HIFU in Uterine Fibroids

Uterine fibroids or myomas are the most common tumours to affect women, and are present in up to 40% of women in the reproductive age group. Not all of these women are symptomatic, and they usually do not require any treatment for these fibroids. Occasionally, the fibroids can cause pain, heavy menstrual as well as inter-menstrual bleeding, and pressure effects such as frequency of urination due to the size of the fibroid. In a small number of cases, fibroids can be a cause of infertility.

Fibroids are traditionally known to grow very slowly throughout the reproductive life of a woman, and they exhibit a growth spurt during pregnancy. After menopause, a fibroid typically begins regressing in size, and at this stage, fibroids rarely need to be treated.

Attempts at symptomatic relief through medications have largely been unsuccessful, leaving the patient suffering from fibroids no option other than surgery.

The mainstay of treatment of symptomatic fibroids has been surgery, which could be either myomectomy (removal of the fibroid), or hysterectomy (removal of the uterus). Of these, only hysterectomy ensures that the patient will never suffer from fibroids again, but is a rather radical option for a benign tumour that only requires symptomatic relief. Also, a hysterectomy is followed by a lengthy recovery period before the patient returns to normal activities. Both hysterectomy as well as myomectomy can also be done laparoscopically (key-hole surgery), dramatically reducing the post- operative morbidity. However, even these are invasive techniques, and the risks and possible complications of surgery and anesthesia remain a constant threat.

The search for non-invasive techniques to provide the patient with relief from this otherwise non- threatening illness led to other minimally invasive options like Uterine Artery Embolisation, and Radio- Frequency Ablation which however had limited efficacy, and considerable adverse effects like excruciating post-treatment pain.

MRI guided HIFU or Magnetic Resonance Imaging- guided High Intensity Focused Ultrasound is an innovative mode for genuinely non-invasive treatment of fibroids. Under MRI guidance, sound waves are passed into the body and focused into the fibroid to heat and coagulate the tissues.

As fibroids are almost always benign, with a neglible percentage showing the presence of a sarcoma (malignancy),fibroids only require treatment for the alleviation of symptoms due to the fibroid.

This is a day-care surgery, where the patient reports to the clinic for the procedure, undergoes the procedure and is able to walk out and go home after the procedure. The patient is able to go back to her regular routine within the next 24 hours, and the symptomatic relief obtained with this procedure is comparable to that following a myomectomy in the long term

In this procedure, the MRI acquires high resolution 3-D images of the fibroid and surrounding structures. These images are used for accurate planning and mapping of the treatment. During treatment, the HIFU transducer focuses the ultrasound beam into the fibroid as per the planned areas (cells) and heats the tissue up to 65 degree Celsius, coagulating it. This is called sonication.

MRI guided HIFU ensures patient safety by having a number of safety mechanisms built into the system. All of these ensure that apart from the tissue being targeted, no other organ or tissue is affected by the treatment.

In a nutshell, MRI guided HIFU satisfies the need for a non-invasive procedure that is a safe, gentle, and convenient way to provide long-lasting relief from the symptoms caused by uterine fibroids

Watermelon - A feast for tongue and Health

Watermelon (Citrullus lanatus (Thunb), family Cucurbitaceae is a vine-like (scrambler and trailer) flowering plant originally from southern Africa. Its fruit, which is also called watermelon, is a special kind referred to by botanists as a pepo, a berry which has a thick rind (exocarp) and fleshy center (mesocarp and endocarp). Pepos are derived from an inferior ovary, and are characteristic of the Cucurbitaceae. The watermelon fruit, loosely considered a type of melon – although not in the genus Cucumis – has a smooth exterior rind (green, yellow and sometimes white) and a juicy, sweet interior flesh (usually pink, but sometimes orange, yellow, red and sometimes green if not ripe). It is also commonly used to make a variety of salads, most notably fruit salad.

Nutrition:

A watermelon contains about 6% sugar and 92% water by weight. As with many other fruits, it is a source of vitamin C.

The amino-acid citrulline is also extracted from watermelon 

Watermelon rinds, usually a light green or white color, are also edible and contain many hidden nutrients, but most people avoid eating them due to their unappealing flavor. They are sometimes used as a vegetable. In China, they are stir-fried, stewed or more often pickled. When stir-fried, the de-skinned and de-fruited rind is cooked with olive oil, garlic, chili peppers, scallions, sugar and rum. Pickled watermelon rind is also commonly consumed in the Southern US. Watermelon juice can be made into wine.

Watermelon is mildly diuretic and contains large amounts of beta carotene. Watermelon with red flesh is a significant source of lycopene.

Watermelon also helps in variety of medical conditions which are as under:

Kidney Disorders:Water Melon contains a lot of potassium, which is very helpful in cleaning orwashing off the toxic depositions in the kidneys. Moreover, it is helpful inreducing concentration of uric acid in the blood, thereby reducing the chancesof kidney damages and formation of renal calculi in it. Added to these, beinghigh in water content, it induces frequent urinating, which is again helpfulfor cleaning of kidneys. Also, the anti oxidants present in ensure good healthof kidneys for a long.

High Blood Pressure:A good amount of Potassium and magnesium, present in water melons, are verygood in bringing down the blood pressure. The carotenoids present in themprevent hardening of walls of arteries and veins, thereby helping reduce bloodpressure.

Prevent Heat Stroke:Water melon is effective in reducing your body temperature and blood pressure.Many people in the tropical regions eat the fruit daily in the afternoon during summers to protect themselves from heat stroke. In India, you will find thefruit being sold by vendors in almost every street during summers.

Diabetes:Diabetes patients, who are supposed to have low energy and low sugar diet,often complaint about starving since they don’t get to eat their staple diet totheir full, giving them a feeling of keeping half fed. Water Melons can be agood supplement for them. In spite of being sweet in taste, a thick wedge willgive you very few calories, since ninety nine percent of its total weight iscomposed of water and roughage. Moreover, the various vitamins and mineralssuch as potassium and magnesium help in proper functioning of insulin in thebody, thus lowering the blood sugar level. Arginine, another component found inwater melons, is very effective in enhancing impact of insulin on sugar.Diabetes patients can also have curries, steaks, salads made from water melon rinds which are even lower in sugar.

Heart Care:Lypocene, a carotenoid found in abundance in water melon, improves cardiacfunctions. Beta carotene, known for its remarkable anti oxidant and anti aging properties, also keeps you young at the heart and prevents age related cardiac problems. The roughage in water melon and its very low energy, with help from vitamin-C, Carotenoids and potassium (potassium cuts the risk of a heart attack), help reduce cholesterol and keep heart safe.

Macular Degeneration:Beta carotene, vitamin-C, Lutein and Zeaxanthin. They ensure protection of eyes from macular degeneration. These anti oxidants protect eyes from other age related ailments such as drying up of eyes and optical nerves, glaucoma etc.

Impotence: Arginine, present in water melon, is beneficial in curing erectile dysfunction.

Other Benefits:Lypocene is found to be effective in preventing cancer, prostrate growth andrepair damaged tissues. Water melon seeds are rich in good fats and proteins.Water melons also contain phytonutrients which have very good effect on the health and proper functioning of internal organs, eyes, secretion system etc.

Celiac disease: A single culprit behind many ailments

Celiac disease is believed to be a rare condition, both by the health professionals and the general public. While in western world it is beginning to get more attention than before, in India it is just getting recognized. Today, it is neither rare with 1-2% of population suffering from it, nor necessarily a diarrhoeal condition. Also, no longer is it a childhood disease as majority of cases are being picked up between 40 – 60 years of age. Nearly, 25% cases are diagnosed in individuals over 60 years of age. The disease occurs globally, has no socio-economic boundaries and can occur at any age.

Celiac disease is a condition where individuals cannot commonly tolerate gluten, a protein found commonly in grains including wheat, oats, barley etc. Here this gluten damages the intestinal lining and reduces the ability of the body to absorb food.
Typical symptoms of celiac disease include diarrhoea, gastrointestinal disturbances like abdominal distension, pain, constipation, flatulence, nausea, vomiting, growth problems, stunting, anaemia, but not everyone presents with these. In fact only 50% cases may present with diarrhoea. Other symptoms include weight loss, lethargy, tiredness, bone problems like osteoporosis, muscle cramps, skin problems, infertility, mouth ulcers, numbness and behaviour problems like depression, anxiety, poor school performance etc. Absence of typical symptoms makes the diagnosis difficult and often leads to ill health and life threatening disease.
Causes for celiac disease are still obscure. It is clearly a complex interaction of genetics and environment. Some specific genes have been identified and some are yet to be identified. Some of the environmental risk factors associated with the development of celiac disease, particularly in children include absence of breast feeding, repeated infections and early introduction of cow’s milk, wheat and egg. New hybrid wheat that we are consuming now a days is also implicated as a probable cause for increasing prevalence.
In India, the prevalence of celiac disease is certainly more common than previously appreciated and since it is largely an undiagnosed condition, the real numbers may be much larger.
As far as diagnosis is concerned it is also a challenge. The disease may present itself in many ways – typical, atypical, or silent (with very mild symptoms), which makes the diagnosis very difficult. Left undiagnosed, celiac disease can increase the risk of developing a severe form of malnutrition, non specific ill health and can even prove fatal. Celiac disease can also increase the risk of type-I diabetes, autoimmune diseases, liver diseases, thyroid disorders, pulmonary diseases such as asthma, Inflammatory bowel diseases, as well as cancer. New serological markers like tissue trans glutaminases antibodies (tTg,IgA) and anti endomycelial antibodies can detect the condition with 99% reliability. Endoscopic biopsy can confirm gluten intolerance.
It is a permanent condition and requires life long strict restriction to gluten along with nutritional supplements to correct deficiencies. Gluten-free diet usually helps restore normal health.
Common signs & symptoms: Recurrent digestive complaints, Liver disorders, milk intolerance, Lack of appetite, Mouth ulcers, Growth failure in children, weight loss, unexplained fatigue, fattened nails, easy bruising, anemia, frequent headache, bone and joint pains, infertility, Giddiness and imbalance, numbness and tingling sensation, depression, anxiety, poor attention span, eczema and psoriasis.

Infections in HIV/AIDS

The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems. Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages.

Opportunistic infections are common in people with AIDS. HIV affects nearly every organ system.

People with AIDS also have an increased risk of developing various cancers such as Kaposi's sarcoma, cervical cancer and cancers of the immune system known as lymphomas. Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss. The specific opportunistic infections that AIDS patients develop depend in part on the prevalence of these infections in the geographic area in which the patient lives.

Pneumocystis pneumonia (PCP) is relatively rare in healthy, immunocompetent people, but common among HIV-infected individuals. It is caused by Pneumocystis jirovecii.

Before the advent of effective diagnosis, treatment and routine prophylaxis in Western countries, it was a common immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count is less than 200 cells per µL of blood.

Tuberculosis (TB) is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, is easily treatable once identified, may occur in early-stage HIV disease, and is preventable with drug therapy. However, multidrug resistance is a potentially serious problem.

In early-stage HIV infection (CD4 count >300 cells per µL), TB typically presents as a pulmonary disease. In advanced HIV infection, TB often presents atypically with extrapulmonary (systemic) disease a common feature. Symptoms are usually constitutional and are not localized to one particular site, often affecting bone marrow, bone, urinary and gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system.

Gastrointestinal infections

Esophagitis. In HIV infected individuals, this is normally due to fungal (candidiasis) or viral (herpes simplex - 1 or cytomegalovirus) infections. In rare cases, it could be due to mycobacteria.

Unexplained chronic diarrhoea in HIV infection is due to many possible causes, including common bacterial (Salmonella, Shigella, Listeria or Campylobacter) and parasitic infections; and uncommon opportunistic infections such as cryptosporidiosis, microsporidiosis, Mycobacterium avium complex (MAC) and viruses, astrovirus, adenovirus, rotavirus and cytomegalovirus, (the latter as a course of colitis).

In some cases, diarrhea may be a side effect of several drugs used to treat HIV, or it may simply accompany HIV infection, particularly during primary HIV infection. It may also be a side effect of antibiotics used to treat bacterial causes of diarrhea (common forClostridium difficile). In the later stages of HIV infection, diarrhea is thought to be a reflection of changes in the way the intestinal tract absorbs nutrients, and may be an important component of HIV-related wasting.

Neurological and psychiatric involvement

HIV infection may lead to a variety of neuropsychiatric sequelae, either by infection of the now susceptible nervous system by organisms, or as a direct consequence of the illness itself.

Toxoplasmosis is a disease caused by the single-celled parasite called Toxoplasma gondii; it usually infects the brain, causing toxoplasma encephalitis, but it can also infect and cause disease in the eyes and lungs. Cryptococcal meningitis is an infection of the meninges (the membrane covering the brain and spinal cord) by the fungus Cryptococcus neoformans. It can cause fevers,headache, fatigue, nausea, and vomiting. Patients may also develop seizures and confusion; left untreated, it can be lethal.

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease, in which the gradual destruction of the myelin sheath covering the axons of nerve cells impairs the transmission of nerve impulses. It is caused by a virus called JC virus which occurs in 70% of the population in latent form, causing disease only when the immune system has been severely weakened, as is the case for AIDS patients. It progresses rapidly, usually causing death within months of diagnosis.

AIDS dementia complex (ADC) is a metabolic encephalopahty induced by HIV infection and fueled by immune activation of HIV infected brain macrophages and microglia. These cells are productively infected by HIV and secrete neurotoxins of both host and viral origin. Specific neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and are associated with low CD4⁺ T cell levels and high plasma viral loads.

Prevalence is 10–20% in Western countries but only 1–2% of HIV infections in India. This difference is possibly due to the HIV subtype in India. AIDS related mania is sometimes seen in patients with advanced HIV illness; it presents with more irritability and cognitive impairment and less euphoria than a manic episode associated with true bipolar disorder. Unlike the latter condition, it may have a more chronic course. This syndrome is less often seen with the advent of multi-drug therapy.

Tumors and malignancies

Patients with HIV infection have substantially increased incidence of several cancers. This is primarily due to co-infection with an oncogenic DNA virus, especially Epstein-Barr virus (EBV), Kaposi's sarcoma-associated herpesvirus (KSHV) (also known as human herpesvirus-8 [HHV-8]), and human papillomavirus (HPV).

Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. Caused by a gmammaherpes virus called Kaposi's sarcoma-associated herpes virus (KSHV), it often appears as purplish nodules on the skin, but can affect other organs, especially the mouth, gastrointestinal tract, and lungs. High-gradeB cell lymphomas such as Burkitt's lymphoma, Burkitt's-like lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary central nervous system lymphoma present more often in HIV-infected patients. These particular cancers often foreshadow a poor prognosis. Epstein-Barr viurs (EBV) or KSHV cause many of these lymphomas. In HIV-infected patients, lymphoma often arises in extranodal sites such as the gastrointestinal tract. When they occur in an HIV-infected patient, KS and aggressive B cell lymphomas confer a diagnosis of AIDS.

Invasive cervical cnacer in HIV-infected women is also considered AIDS-defining. It is caused by human papillomavirus (HPV).

In addition to the AIDS-defining tumors listed above, HIV-infected patients are at increased risk of certain other tumors, notably Hodgkin's disease, anal and rectal carcinomas, hepatocellular carcinomas, head and neck cancers, and lung cancer. Some of these are causes by viruses, such as Hodgkin's disease (EBV), anal/rectal cancers (HPV), head and neck cancers (HPV), and hepatocellular carcinoma (hepatitis B or C). Other contributing factors include exposure to carcinogens (cigarette smoke for lung cancer), or living for years with subtle immune defects.

Interestingly, the incidence of many common tumors, such as breast cancer or colon cancer, does not increase in HIV-infected patients. In areas where HAART is extensively used to treat AIDS, the incidence of many AIDS-related malignancies has decreased, but at the same time malignant cancers overall have become the most common cause of death of HIV-infected patients. In recent years, an increasing proportion of these deaths have been from non-AIDS-defining cancers.

Other infections

AIDS patients often develop opportunistic infections that present with non-specific symptoms, especially low-grade fevers and weight loss. These include opportunistic infection with Mycobacterium avium-intracellulare and cytomegalovirus (CMV). CMV can cause colitis, as described above, and CMV retinitis can cause blindness.

Penicillosis due to Penicillium marneffei is now the third most common opportunistic infection (after extrapulmonary tuberculosis and cryptococcosis) in HIV-positive individuals within the endemic area of Southeast Asia.

An infection that often goes unrecognized in AIDS patients is Parvovirus B19. Its main consequence is anemia, which is difficult to distinguish from the effects of antiretroviral drugs used to treat AIDS itself.

Abdominal Tuberculosis - Myths, Misconceptions & Facts

Tuberculosis is still common in the developing world; so common that it must be considered in the differential diagnosis of a majority of the medical, surgical and gynaecological presentations.
Abdominal tuberculosis too is quite common. While abdominal tuberculosis is one of the commonest forms of extra-pulmonary tuberculosis, it is ill understood and is being neglected all too often by clinicians and researchers. Surprisingly, even some text books on infectious diseases make no mention of abdominal tuberculosis. Clinical Features It is not generally realised that abdominal tuberculosis denotes the involvement of the gastrointestinal tract, peritoneum and/or abdominal lymph nodes. In a study a series of 90 cases of abdominal tuberculosis, more patients with peritoneal tuberculosis presented with acute abdomen than those with gastrointestinal lesions. Some authors describe abdominal rigidity and tenderness to be the most frequent signs-being present in as many as 2/3rd of the cases. However, others have found them in only 5% of their cases. The difference could perhaps be explained by the fact that the former series included more cases of peritoneal tuberculosis while the latter had mainly included cases with gastrointestinal lesions. It is also incorrect to say that obstruction and perforation are rare in abdominal tuberculosis.
Abdominal tuberculosis should be considered as a possibility in any patient who presents with a lump, ascites, intestinal obstruction or peritonitis.
As many as l/3rd of the patients with abdominal tuberculosis may present with an acute abdomen. Rolled up omentum, doughy abdomen, alternating constipation and diarrhoea are more commonly described in text books but are less frequently seen in clinical practice. The presence of associated pulmonary tuberculosis and/or peripheral tuberculous lymphadenitis is not so common as believed but should be looked for. The average age of Indian patients (26 years) is less than that in the whites (45 years). Does it mean that the Indian disease is different from that seen in the West? Investigations It is wrongly advocated that non specific features like malaise, raised ESR and positive Mantoux test should be taken as diagnostic of abdominal tuberculosis in a difficult to diagnose abdominal problem in an Asian patient. Radiological studies too have a high false negative rate (ileal strictures are more likely to be missed) and may fail to differentiate between tuberculosis and carcinoma. Besides, adhesions may be construed as intestinal lesions. Blind percutaneous needle biopsy of the peritoneum, laparoscopic biopsy and peritoneal biopsy with a small grid iron incision in the right iliac fossa under local anaesthesia have been advocated but are hazardous to carry out except in patients with ascites. To sum up, while diagnosis of abdominal tuberculosis should always be kept in mind, a definite diagnosis needs careful and painstaking investigation. Therapeutic trial with anti-tuberculosis chemotherapy, though recommended is not really justified. Although systemic symptoms like fever, anorexia and weight loss may subside within 4 to 6 weeks of anti-tuberculosis chemotherapy, bowel symptoms take much longer to respond. Also, anti-tuberculosis chemotherapy, given for 4 to 6 weeks for purposes of trial, can alter the histological picture so much that subsequent differentiation from Crohn,s disease becomes difficult.
Pathology and Microbiology The pathology of abdominal tuberculosis is well understood—epithelioid cell granulomas, with Langhan,s giant cells, with or without central caseation necrosis. The histological findings of tuberculosis may be present only in the lymph nodes and not in intestinal lesions. Also, previous anti-tuberculosis chemotherapy may alter the histopathological picture. A monograph on inflammatory bowel disease, surprisingly, says that only bacteriological studies.can differentiate gastrointestinal tuberculosis from Crohn,s disease.
The relationship, if any, between abdominal tuberculosis and Crohn,s “disease (regional enteritis) remains a myth: many cases of so called regional enteritis could only be a manifestation of abdominal tuberculosis because mycobacteria like organisms have been isolated from patients with Crohn,s disease. Haddad et al go to the extent of saying that cases being presently diagnosed as regional enteritis are, in fact, abdominal tuberculosis and, in future, regional enteritis may be described as a variant of abdominal tuberculosis. However, there is sufficient evidence in support of a possible separate entity of regional enteritis.
A large number of cases of inflammatory intestinal disease remain unclassified. Microbiological confirmation of tuberculous etiology is difficult, except in tuberculous peritonitis where processing of one litre of ascitic fluid may yield upto 80% positive results. The mycobacterial strains causing abdominal tuberculosis, at least in India, are of the human type.”
Etiopathogenesis The etiopathogenesis of abdominal tuberculosis-either through ingestion of bacilli, hematogenous spread from an active pulmonary focus or reactivation of a latent abdominal focus-does not explain why the gastro-intestinal tract is involved in some patients but in others the disease remains confined to peritoneum and/or lymph nodes; why do some patients develop ulcero-constrictive lesions, while others have hyperplastic masses and why do some patients with tuberculous peritonitis have frank ascites but others largely develop adhesions? The answers to these questions may come from immunological studies of patients with abdominal tuberculosis.
Surgical Treatment Surgical intervention may become necessary in abdominal tuberculosis for two reasons-diagnostic and therapeutic. Diagnostic laparatomy becomes necessary for histopathological/microbiological diagnosis, more often in patients with peritoneal and/or lymph node tuberculosis. Therapeutic surgery is indicated for complications like intestinal obstruction (acute, acute-on-chronic, chronic), perforation and peritonitis. A textbook of surgery mentions that surgical therapy for hyperplastic lesions is rarely indicated and another (of tropical medicine) makes no mention of surgical treatment at all, but that is not true. Strictureplasty may be performed in patients with multiple ileal strictures to preserve intestinal length, in selected cases. For hypertrophic ileocaecal lesions, the surgical procedure of choice is not a right hemicolectomy but a limited (segmental) resection, including only 5 cms of ascending colon, with ileoascending colostomy.

Anti-tuberculosis Chemotherapy The regimen, doses and duration of anti-tuberculosis chemotherapy for abdominal tuberculosis are becoming fairly standardized, but the role of steroids in preventing adhesion formation remains controversial. Cooke has recommended 12-18 months treatment but Dutt : et al found short course (9 months) regimens to be equally effective. Recently, Balasubramanian et al have shown in a controlled trial that a 6 month regimen is as effective as the conventional regimes in the treatment of abdominal tuberculosis. This can be accounted for by the progress made in the recent past in a clearer understanding of the role of multiple drugs, rhythm of administration, duration of treatment and the mode of action of anti-tuberculosis drugs on tubercle bacilli, wherever they are in the body. The site of the disease in abdomen, however, appears to be important in respect of the clinical response to chemotherapy. While peritoneal and nodal lesions respond well, the healing process in intestinal lesions may lead to increased fibrosis going on to intestinal obstruction. An increased occurrence of perforation has been reported in patients with intestinal tuberculosis who were on anti-tuberculosis treatment. However, Anand et al have shown that surgery was required in only 3 out of 39 patients with intestinal strictures treated with chemotherapy.
The first country to eliminate tuberculosis will be the one which regards the disease as a serious problem, right to the end. We in India need to keep this message always in mind as tuberculosis is one of our “National” disease.

Pharyngitis

Acute Pharangitis
It may be an accompanying feature of many local and systemic diseases e.g. Acute attack of common cold or feature of other infections like measles, chicken pox or influenza. May also develop after trauma or after instrumentation.
The chief symptom is sore throat, associated with fever or other constitutional symptoms. Examination reveals diffuse congestion of the pharyngeal wall, uvula and adjacent faucial tissues. Oedema of the lining mucosa and uvula and enlargement of the glands of the neck may be present.
Treatment consists of bed rest, analgesics and antibiotics preferably erythromycin.

Membranous Pharyngitis
Various diseases local or systemic are associated with membrane formation in the pharynx.
Faucial diphtheria: The condition is caused by Corynebacterium diptheriae. The membrane is greyish white and extends to the uvula and soft palate. It cannot be easily removed and on removal leaves a raw bleeding surface. There occurs marked toxaemia associated with a fast pulse rate, disproportionate to the rise in temperature.
Treatment: Diptheria antitoxin along with erythromycin/penicillin.
Vincent’s Angina:

This condition is characterised by an ulcerative lesion on the tonsils, usually on one side. The lesions are covered by slough, which may extend to the adjacent pharyngeal tissues and gums. Low grade fever and malaise are accompanying features. There occurs characteristically fishy odour.
Treatment is by administering penicillin or erythromycin in addition to analgesics and mouth washes.
Agranulocytosis:

It occurs as a result of sensitivity to drugs like sulphonamide, chloramphenicol, cytotoxic drugs. The symptoms are sore throat, ulcerations in the buccopharyngeal mucosa and false membrane formation. Diagnosis is confirmed by the blood picture which shows marked reduction in neutrophils.
Treatment is withdrawal of the drugs.
Leukemia:

Acute lymphocytic leukemia may sometimes present as oropharyngeal ulcerations with membrane formation. Diagnosis is by blood picture.
Infectious Mononucleosis:

It is viral disease which may sometimes be associated with oral lesions. The uvula may be swollen and there may occur inflammatory lesions in other part of buccopharyngeal mucosa. The blood picture shows leucocytosis and relative increase in lymphocytosis. The Paul-Bunnel test is positive.
Moniliasis (Thrush)

It is a fungal infection of the mouth due to candida albicans. The lesions appear as white or greyish whit patches on the oropharyngeal mucosa surrounded by areas of slight redness.
Treatment consists of local application of nystatin in glycerine.

Chronic Pharyngitis:

Chronic inflammation of the pharynx may be non-specific or specific.
Chronic non-specific Pharyngitis: Various aetiological factors in the nose or oral cavity may produce secondary effects in the pharynx. The most constant symptom is discomfort in the throat with a foreign body sensation. Spasms of cough and tendency to clear throat are common. Tiredness of voice and difficulty in swallowing may occur. Diffuse congestion of the pharyngeal wall may be seen and prominent vessels are seen through the inflamed mucosa.
Treatment: It is difficult to reverse the chronic changes once they have set in. However, symptoms can be alleviated to a great extent. Cough suppressants like codeine phosphate linctus and local application of various soothing paints like Mandl’s paint is of help. Alcohol, smoking, irritants and spicy foods should be avoided.

Benefit of improving Foot Muscle Strength

When we think of strengthening exercises, we often assume this refers only to the development of the compound muscles in the body. This is not always an accurate assessment. You can strengthen other components of the body.
For example, you can employ a variety of exercises for the express purpose of enhancing the strength of the muscles in the feet. And this would certainly be a wise move.
The feet have the unenviable task of supporting your body weight. By increasing the strength levels in the muscles in the feet, you will be able to move without discomfort or limitations. How is this so? The answer can be found in a description in the physiology of the feet.

Description of Muscles in Foot
The foot is primarily comprised of muscles, tendons, blood vessels, and bones. In terms of the muscles, there are 20 specific muscles.
These muscles include
• The anterior tibial
• The posterior tibial
• The peroneal tibial
• The flexors
• The etensors
These muscle all tie together to perform the basic function of the feet. In short, the muscles not only support the ability for the toes to move, the stabilization of the toes and ankle to the ground, the ability to move the foot upwards, arch support and movement of the foot but essentially allow the foot to do what it is intended to do when you wish to use your feet!
And, of course, if you do not work to strengthen the muscles, you will not get the most benefit out of your feet.

Benefit of Feet Exercises
It would be difficult to list all the benefits since there are so many but probably the most obvious benefit would be a reduction in the fatigue of the muscles when you use them. In other words, if you need to stand all day or walk a great deal, you can do so without becoming too tired or sore.
Cramps and foot pain will dissipate as the strength of the foot is enhanced and increased. You could even gain greater range of motion with the foot which will also reduce injuries.