to:

1. preserve life

2. limit the amount of brain damage

3. lessen the extent of disability and deformity

4. prevent recurrence of a stroke.

Admission to hospital is necessary to determine

1. the cause of the stroke

2. the extent of damage to the brain using MRI of the brain

3. immediate treatment with medicines(usually anticoagulant,blood circulation,nerve vitamins).

4. whether Surgery is necessary to stop bleeding or remove a blood clot

5. risk factors for stroke are investigated and treated (diabetes, high blood pressure etc)

During the acute phase of stroke:
1. A clear airway must be maintained

2. Sufficient fluid and electrolyte intake must be maintained

3. Adequate nutrition in the form of glucose, proteins and calories must be given

4. Adequate nursing care is provided to prevent bed sores etc

5. Proper medicines are given

Once the stroke is stable:
The stroke patient is started on a rehabilitation programme.

This will include
a.exercises to strenthen his muscles,

b.speech training for patients with dysphasia (difficulty in talking)

c.training on how to carry out his daily activities.

d.advice about his diet

Immediate care improves the chance of a complete recovery.

How to care for a Stroke Patients?
----------------------------------------

A stroke can be very devastating and depressing for a patient.

He will feel that part of his body and brain function is incapacitated.

Therefore he need all the support from everyone involved in the treatment of his condition:
1.doctors,
2.nurses,
3.physiotherapist,
4.speech therapist
5.occupational therapists
6.family members and friends

Family members can provide the most important means of support.
They should be familiar with his disabilities and help him accordingly:

Please do:
--------------
1.be understanding and patient.

2. keep the patient cheerful and hopeful

3.learn how to help him with the diet, daily exercises and other care necessary for him

4.allow the person more time to do any task

5.encourage and praise the patient to do as much as possible for himself at his own pace.

6.involve the person in family discussions and activities.

7.be encouraging and praise his daily efforts.

8.encourage the person to look at, touch, and move his affected limbs.

Do not:
----------
1.ignore him or treat him like a child .

2.encourage the person to do things using the good side only.

3.pull on the affected arm or leg as it can be extremely painful.

4.interrupt or speak up for him.

5.make discouraging remarks.

6.allow the person to squeeze rubber balls as this may tighten his hand muscles.

7.let him be depressed

8.let him develop bed sores. Try to turn his body regularly.

In order to help the person be as independent as possible, there are
special aids(such as tripod walking cane) and
appliances(wheelchairs) which can be used to help him with his daily activities.

There are also special clothes and shoes which uses velcro instead of buttons or zips.

Make the home a safe place with non-slipmats and grab bars

How to Prevent Stroke?
----------------------

Prevention of a stroke is the same as the prevention of a heart attack as both involve the avoiding the blockage or bleeding of a major artery to the brain or heart.

1.Control the Blood Pressure
Have your blood pressure checked at least once a year from the age of 40 years.
If there is high blood pressure, lifelong treatment with monthly checkups will keep it under control.

2.Control the Diabetes
Check for diabetes starting from the age of 40 years.
If there are risk factors for diabetes, screening should start earlier.
If there is diabetes, take the medicine or injections regularly.
Monitor the sugar levels daily.
Control the diet.
Check with the doctor regularly.

2.Watch Your Diet
Reduce consumption of fat, high-cholesterol food, sugar and salt.
Take more fruit, vegetables and moderate servings of carbohydrates.
Eat more beancurd, dried peas, dried beans, fish and chicken instead of red meat.
Drink low-fat milk.
Avoid full cream milk.
Avoid alcohol.
Drink less coffee, tea and cola drinks.

3.Don't Smoke
Stop smoking immediately.
Don't start smoking if you are not a smoker.

4.Physical Activity
Regular exercise is good for you.
Do moderate intensity physical activity for 30 minutes such that you sweat and breathe deeply without getting breathless.
Examples include brisk walking, swimming, cycling.

6.Learn To Relax
Have adequate rest especially when you feel tense or tired.
Take up a hobby.
Do relaxation exercises such as yoga or deep breathing exercises.
Time management is important.

A Simple Guide to Candidiasis

A Simple Guide to Candidiasis
------------------------------------

What is Candidiasis ?
-------------------------

Candidiasis is caused usually by the fungus Candida albicans.
Other Candida species or yeasts are also responsible.

What are the causes of Candidiasis ?
-------------------------------------------

1. Broad spectrum Antibiotic therapy kills off normal bacterial flora, resulting in invasion of fungi or yeasts
2. Diabetes mellitus - the high sugar content in the blood and vagina lining are conducive to fungal or yeast infection
3. Steroid or immunosuppressive drugs suppress the immune response to bacterial and fungal infection.

What is the symptoms of Candidiasis ?
----------------------------------------------

30% of patients do not have any symptoms.
The rest have symptoms like:
1. pruritus,

2.vaginal soreness,

3.dyspareunia,

4.external dysuria, and

5.abnormal white transparent vaginal discharge with heavy odour.

About 75% of women will have at least one episode of Candidiasis, and 45% may have two or more episodes.

How do you diagnose Candidiasis ?
------------------------------------------

A diagnosis of Candida vaginitis is made clinically by the presence of:
1.external dysuria

2.vulvar pruritis, pain, swelling, and redness.

3. vulvar edema, fissures, excoriations,

4.thick curdy vaginal discharge.

The diagnosis is confirmed by
1) a Gram stain of vaginal discharge showing the presence of yeasts
2) a vaginal swab for culture shows the presence of a yeast species.

What is the treatment of Candidiasis ?
---------------------------------------------

Short-course intravaginal antifungal pessaries effectively treat uncomplicated Candidiasis .
The topically applied imidazole drugs are more effective than nystatin.
90% of patients are usually cured.

Oral Agent such as Fluconazole 150 mg may be given in one tablet in single dose.

Patients should be instructed to return for follow-up visits only if symptoms persist.

Candidiasis is not usually acquired through sexual intercourse.

A minority of male sex partners might have balanitis, which is characterized by itchy red areas on the glans of the penis.
These men benefit from treatment with topical antifungal agents to relieve symptoms.

Topical agents usually do cause any systemic side effects although in some people local burning or irritation might occur.
Oral agents sometimes cause nausea, abdominal pain, and headache.
Some abnormal elevations of liver enzymes may occur with treatment with the oral azoles.

What are the complications of Candidiasis?
---------------------------------------------------

1.Recurring Candidiasis:A small percentage of women (<5%)>.
The majority of women with recurring Candidiasis have no apparent predisposing or underlying conditions.
Vaginal cultures should be obtained from these patients to confirm the clinical diagnosis and to identify unusual species, including nonalbicans species, particularly Candida glabrata
Conventional antimycotic therapies are not as effective against these species as against C. albicans.

A longer duration of initial therapy is necessary to attempt mycologic remission before initiating a maintenance antifungal regimen:

Oral fluconazole (i.e., 100-mg, 150-mg, or 200-mg dose) weekly for 6 months
topical clotrimazole 200 mg twice a week,
clotrimazole (500-mg dose vaginal pessaries once weekly)

2.Women with underlying debilitating medical conditions (e.g., uncontrolled diabetes or on corticosteroid treatment) do not respond as well to short-term therapies.
The underlying diseases should be treated and more prolonged (i.e., 7–14 days) conventional antimycotic treatment is necessary.

3.During pregnancy, Candidiasis is quite common.
Only topical azole therapies, applied for 7 days, are recommended for use .
Oral treatment is contraindicated because of risks of deformity in the foetus.