Blog Archive

Roth’s Spots Pictures, Definition, Symptoms, Causes, Treatment

A disease in which there is a hemorrhage on the retina with white or pale centers is termed as Roth’s spots. The disease was discovered and explained by a Swiss pathologist “Mortiz Roth” and hence it is named after his name. It is originally associated with a bacterial infection of heart, in which its wall “endocardium” gets swelled. Roth’s spots may also be formed in leukemia, diabetes, collagen-vascular diseases, and other conditions that predispose to hemorrhage in the retina. These spots are believed to be composed of coagulated fibrinogens which may include platelets or neoplastic cells.

Roth’s Spots Pictures

Roth’s Spots Pictures, Definition, Symptoms, Causes, Treatment

Roth’s Spots Pictures, Definition, Symptoms, Causes, Treatment

Roth’s Spots Symptoms

  • Extreme tiredness, typically resulting from mental or physical exertion or illness.
  • Repeated episodes of extreme perspiration that may soak your nightclothes or bedding this condition is called as night sweats.
  • Having temperature more than the normal body temperature this condition is termed as pyrexia or simply fever.
  • Loss of weight that causes weakness.
  • Roth’s spot due to hypertension include following
  • Pain in forehead.
  • Difficulties in breathing
  • Problems in vision.
  • Redness of eyes is also an important symptom of Roth’s spots disease.

Roth’s Spots Causes

The disease can be caused by following major reasons:

  • Swelling of blood vessels mediated due to immune complex resulting from bacterial infection of heart in which endocardium gets swelled.
  • Abnormal mass of blood cells those are dangerous to health.
  • Abnormal increase in growth of blood cells, the leukocytes.
  • Abnormally high sugar level in blood.
  • Sub acute bacterial endocarditis.
  • Retinal loss of vision due to human immunodeficiency virus.
  • Loss of red blood cells.
  • Deficiency of vitamin B12.
  • Restriction in blood supply to tissues, causing a shortage of oxygen and glucose needed for cellular metabolism, to keep tissue alive.
  • Damage to the retina and retinal circulation due to high blood pressure.

Roth’s Spots Treatment

Treatment of roth's spots depends upon underlying cause e.g if endocarditis is main reason of roth's spots then treatment of infection is primary goal to removal all associated complications. Similarly, viral infection, diabetes, leukemia etc may also act as triggering factor in pathogenesis of roth's spots. It is always recommended to consult you health care provider for proper diagnosis of disease and its root cause before initiating any kind of therapeutic treatment.
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Janeway lesion Pictures, Definition, Symptoms, Causes, Treatment

The janeway  lesion is described as collection of pus that has built up within the tissues of the body with marked localized death of living tissue and inflammatory filtrate not involving the epidermis. These macules are only few millimeters in diameter. Janeway lesions are distal, flat, ecchymotic (the escape of blood into the tissues from ruptured blood vessels) and painless. Janeway lesions are named after Edward Janeway (1841–1911). He was a prominent American physician and pathologist who initially described the lesions and after brief research it is named Janeway Lesions.

Janeway lesion Pictures

Janeway lesion Symptoms

  • There are small areas of bleeding under the nails which is also called splinter hemorrhages.
  • There are red colored and painless skin spots on the flat,expanded concave part of the palms of hands between the bases of the fingers and the wrist and soles.
  • There are red colored, painful nodes when touched in the pads of the fingers and toes and these are similar to osler’s nodes.
  • There is very high shortness of breathing during light or hard activity or during exercise.
  • Swelling  and inflammation of feet, legs and the dorsal side of abdomen.
  • Irregular flat,injured and diseased spot on the skin of  hands and feet
  • These are painless skin spot but painful in osler’s nodes. 
  • The color of skin lesions may change from reddish to purplish.

Janeway lesions and Osler's nodes

According to research which is related to pathology janeway lesion is also just similar to osler’s nodes but osler’s nodes is painful when touched with finger tip or simply exerting pressure on it.

Janeway lesions Causes

  • They are caused by infected and contaminated particles circulating in the blood and deposition of  bacteria, forming a painful area of inflamed tissue that is filled with pus.
  • Janeway's lesions are caused by bacteria that have spread from an infection of the lining of the heart 
  • Janeway lessions and Osler’s nodes are may occur due to cutaneous immune-complex mediated by vasculitis, only present in around 25% of patients with inflammation of the linning of heart and its valves.
  • Janeway lesions occurs in endocarditis caused by staphylococcus aureus.
  • Janeway lesions are caused by septic emboli. 
  • Osler's nodes result from the depositing of immune complexes. 
  • The resulting inflammatory response leads to swelling, redness, and pain that characterize these lesions.
  • Serious and deadly infections if not treated became aggressive and can even result in death.

Janeway lesions Treatment

Treatment mainly depends upon the causative agent. If it happen due to infection then broad spectrum anti-biotics like aminoglycosides, fluoroquinolones, macrolides etc should be used to eradicate infection completely. It is assumed that neem oil and eucalyptus oil are very effective in the treatment of janeway lesions but it is not proved by any health authority.
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Mcburney's point Location, Tenderness, Test

Mcburney's point was named after a surgeon who first described it in 1800's. This is very useful test to identify various abdominal pains associated with diseases like appendicitis, peritonitis, inflammatory abdominal disease or pain due to some abdominal infection.

Mcburey's point lies in right lower quadrant of abdomen at the junction of spinoumbilical line. It has about one third distance from anterior superior iliac spine to umbilicus. Clinically, this area is important because pain of certain acute infections can be felt at this point upon putting mild to moderate pressure on this point.

Mcburney's point and Mcburney's sign are related terms used in same conditions. For example if patient feels pain or tenderness at Mcburney's point then it means he/she has some kind of acute infection and this tenderness will be termed as Mcburney's sign.

This area is also important from surgery point of view because surgeon mark incision right at this point (spinoumbilical line) to remove inflamed appendix (appendicitis). This surgical procedure is termed as appendectomy. Clinically, this point has strong correlation with appendix pain most commonly adopted by surgeon and physicians to rule out appendicitis pain. Further confirmation is done via lower abdominal ultrasound which reveals out the inflammatory process clearly if there is any.

Mcburney's point Location, Tenderness, Test

Mcburney's point Location

Mcburney's point (marked with blue arrow in the picture) is located at the junction of spinoumbilical line. It is about 5cm above the anterior superior spine of ilium and between the umbilicus and spine where patient feels pain and tenderness upon exerting mild to moderate pressure via finger tip.

Mcburney's point Tenderness

Mcburney's point tenderness is also termed as Mcburney's sign or simply positive Mcburney's test. During this procedure when doctor exerts pressure via finger tip on Mcburney's point that gives a sensation of deep tenderness or pain to patient is ususally known as Mcburney's point tenderness or Mcburney's sign.

Mcburney's point Test

To perform Mcburney's test ask patient to lie in spine position with relaxed abdominal muscles and slightly flexed the knees. Now, put pressure slowly but deeply in the right lower quadrant of abdomen at 5 cm away from anterior superior spine of ilium and between the umbilicus and spine. If this procedure gives a pain sensation or deep tenderness to a patient then Mcburney's point test will be consider positive and more likely to indicate acute infection like appendicitis.
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Bell Clapper Deformity Pictures, Test, Symptoms, Causes, Treatment

Bell Clapper Deformity is a congenital anatomical disorder in which there is an innate lack of gubernaculum, the back fixation of the tunica vaginalis to the scrotum. With bell clapper deformity, testicles are poorly connected to the scrotum and able to move freely in the scrotal sack and bend around the axis of the blood vessels. Bell clapper deformity is usually bilateral in about 60% to 70% of such cases.

Bell clapper deformity leaves testicles  to rotate and swing within tunica vaginalis just like clapper inside of a bell. This condition may lead to testicular torsion around the axis of the seminal cord that is termed as spermatic cord torsion.

Deformation itself is difficult to detect from radiographic images. However, there are some specific findings in case of MRI for example an abnormal direction of the longitudinal axis of the testicles and irregular pattern of fluid collection inside the cavity of tunica vaginalis.

About 40% to 60% cases of Bell clapper deformity lead towards testicular torsion while rest of the cases does not cause torsion and ischemia. Torsion usually occurs when mesorchium becomes abnormally long and allows testicles to bend and twist around its own axis. Possible causes of bell clapper deformity and testicular torsion are forceful contraction of cremasteric muscle, trauma, sexual intercourse and strenuous activity.

 Bell Clapper Deformity Pictures

Bell Clapper Deformity Tests

It is difficult to diagnose bell clapper deformity via physical examination because it is cannot be observed with naked eye. For this purpose you healthcare provide may ask you you to perform some radiographic as well as sonographic test for clear diagnosis. Lower abdominal ultrasound with special focus to testicular region is beneficial in this regard. However, sometimes it is necessary to perform MRI if ultrasound does not provide adequate results.

Bell Clapper Deformity Symptoms

Symptoms of bell clapper deformity are not so much obvious unlike other testicular abnormalities. However, following signs must be kept in consideration as far as bell calpper deformity is concerned.
  • Presence of blood in semen
  • Nausea
  • Vomiting
  • Lumps in the scrotal region
  • Swelling in the scrotum
  • Lower abdominal pain
  • Painful urination

Bell clapper deformity Causes 

Bell calpper deformity may occur at any age with or without obvious cause. Some commonly known factors that results in bell clapper deformity are trauma, accidental injury to testes, birth defect, strenuous activity, cremasteric muscle stretchiness, cold temperature and aggressive testicle growth during puberty.

Bell clapper deformity Treatment

There is no therapeutic treatment for bell clapper deformity. Surgery is the mainstay for such problem. In this surgeon will make a small incision in your scrotum, untwist your spermatic cord and then stitch one or both testicles. Only 2-5% of the cases require removal of testicles due to secondary complications.
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Pneumaturia ICD-10, Definition, Symptoms, Causes, Treatment

Pneumaturia is the passage of gas into the urine. In patients who did not have a recent urinary tract procedure or urethral catheterization, it is almost always due to the fistula between the intestine and the bladder. Common causes include diverticulitis, colon carcinoma, regional enteritis (Crohn's disease). In rare cases, diabetic patients may have gas infections due carbon dioxide formation from fermentation of high urinary sugar concentrations.

First of all, there may be a rectovesical fistula. In these cases, there are usually presence of fecal matter in urine. Usually, it results from ruptured diverticulitis, ruptured appendix, or tumor that forms pelvic abscess gradually and spreads into the walls of bladder. Second, there may be a urinary tract infection with gas generating micro-organisms e.g E. coli.

Pus formation and bloody discharge is common is both types so further diagnosis is much necessary to make it confirm. The fistula can be diagnosed by intravenous pyelogram, cystoscopy or barium enema. Urine culture can show presence of micro-organisms in cases there is no fistula.

Though, it is a rare kind of disorder in clinical practice but it may lead to irreversible complications so, prompt treatment is much necessary to avoid secondary problems and in some cases surgical intervention is the only option left behind.

Pneumaturia ICD-10, Definition, Symptoms, Causes, Treatment

Pneumaturia Symptoms

Symptoms of pneumaturia are not same in all cases but following symptoms should be kept under consideration as far as pneumaturia is concerned.
  • Pus like discharge
  • Pain during urination
  • Presence of fecal matter in urine
  • Presence of air or bubbles in urine
  • Changes in the color of urine
  • Presence of blood in the urine
  • Bladder pain

Pneumaturia Causes

There are number of causes of pneumaturia that must be ruled out before starting any kind of therapeutic treatment. Fistula between the intestine and the bladder is at the top of the list in pneumaturia. Other causes that might be the main the main culprit are colon carcinoma, ruptured diverticulitis, diabetes, E.coli infection, and accidental injury or trauma.

Pneumaturia Treatment

Treatment of pneumaturia is depends upon the root cause. If patient is having such disorder due to infection then therapy of broad spectrum antibiotics is the mainstay to resolve this problem. Most commonly used antibiotics in UTI are quinolones, macrolides and cephalosporins.

Similarly, if it is happening due to any structural defect associated with trauma, injury etc then surgical intervention is mainstay to eradicate it completely. This options has some limitations as well e.g in case carcinoma cancer staging is very critical point. Early diagnosis makes it more possible to eliminate completely while later stages become resistant and chances of survival are less.

Pneumaturia ICD-10

Following code is used for Pneumaturia in ICD-10

R39.89--Other symptoms and signs involving the genitourinary system--Billable
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Osler's nodes Pictures, Definition, Symptoms, Causes, Treatment

Osler's nodes are small red tender nodules located in the fingertip and at the proximal end and the lateral edge of the nails. They grow over a period of several days to weeks. Janeway lesions are little different from from osler's nodes because they often appeared as non-tender hemorrhagic or nodular lesions on the palms and feet. Clinically both are cardinal manifestations of subacute bacterial endocarditis.

At the beginning of these nodes, patients might feel nerve pain or neurological pain. Although these nodes originally considered to be derived via immune system response. It is proposed that the microembolization along with micro-abscess is occurred due to vasculitis triggered by immunomodified hypersensitivity. Osler's nodes may appear at any time during subacute cutaneous lupus erythematosus and may take several hours to a few days to settle down. They may also be due to infective endocarditis.

Osler's nodes usually ranges from 0.5cm to 1cm and appear as painful brownish or reddish subcutaneous papules on feet, finger tips, toes and palms. Many researchers are still trying to find out exact underlying pathophysiology that triggers such kinds of nodes. However, current clinical data suggests that these nodes are occurred due to immune system hypersensitivity.

Osler's nodes Pictures

Osler's nodes Pictures, Definition, Symptoms, Causes, Treatment

Osler's nodes Pictures, Definition, Symptoms, Causes, Treatment

Osler's nodes Symptoms

Physically, osler's nodes are quite similar to janeway lesions so, it is difficult to differentiate them without examining further via microscopical or histological examination. However, some commonly observed features of osler's nodes during clinical practice are

  • Nodules like appearance at finger tips, palms, toes and feet
  • Reddish brown in color
  • Painful
  • Itching
  • Feeling of tenderness
  • Slightly raised with pale surface

Osler's nodes Causes

Exact etiological factors that drive the whole process are still not fully understood but many immunologist believe that infective endocarditis, subacute cutaneous lupus erythematosus and gonococcal infection are strongly associated with such kind of nodes and lesions. Hypersensitive immune system is another factor that triggers such phenomenon.

Osler's nodes Treatment

Osler's nodes usually last several hours to a few days to settle down. However, root cause treatment is necessary otherwise they might appear again at some point. If osler's nodes appear due to infective process then then primary problem should be treated accordingly to avoid further progression. Similarly, if immune system is main culprit then anti-allergic drugs should be used to reduce hypersensitivity of immune system.
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Hollenhorst plaque Images, ICD-10, Definition, Symptoms, Causes, Treatment

Hollenhorst plaques are cholesterol emboli found at the bifurcation of the retinal arteries. The source of these emboli is generally the heart or carotid arteries. They are usually unilateral and occur in elderly patients with advanced atherosclerosis. Symptoms of fugitive alteration of vision may accompany these emboli.

Light yellow deposit usually stick to the peripheral artery at the bifurcation of a peripheral arteriole due to which they cause occlusion of branch retinal artery. This often appears larger than the artery where it is and sometimes you can even see it during migrating down. Migration can be facilitated by lightly massaging the eyeball. It is an arterial cholesterol embolism from an atheromatous plaque ulcer in a proximal artery, usually the internal carotid artery.

Usually embolism associated with retinal artery are often termed as hollenhorst plaque. Due to insignificant symptoms they often diagnosed during routine checkups but appearance of several emboli over time in the arterial tree gives temporary vision loss for seconds at a time. Loss of vision occurs because a temporary artery occlusion occurs, followed by a break of embolism, the components are taken down into the fine capillary system. Larger embolism can be lodged in a vessel permanently and cause massive ischemia in the part of the retina, with permanent loss. In some cases, larger emboli settle down in retinal artery with no obvious symptom in general. This is usually due to the blood flowing around the embolus and continuing retinal tissue supply.

Hollenhorst plaque Images

Hollenhorst plaque Images, ICD-10, Definition, Symptoms, Causes, Treatment

Hollenhorst plaque Images, ICD-10, Definition, Symptoms, Causes, Treatment

Hollenhorst plaque Symptoms

Usually patient remains asymptomatic in case of small emboli. It is often diagnosed during routing examination of eye. If the large sized emboli deposit in retinal artery then sudden vision loss just for few second or blurry vision for few seconds might be a major symptom of Hollenhorst plaque. Usually white color deposits occur due to deposition of calcium while yellowish appearance reveals the deposition of cholesterol.

Hollenhorst plaqueCauses

There number of causes that trigger hollenhorst plaque. These are diabetes mellitus, atherosclerosis, hypercholesterolemia, blood thickening, geriatric patients. However, about 60% cases of hollenhorst plaque are mainly due to diabetes mellitus so, patients having diabetes are more prone get hollenhorst plaque.

Hollenhorst plaque Treatment

Hollenhorst plaque is alarming condition because patient is at high risk to have hemorrhage, stroke, myocardial infarction, circulatory disorder etc. A prompt strategy to minimize such problems is usage of blood thinning agents like aspirin, low molecular weight heparin and anti-clotting agents.  Similarly, if patient is diabetic he must control his/her diabetes by using insulin or other anti-diabetic agents like metformin etc.

Hollenhorst plaque ICD-10

Following code is used for Hollenhorst plaque in ICD-10

H34.219--Partial retinal artery occlusion, unspecified eye--Billable
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Gingival hyperplasia Classification, Symptoms, Causes, Treatment

Hyperplasia of the gums is a slowly progressive and gradual proliferation of the gums in the dental arch of the jaw and mandibular, caused by inflammatory or non-inflammatory factors. Hyperplasia of the gums can be either diffused or focal. Gingival hyperplasia is considered as non malignant kind of hypertrophy around gums. The association with dental disease is most commonly observed factor in case of gingival hyperplasia.

The other most commonly observed conditions that are associated with gingival hyperplasia are exposure to immunosuppressive drugs and genetic predispositions. Clinical manifestations associated with gingival hyperplasia are visible swelling in the cheek area and difficulty in eating. The diagnosis is derived through in-depth oral cavity examination, X ray assessment of dental disease, associated ultrasound and visible external edema. Histological examination provides better results to confirm diagnosis especially in case of findings like fibrous connective tissue and thick or dense epithelium etc.

Generally, gingival hyperplasia is classified into three main categories depending upon their underlying causes or etiological factors.

Drug induced Gingival hyperplasia

About 60-70% cases of gingival hyperplasia are somehow induced by drug therapy like anti-convulsants such as phenytoin, Immunosuppressive drugs such as cyclosporine and calcium channel blockers such as nifedipine.

Dental disease related Gingival hyperplasia

Periodontitis and other gingival pathological conditions are often associated with abnormal proliferation of gum cells leading to gingival hyperplasia. It has also been proposed that dental braces may also act triggering factor for gingival hyperplasia.

Genetically induced Gingival hyperplasia

Though, cases in which genetic predisposition is observed are somehow less than above mentioned factors but still genetic susceptibility remains an obvious cause of gingival hyperplasia.

Gingival hyperplasia Classification, Symptoms, Causes, Treatment

 Gingival hyperplasia Symptoms

Symptoms of gingival hyperplasia are common in almost all cases in which some are visible through naked eye while others can be seen via histological examination. These symptoms are as follows

  • Swelling around gums
  • Abnormal proliferation of gums cells
  • Redness
  • Pus formation around gums
  • Dental plaque can also be seen in case of poor oral hygiene.
  • Bruising 
  • Bad breath
  • Loose teeth
  • Feeling of tenderness around gums 

Gingival hyperplasia Causes

It is not so much to find out obvious cause associated with gingival hyperplasia. As mentioned above drug therapies are on top that induce such kind of hyperplasia. Eaxct underlying mechanism that drives such proliferation of gum cells is still not fully understood in case of drug induced gingival hyperplasia. Other causes that play important role in pathogenesis of gingival hyperplasia are dental braces, oral cavity surgeries, oral and mucousal infections, poor oral hygiene and genetic predisposition.

Gingival hyperplasia Treatment

As far as treatment is concerned, first you need to find out underlying cause of gingival hyperplasia. Suppose if you having such problem due to drug therapy then consult with health care provider and shift your therapy to alternatives or second line therapies. If your routine drug therapy is not that much necessary then abruptly discontinue it. Use mouthwash that contains chlorhexidine gluconate because it readily kills oral cavity micro-organisms. It is strongly recommend that wash you teeth after every six months from any professional dentist because it is very beneficial in reducing risk of tooth problems.
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Hypercortisolism Definition, Symptoms, Causes, Treatment

Cardinal manifestation of prolonged hypercortisolism is cushing's syndrome, which may include not only obesity but also connected with hypertension, hyperglycemia, osteoporosis and female hirsutism.

Hypercortisolism has a number of effects on bone metabolism, and there is suppression of osteoblast activity with increased bone matrix protein resorption. Increased renal excretion of calcium combined with decreased absorption of calcium from intestinal results in hypocalcemia. This hypocalcemia is offset by slightly increased secretion of PTH. At the same time, PTH increases the activity of osteoclasts.

The overall effect is marked osteopenia. Since hypercortisolism reduces growth hormone and IGF-1 secretion, over time, marked linear growth retardation. Thinning of the skin and the formation of purple strips on the abdomen, thighs, buttocks are associated with a hypercortisol effect on the collagen metabolism. Hypercortisolism increases gastric acid secretion, which is considered to be associated with a high incidence of peptic ulcers.

Primary hypercortisolism, where cortisol hyper-secretion is autonomous and usually depends on ACTH. This is due to either adenoma or rarely, adrenal gland cancer. Circulating plasma cortisol inhibits the release of the ACTH, so that the levels of the trophic hormone are low. Tumor usually develops unilaterally and the contralateral gland atrophies are due to the lack of ACTH.

Secondary hypercortisolism results in hyperplasia of gland dependent on pituitary secretion. Secondary hypercortisolism may be associated with a small anterior pituitary adenoma (about 15% of cases, a Nelson syndrome) or derangement in the mechanism controlling ACTH release, which may include hypothalamus CRF and factors that control it. However, ACTH production is not independent because it can still be inhibited by high doses of glucocorticoid.

Hypercortisolism Definition, Symptoms, Causes, Treatment

Hypercortisolism Symptoms

Some commonly reported symptoms of Hypercortisolism are given below

  • Central Obesity
  • Hypertension
  • Memory Problems
  • Weakness
  • Loss of energy
  • Redness on skin
  • Fat depots around neck and shoulders
  • Difficulty in focusing
  • Delayed healing
  • Depression
  • Hair loss
  • Swelling around feet and legs

Hypercortisolism Causes

Exact underlying cause of hypercortisolism depends upon number of factors. However, in many cases tumor of adrenal gland is main cause which leads increase secretion of cortisol. Similarly, administration of high doses of exogenous corticosteroids result in exogenous hypercotisolism. Conditions in which high doses of corticosteroids are administered include arthritis, asthma and some autoimmune diseases.

Hypercortisolism Treatment

Treatment of hypercortisolism highly depends upon root cause treatment. e.g if hypercortisolism occurs due to high dose corticosteroids then their use must discontinue or dose should be adjusted to make it tolerable for body. Similarly, if cortisol is overproducing then cortisol inhibitory drugs would be mainstay. Tumor induce hypercortisolism can managed via cytotoxic drugs.  
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Hemopneumothorax Definition, Symptms, Causes, Treatment

When a fracture of the rib breaks through the lungs, the blood of the affected lung also accumulates in the pleural space this is called hemopneumothorax because the pleural space contains both blood and air. The amount of blood that accumulates in the pleural space depends on the size and extent of lung damage. In some cases, the accumulation of blood is minimal in other cases, it is significant. As blood and air continue to accumulate in the pleural space, the pressure on the lungs shrinks through the mediastinum to the healthy lung.

A pneumothorax is a hemopneumothorax with bleeding in the pleural space. This is usually due to a penetrating trauma, such as a shot or a knife. Initial trauma allows air to enter pleural space and create pneumothorax. Bleeding caused by trauma allows the blood to collect in the pleural space with air, creating hemopneumothorax.

Bleeding may originate from damaged blood vessels, pulmonary bruising, or even rapid deceleration. History and physical results of hemopneumothorax are similar to hemothorax, including dyspnoea, tachypnea and tachycardia. Patients can also obviously represent chest trauma, possibly hypotension and shock. Physical exploration can reveal possible segments of ulcers, subcutaneous emphysema or hematoma. Lung exudation reveals reduced or absent breathing sounds of affected lungs and hyperresonance on percussion.

Hemopneumothorax Definition, Symptms, Causes, Treatment

Hemopneumothorax Symtoms

Some commonly reported symptoms of pneumothorax are given below

  • Chest Pain
  • Shortness of breath
  • Tachypnea
  • Tachycardia
  • Hypoxia
  • Decreased breath sounds
  • Subcutaneous Emphysema
  • Palipitation
  • Feeling of Heavy chest

Hemopneumothorax Causes

Exact underlying cause of hemopneumothorax can only be done via radiological findings. However, some injuries that have strong correlation with hemopneumothorax are blunt chest taruma, penetrating chest injury, fractured ribs and aspiration of hemothorax. Important radiological findings during scanning are obliteration of costophrenic angle, fluid level with air shadow above, collapsed lung border.

Hemopneumothorax Treatment

Treatment of hemopneumothorax mainly depends on invasive procedure. Patient having severe form of hemopenumothorax should be decompressed via chest tube before starting any procedure. In case of tension penumothorax emergent needle decompression with large gauge needle placed in the second intercostal space at midclavicular line. To minimize chances of infection you health care provider may prescribe you antibiotics as well. 

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Enthesophyte ICD-10, Treatment, Symptoms, Causes

Enthesophyte, can be defined as abnormal development of bony prominence at the end of the normal bone contour, that can be observed in two perpendicular planes, either with acoustic shadow or with out it.

Enthesophyte formation is a new bone to the site of attaching tendons, ligaments or the capsule of the joint. Enthesophyte reflects the response of bone to stress applied through these structures such as ligamentous or capsular tearing. Enthesophyte formations take several weeks to months to develop and may or may not be associated with clinical signs. Indentifying tendons, ligaments and capsule insertions is essential to determine which structure of soft tissues may be damaged. In some places, such as the hock, the differentiation between enthesophyte formation and osteophytes is not easy.

Development of enthesophyte is a new bone at the site of ligament or tendon. Newborn Entheseous bones reflect the response to stress applied through the following structures, such as tear connections or capsular tension. Like osteophytes, enthesophytes development take several weeks to months and may or may not be associated with clinical signs.

Knowing the anatomy of ligamnet, tendons and capsule insertions is essential to determine which structure of soft tissues may have been damaged. In some places, such as the hock joint, the distinction between entesophyte development and osteophytes is not easy. Cranialis tibialis, dorsal tarsal ligament and fibularis tertius are close to the general boundary of tarsometatarsal joint and the differentiation between new bone and bony prominence of osteophyte can be difficult.

Enthesophyte ICD-10, Treatment, Symptoms, Causes

Enthesophyte Symptoms

Some commonly reported symptoms of enthesophyte are given below

  • Problem in joint mobility
  • Narrowing of joint space
  • Swelling
  • Deep and intense pain
  • Joint stiffness
  • Feeling of grating
  • Bone spur

Enthesophyte Causes

Though exact mechanism by which enthesophytes are formed is not fully understood. However, many orthopedic surgeons believe that putting excessive stress over bony structure may cause abnormalities in normal bone development in the form of enthesophytes. Some other diseases that have strong correlation with enthesophytes are tennis elbow, postman's heel, plantar fasciitis, golfers elbow and spondylitis.

Enthesophyte Treatment

Treatment mainly depends upon severity of symptoms. If patient feels only mild to moderate pain then pain killers are mainstay for such problem. Most commonly used pain killers are diclofenac sodium and naproxen sodium. If patient feels intense pain along swelling around affected area and mobility of joint is compromised then surgery would be preferred because at this stage medicines may become useless to decrease the severity of symptoms.

Enthesophyte ICD-10

Following code is used for Enthesophyte in ICD-10

M77.9--Enthesopathy, unspecified--Billable.

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Hypoproteinemia - ICD-10, Symptoms, Causes, Treatment

Hypoproteinemia is the reduction in total protein concentration in plasma or serum that is lower than expected according to age, gender, physiological. Hypoproteinemia may result from a decrease in albumin and globulin concentration or a decrease in both albumin or globulin concentrations. Some basic types of  hypoproteinemia include

  • Panhypoproteinemia: It includes reduction in both types of proteins e.g hypoalbuminemia and hypoglobulinemia 
  • Hypoproteinemia: It includes reduction in one type of protein e.g hypoalbuminemia and normal globulin concentration 
  • Hypoproteinemia: It includes reduction in one type of protein e.g hypoglobulinemia and normal albumin.
Hypoproteinemia may be caused by protein synthesis reduction and seen in malnutrition and chronic liver disease. Protein malnutrition deprives the hepatic system for production of plasma proteins and is a common problem in hospitalized patients. In chronic liver disease, the protein synthesis machine is impaired, which means hypoproteinemia. Protein increased catabolism is observed in various inflammatory and neoplastic conditions. 

Excessive loss of protein may occur in the kidneys, the gastrointestinal tract, or the skin. Examples include nephrotic syndrome, inflammatory bowel disease, extensive burns, and any severe exudative process. The most serious loss can be seen in nephrotic syndrome where number of plasma proteins, in particular albumin, is passed through the glomeruli into the urine. Changes in total serum protein may cause changes in albumin, globulin, or both. For this reason, it may be useful to determine the ratio of the concentration of albumin to the concentration of globulin. 

Hypoproteinemia - ICD-10, Symptoms, Causes, Treatment

Hypoproteinemia Symptoms

Sign and Symptoms associated with hypoproteinemia may vary depending upon underlying cause. However, some commonly reported symptoms of hypoproteinemia are edema, tachycardia, asthenia, weight loss, diarrhea and polyuria. Some patients may also feel melena, ascites, rashes on body, swelling in extremities and tingling.

Hypoproteinemia Causes

Some common causes that are associated with Hypoproteinemia are as follows

  • Vasculitis
  • Hepatic impairment
  • Protein losing enteropathy
  • Ulcerative colitis
  • Enteritis
  • Granulomatosis
  • Severe infections
  • Drug induced Hypoproteinemia
  • Pyelonephritis
  • peritonitis
  • Pleuritis
  • Chronic heart failure

Hypoproteinemia Treatment

Treatment of hypoproteinemia is mainly consist of bolus infusion of protein in case of severe protein loss especially seen in chronic kidney disease patients. However, it is important treatment underlying cause along with bolus protein infusion to limit its further loss. If you have mild hypoproteinemia then your health care provider might recommend you tablets that increases protein synthesis in the body like ketosteril etc. 

Diet plan may also provides beneficial results e.g eating products that are rich in amino acids improve protein synthesis. Examples of such diet include protein shakes, milk, egg white, dates, red meat etc.

Hypoproteinemia ICD-10

Following code is used for Hypoproteinemia in ICD-10

E88.09--Other disorders of plasma-protein metabolism, not elsewhere classified--Billable
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What are schistocytes - Defintion, Symptoms, Causes, Diagnosis

Schistocytes (schistocytes) are fragments of erythrocytes that are small and irregular in shape. Since these cells are produced as a result of rupturing of the red blood cell (RBC's) apart, the schistocyte is about half the size of normal erythrocytes and may have a deeper red appearance. An increase in schistocytes can be seen in hemolytic anemia associated with burns and prosthetic implants and rejection of kidney transplants.

Basically, schistocytes are fragments of red blood cells (RBC's) formed by fragmentation of abnormal cells, for example, in pyropoikilocytosis associated with some genetic defect or mechanical injury, toxin or heat-induced change of pre-normal cells. When as a result of mechanical damage, schistocytes often coexist with keratocytes.

Many Schistocytes spiculated. Others have been left too little for their membrane cytoplasmic volume and therefore form microspherocytes (spheroschistocytes). In patients with burns schistocytes can be obeserved as microdiscocytes and microspherocytes. A rare form of red blood cell fragment, linear or filamentous structure is observed in sickle cell anemia. The most common causes of schistocytes are hemolytic anemia and microangiopathy. Schistocytes may be a characteristic of myelodysplastic syndrome which is common in erythroleukemias patients.

What are schistocytes - Defintion, Symptoms, Causes, Diagnosis

Schistocytes Symptoms

Physically it is difficult evaluate symptoms associated with schistocytes because it might be an outcome of any hemolytic disease or kidney disease.  It can only be confirmed via differential cell count or morphological assessment of blood. Many doctors recommend routine screening of blood 2-3 times in year to rule any hemolytic disease.

Schistocytes Causes

Schistocytes exhibit micro-enteropathic haemolytic anemia and are associated with various non-infectious diseases, particularly disseminated intravascular coagulation (DIC). Schistocytes are present with DIC whether caused by non-infectious disorder, for example, malignant tumor,  or underlying infectious disease for example, meningococcemia. Spherocytes are characteristic of gas gangrene, but can be found in various other diseases, including autoimmune hemolytic anemia, cirrhosis, transfusion reactions and severe burns.

Schistocytes Diagnosis

Schistocytes  are usually obtained from direct physical damage to red blood cells secondary to vascular abnormalities or turbulent blood flow. The shape of the fragments may vary from acute or triangular spiculated. Microangiopathic granulation has been reported in several different disorders, including disseminated intravascular coagulation (DIC), glomerulonephritis (GN). Hemangio sarcoma, myeloflbrosis, dyserythropoiesis and Chronic Toxic inoculation with doxorubicin. Schistocytes have also been identified as a common characteristic of disseminated intravascular coagulation.
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Pseudarthrosis ICD-10, Symptoms, Causes, Treatment

Pseudarthrosis ( non-union) of the tibia results from a pathological fracture that may occur before or after birth. It can be preceded by the anterolateral bend of the tibia and sometimes associated with neurofibromatosis. The pseudarthrosis encounter in the distal tibial diaphysis can be assessed by severity.

When pseudarthrosis develop, it is not necessary to require a surgical correction. pseudarthrosis can not be considered as the main cause of ongoing symptoms. In fact, many pseudarthrosis are asymptomatic and in some degenerative conditions, the preferred treatment is observation. However, in cases where the inability to achieve a stable anhrodesis can lead to the development of deformation, consider surgery, even in the absence of pain.

Progression of kyphosis and the development of osteophytes neurocompressive led to reports of isolated cases at the end of paraparesis and even torn aortic pseudo-aneurysm. When pseudarthrosis is accompanied by pain or other symptoms, a careful reassessment of the patient should be performed to establish a causal relationship between the pseudarthrosis and the symptoms. In general, symptomatic lumbar pseudarthrosis causes back pain as the most important feature. Pain is usually close to the level of the pseudarthrosis and is axial in one place.

Indications for surgical repair of pseudarthroses include myelopathy, structural instability, deformity or irreversible back pain. Surgical repairs of pseudarthroses might be helpful in improving overall clinical outcome. However, patients and physicians should be aware that for symptomatic pseudarthrosis repeated surgery is associated with higher rates of recurrent pseudanhrosis and clinical failure.

Pseudarthrosis ICD-10, Symptoms, Causes, Treatment

Pseudarthrosis Symptoms

Many patients with pseudarthrosis show no special symptoms, and for these patients additional treatment and evaluation are not always needed. If necessary, x-rays and computer tomography of the spine can be used to determine whether there is a spinal fusion occurred or not. Moreover, precise physical examination provides valuable information to rule out pseudarthrosis suspect.

Pseudarthrosis Causes

The exact underlying cause of pseudarthrosis is still not fully understood but many researchers believed that genetic predisposition is very important in this disease. Some other factors that might have some correlation with this disease are

  • Hyperthyroidism
  • Bone Demineralization
  • Distraction
  • Infection
  • Skeletal muscle rupture
  • Nutritional deficiency
  • Bone fragility

Pseudarthrosis Treatment

Treatment of pseudarthroses in asymptomatic individuals is non-operative, and up to 30% does not  require surgical intervention. Surgical treatment is required for people with unstable or defective structure and suitable for those patients who remain symptomatic despite conservative measures. Treatment of the back pseudarthroses can be complicated in the context of pre-decompression because there is an increased risk of accidental durotomy during surgical dissection. In these cases, anterior cervical fusion is preferred.

A non-surgical treatment can be considered as management for delayed fusion in the absence of neurological compromise or progression of deformity. Treatment strategies include bracing, restricted activity, and careful monitoring. When non surgical treatment does not provide adequate response then surgical intervention will be required.

Pseudarthrosis ICD-10

Following code is used for pseudarthrosis in ICD-10

M96.0--Pseudarthrosis after fusion or arthrodesis--billable
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Monocytosis ICD-10, Symptoms, Causes, Treatment

Monocytosis is defined as an increase in peripheral blood monocytes greater than 0.8 X 109 / L and is predominantly associated with inflammatory and immune disorders. It is difficult to connect elevated levels of monocytosis with some specific diseases, unlike neutrophils. One of the classical monocytosis associations is tuberculosis infection.

However, other infections such as subacute bacterial endocarditis, salmonellosis, listeriosis, syphilis, leprosy and brucellosis may also be associated with monocytosis. The monocytosis often occurs during the recovery phase of acute infection or after removal of the bone marrow. Monocytosis may also be associated with haematological malignancies such as myelodysplastic syndrome and certain types of acute and chronic leukemias. Interestingly, 25% of patients with Hodgkin's disease have been reported to have monocytosis.

Monocytosis may also accompany many non-hematopoietic malignancies and some vascular diseases of collagen. Thus, the detection of a monocytosis is relatively non-specific and can be associated with various haematological disorders that might be benign or malignant in natures. The mononuclear phagocytic system is also the major cell system affected in several storage disorders. These storage disorders are usually inherited disorders or enzyme deficiencies that are necessary for the storage and processing of lipids. Macrophages become the most obvious morphological anomalies in these diseases as they are filled with lipid materials that can not  be further digested.

Monocytosis ICD-10, Symptoms, Causes, Treatment

Monocytosis Symptoms

Monocytosis  is associated with inflammatory response in case of any infection, pathological disorder or autoimmune disease. Symptoms are not so obvious to distinguish it clearly from other disorders. However, some commonly reported symptoms are swelling around body especially in extremities, joints pain due to inflammatory response, fever like condition. These symptoms may vary from patient to patient depending upon the underlying cause.

Monocytosis Causes

Monocytosis is an unusual finding in children. Infection with intracellular micro-organisms or parasites is the most common cause of monocytosis. Infections include malaria, trypanosomiasis, Rickettsia disease and Listeria monacytogertes. Persistent monocytosis with unusual forms may precede various lymphoproliferative disorders and histopathological disorders such as hodgkin's disease and juvenile myelomonocytic leukemia. Some other possible causes include ulcerative colitis, regional neuritis, lipid storage disorders, neutrophil suppression, collagen vascular disease etc.

Monocytosis Treatment

Monocytosis itself does not require any treatment because it is always a manifestation of disease. So, it is important to rule underlying cause of monocytosis before treatment. If monocytosis is associated is with infection like brucellosis or tuberculosis then antibacterial therapy is much effective to bring this condition at normal level. However, if it is associated with auto immune disorder then steroidal therapy and immunosuppressant might be required.

Monocytosis ICD-10

Following code is used for monocytosis in ICD-10

D72.821--Monocytosis (symptomatic)--billable
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Arthrography Pain, Types, Uses, Complications or Side effects

First Knee arthography were carried out by Robinson and Werndorff in 1905 after insufflation of oxygen in the knee joint. Arthrography using gas as a negative contrast agent has remained only a method used for several decades. Common Indications for all arthrographic procedures are first visualized internally that can not be properly identified on conventional X-rays. This includes the capsule, synovium, cartilage structures and internal joint and collateral tendons. Secondly, it is often necessary to obtain synovial fluid for its assessment in diagnostic laboratories. The arthrographic contraindications other side are superficial skin infections and severe allergic reactions for administration of contrast.

Magnetic resonance imaging (MRI) replaces arthrography in most cases for displaying soft tissues of the temporomandibular joint (TMJ). Arthrography can still provide valuable information which is not available from any other imaging technique. It's just an imaging technique that shows disk perforations in real time as the operator can see the dye escape from the inferior to the superior joint space during the initial injection. The usual technique involves injection of water-soluble, iodized contrast media in the lower joint space under fluoroscopy. Visual arthrofluoroscopy can clearly show the various stages of disk displacement  with or without reduction, but fails to show internal or lateral displacement of the disc. Potential complications of arthrography include allergic reaction to contrast, infection and pain and swelling due to invasive technique used during the procedure.

Arthrography consists of two basic types mainly used for evaluation of internal structures of joint. CT arthrogrpahy in which 2-3ml of contrast media is used followed by incorporating 5-10ml of gas usually oxygen or carbon dioxide depending upon patient tolerability. After this procudre a double contrast athrogram is obtained. This technique is called as Ct arthrograpy. Similarly, MR arthrography has many advantages over conventional MRI especially in case of collateral ligaments, synovial and capsular pathology, articular cartilage and osteochoral injuries. In this type of arthrograpy about 8-15ml of saline followed by incorporation of gadolininium  DPTA into joint directly.

Pain major undesirable phenomenon during this procedure especially when your health care provide is performing procedural arthrography. In case of case severe pain local or general anesthesia might require to inhibit pain sensation. A major drawback associated with arthrography is that is invasive procedure that may cause severe pain or allergic reaction to contrast medium used for enhanced imaging.

Arthrography Pain, Types, Uses, Complications or Side effects

Arthrography Complications or Side effects

Some commonly reported complications associated with arthrography are listed below

  • High risk of infection 
  • Deep vein thrombosis
  • Complex regional pain syndrome
  • Iatrogenic injury
  • Neurological or nerve injury
  • Anesthesia associated complications
  • Compartment syndrome
  • Vascular Injury
  • Extravasation
  • Broken cartilage
  • Scuffing
In current practice though it has been largely replaced by some non-invasive techniques but some orthopedic surgeons still prefer arthrography especially when the problem is associated ligament or osteochondral area.

Arthrography Uses/Indications

Arthrography is mainly performed to investigate areas such as 

  • Collateral ligaments
  • Synovial
  • Capsular pathology 
  • Articular cartilage 
  • Osteochoral injuries

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Hyperhomocysteinemia - ICD 10, Definition, Symptoms, Causes, Complications, Treatment

Hyperhomocysteinemia is a heterogeneous disease characterized by elevated plasma levels of the amino acid homocysteine (HCY). Severe Hyperhomocysteinemia (> 100 nmol / l) is caused almost exclusively by hereditary deficiency of homozygous cystatinone-13-synthase, an enzyme involved in the degradation of homocysteine . The prevalence of heterozygous form in the general population is 0.3 to 1.4%. Mild (16-24 itmol / L) to moderate (25-100 itmol / L) Hyperhomocysteinemia can be seen in a minority of patients due to homozygous for inherited mutation in 5,10-methylenetetrahydrofolate reductase (MTHFR) other enzyme involved in metabolism of homocysteine , resulting in a thermolability of enzyme.

Increased plasma homocysteine levels are an important risk factor not only for venous thrombosis (eg deep vein thrombosis, pulmonary embolism) but also for arterial thrombosis (for example, stroke, myocardial infarction), hyperhomocysteinemia may be inherited, or might be the result of nutritional deficiency of folic acid and to a lesser extent, vitamins B12 and B6, because these vitamins are co-factors in homocysteine metabolism.

For unknown reasons, elderly people, people with kidney disease, and smokers may have high levels of homocysteine in the absence of dietary deficiency of these vitamins. While simple measurement of fasting plasma homocysteine can be a useful screening testing those people with genetically inherited hyperhomocysteinemia and those with vitamin B6 deficiency may have normal or slightly elevated levels.

A more sensitive method is to obtain a second measurement of 4 hours after the patient consumes methionine. Hyperhomocysteinemia was found twice as often when using this method. In hyperhomocysteinemia, the endothelial lining of the vessel wall is empty, which can precipitate the formation of a thrombus. Patients who are found to be suffering from hyperhomocysteinemia receive folic acid, vitamin B6, vitamin B12 and supplements and should understand the reasons for their use.

Hyperhomocysteinemia - ICD 10, Definition, Symptoms, Causes, Complications, Treatment

Hyperhomocysteinemia Symptoms

Hyperhomocysteinemia symptoms vary in patient to patient depending upon the elevated level of homocysteinemia and other associated health conditions. Clinically following some commonly reported symptoms of hyperhomocysteinemia are
  • Thrombosis
  • Micoralbuminuria
  • Degradation of collagen
  • Mental irritability
  • Malfunctioning of cognitive system
  • Dementia like condition
  • Bone fractures due to low density
  • Cardiovascular events

Hyperhomocysteinemia Causes

About 90% cases of hyperhomocysteinemia are due to genetic mutations.  People who have cases of hyperhomocysteinemia in their family history are more prone to get hyperhomocysteinemia at some stage of their lives. Howevere, some possible causes of hyperhomocysteinemia are deficinecy of B-complex vitamins such B1, B9 and B12. These vitamins are important to regulate the level of homecysteine.

Hyperhomocysteinemia Complications

A large number of epidemiological studies have shown that hyperhomocysteinemia is a common risk factor for myocardial infarction, stroke, peripheral arterial disease and venous thrombosis. It is still not fully understood, the pathophysiology by which high plasma concentration of homocysteine predisposes to cardiac issues.

Some researchers presumed that hyperhomocysteinemia causes vascular dysfunction while others suggest that hyperhomocysteinemia is a marker for another factor that increases the risk of cardiovascular disease. The uncertainty lies in the fact that hyperhomocysteinemia is caused by several genetic and nutritional factors, and it is unclear which of these factors adds to the risk of cardiovascular disease.

Hyperhomocysteinemia Treatment

Treatment of  hyperhomocysteinemia mainly depends upon the underlying cause due to which it occurs. Recent studies reveal that supplementation of Cyanocobalamin (Vitamin B12) is very beneficial in those who have high levels of homocysteine. Though, it does not directly brings down homocysteine levels but it works as co-factor in apthway that normalizes homocysteine level in the body.

Hyperhomocysteinemia ICD-10

Following code is used for hyperhomocysteinemia in ICD-10

E72.11--Endocrine, nutritional and metabolic diseases / Metabolic disorders / Other disorders of amino-acid metabolism--Billable
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Adenomyomatosis gallbladder icd 10, Symptoms, Causes, Treatment

Gall bladder adenomyomatosis is a common benign condition, with features such as tumors of unknown origin characterized by hyperplastic wall changes, and often termed as hyperplastic cholecystosis. Adenomyomatosis of the gall bladder and the associated Rokitansky Aschoff sinuses may include the gall bladder as a focal, segmental or diffuse form.

A barrier or annular thickening causes peripheral narrowing of the lumen often associated with adenomyomatosis and must be distinguished from congenital folds of the wall of the gallbladder which is usually thinner and smoother and is located at the bottom while adenomyomatosis may include a part of the gallbladder. Adenomyomatosis is most common in middle aged women and its aetiology remains unclear.

Thickening of the wall of the gallbladder may suggest the diagnosis of gallbladder cancer, resulting in unnecessary treatment or even surgery. Gallbladder compartmentalization in the hourglass type of adenomyomatosis often makes difficult to  identify the distal compartment during radiographic scanning or contribute to incomplete cholecystectomy when only the distal half of the gallbladder is removed at surgery.

 Adenomyomatosis gallbladder icd 10, Symptoms, Causes, Treatment

Adenomyomatosis Symptoms

Symptoms of  adenomyomatosis are so obvious however some commonly observed symptoms are bloating, biliary colic, vague abdominal pain, intolerance to fatty foods and dyspepsia. In a small amount of patients adenomyomatosis associated with fever and jaundice.

Adenomyomatosis Causes

Adenomvomatosis (or diverticulitis of gall bladder) is an acquired hyperplastic condition characterized by excessive epithelial surface proliferation with extensive invaginations or diverticles (so called sinusoidal Rokitansky Aschoff) protruding into the muscular layer of the wall of gall bladder. Adenomyomatosis causes the gallbladder to thicken or diffuse the wall containing small cyst type spacesat cross sectional imaging. These cysts as spaces can result in a "pearl necklace" sign in T2 weighted MRI. The state has a propensity for the bottom of the gallbladder. The central gallbladder can also be affected, as a result of typical "hourglass" configuration.

Adenomyomatosis Treatment

Adenomyomatosis itself remains asymptomatic  unless it is associated with other pathological condition like gallstones or cholecystectomy. If such conditions are associated with adenomyomatosis then surgery is mainstay to resolve underlying cause. However, pain might be used in case of severe pain. Adenomyomatosis itself is serious medical issue but it must be followed up for further diagnosis to find out main problem.

Adenomyomatosis ICD-10

Following code is used for Adenomyomatosis in ICD-10

K82.8--Other specified diseases of gallbladder--billable

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Leukocoria - Definition, Symptoms, Causes, Treatment, diagnosis

Leukocoria means "white pupil" and is a term used for the clinical finding of white pupil reflex. Leukocoria is caused by anomalies with the retina, lens or vitreous. It is often the first manifestation of a number of intraocular and systemic diseases. Assessment of leukocoria is part of the routine study.

In the first year of life, the asymmetry of the red reflex when viewed through a direct ophthalmoscope or torch is the most common presentation of leukocoria. The presence of leukocoria should give a sense of urgency for prompt treatment.. First of all, the presence of non-accidental head injuries should be excluded. Vitreous hemorrhage is usually the result of trauma, including non-accidental head injuries in infants.

Every patient with suspected non-accidental head injuries should undergo an emergent eye examination performed by an ophthalmologist. Other conditions that cause leukocoria are fetal vasculature, retinopathy in prematurity, cataracts, toxocariasis and vitreous hemorrhage.

Leukocoria - Definition, Symptoms, Causes, Treatment, diagnosis

Leukocoria Symptoms

Some common opthalmological conditions that may represent with leukocoria include uveitis, disease envelope, optical disks abnormalities and retinal dysplasia. Major sign and symptoms include abnormal size of pupil, reduced vision, decreased visual acuity, nystagtnus, strabismus, buphthalmos, microphthalmos, anterior chamber cells and flare etc.

Because leukocoria affects mainly children, the condition is detected when a parent or guardian sees the pupil is being white. However, in some cases, the underlying disease occurs as reuslt of  secondary strabismus and he cause is found during dilated fundus examination.

Leukocoria Causes

One of the most important signs of an intraocular tumor in children is leukocoria or white pupil reflex. There are many reasons for Icukocoria in children. Most often include congenital cataracts, retinal detachment due to retinopathy in premature, persistent hyperplastic primary vitreous and retinal telangiectasia. Retinoblastoma is probably the most serious cause of leukocytes in children.  Each child diagnosed with leukocoria must be treated immediately to avoid further prorgression of disease.

PHPV is the second most common cause of leukocoria in children. Clinically, PHPV is present as a one-sided Leukocoria. The condition is caused by damage to the hyaloid vasculature regresses with the resulting resistance of the primary vitreous. Since direct visualization with ophthalmoscopy may be difficult, in some cases, CT-Scan and MRI may be useful to make proper diagnosis. Few eyes that are not associated with calcifications and normally increased vitreous density are common to CT findings. MRI demonstrated microphthalmia and marked hyperintensity of vitreous TI-W and T2-W images. Retinal detachment and sub-retinal blood can be seen. The diagnosis is made by visualizing a Cloquet CT scan or magnetic resonance imaging.

Leukocoria Treament

Patient survival is the primary goal of the treatment of Leukocoria and retinoblastoma, and is indeed a priority, saving vision is of secondary importance. Advanced treatment of tumors is enucleation, which involves surgical removal of the entire eye and the optic nerve. This is the only way to eliminate the tissue of eye cancer to prevent recurrence and metastasis in other body sites. After surgery, patients are equipped with artificial eye (dentures) that have eye movement capabilities.

All eye vision and transplants are not available. Vision conservation procedures are also available, and include an external ray beam. Brachytherapy, photocoagulation, thermotherapy, cryotherapy and chemotherapy are also used for treatment. External radiation uses high energy rays to kill and reduce tumor cells, and in brachytherapy, radioactive plaques are implanted into the sclera.  Photocoagulation uses lasers to burn blood vessels that deliver nutrients to tumors and thermotherapy directly heating tumors with lasers or ultrasound.

Cryotherapy involves freezing the tumor by placing cryoprobes on the sclera near the tumor. These therapies are often used in a chemo chemotherapy suite that uses drugs to disrupt the ability of tumor cells to grow and multiply.
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Common Health Problems in USA, Prevention, Diagnosis and Treatment

Medical science has now made it possible for a much larger proportion of men and women to live out a normal lifetime than was true a hundred or even fifty years ago. The resulting increase in the average length of life has been due primarily to the control of infectious and contagious diseases, especially those common in childhood. In this chapter we shift our attention from medical practice to the community's defenses against disease.

Immunization may protect against contracting disease even in the face of exposure. The community's defenses are designed to reduce the chances of the individual's being exposed in the first place. Modern health departments are responsible for keeping communities free from the hazards of preventable diseases, especially from communicable ones. The United States Government has several public-health agencies, the one probably most well known to the average citizen being the Food and Drug Administration.

State laws govern, for the greater part, the work done in local health departments; but any public-health problem large enough to involve more than one state or an outside country is the primary concern of the USA Federal Government. This being true, the general public health program is in many respects the same throughout the country, but it varies somewhat from state to state. Additional variation exists from community to community, because local health officers must also be governed or guided by the orders and ordinances of local governing bodies-city councils or county boards of supervisors, for instance.

Many of the variations exist also because of the need to fit laws and regulations to differing conditions. Several of the most important means by which a community's health is protected are often grouped together under the heading of sanitation. By sanitation is meant care of food and drink, disposal of excreta, and regulation of environment all focused on preservation of health and prevention of disease.

Scraps of food were thrown on the floors in eating places. People seldom took baths and knew nothing about how disease is spread from person to person. They feared disease but often thought it to be an act of God and did not know how to prevent it. During the fourteenth century a terrible epidemic of the Black Death (a good deal of it bubonic plague) swept across Europe.

It killed millions of people perhaps a third of the population of that continent. This disease thrives among rats, and the germs are readily carried to humans by ratfleas. One of the first signs that it may be threatening a community is an unusual number of dead rats lying around. The control of bubonic plague, then, centers around the control of rats-a sanitation problem.

Control of rats, a sanitation problem, aids in prevention of disease. Another disease that thrives amid unsanitary conditions is typhoid fever. It is usually transmitted by contaminated food, milk, or water and flies can spread the germs that cause it. Diseases prevalent under poor sanitary conditions have been greatly reduced in recent decades, but they are not yet entirely controlled.

Typhoid fever still occurs commonly in many parts of the world and occasionally even in the United States. Plague could still be a terrible scourge were it not for the constant vigilance of health departments and other health-guarding agencies. The effective protection of individual health, as well as of community health, calls for the active cooperation of each citizen in obeying the rules of sanitary living.

It is not enough that we pay taxes and expect the health departments to do the complete job of preventing infectious diseases. Each family needs to keep its own home and surroundings clean. Each person must be alert to the need for keeping food, milk, water, and air as free as possible from disease-producing agents.

Food Sanitation Food sanitation includes care in producing, marketing, preparing, and serving food. For the purpose of our present discussion, vegetable and animal foods will be considered separately. Vegetable foods are easily contaminated by contact with soil fertilizer, especially animal or human excreta of recent origin.

This kind of contamination carries germs that can cause serious bowel infections and diarrhea. All vegetables to be cooked should of course be clean, but if they are to be eaten raw, they must be more than merely clean. They must also have been produced and handled with proper sanitary safeguards. A comparatively recent new hazard in eating fruits and vegetables has come from the use of poisonous sprays to kill pests.

When crops are marketed too soon after the last spraying, they may carry a sufficient amount of poison from the spray to affect the health of consumers. Health officers try to avert this danger by enforcing regulations requiring that fruits or vegetables that have been sprayed be washed before being marketed. Some contaminants can be removed by washing with plain water. Others require the use of a mild acid solution or some other chemical.

Fruits and vegetables should be carefully handled while being harvested, transported, or marketed. Bruised spots on fruits cause them to decay rapidly. Fruits and vegetables are easily contaminated by germs carried by flies. Unpacked foods, therefore, should be protected against flies while being transported and marketed.

Cooked foods should be served promptly, before there is any possibility of contamination. If such foods must be kept over from one meal to another, they should be kept in a refrigerator. Foods allowed to remain at room temperature can serve as a breeding medium for germs. The kitchen and dining room should be kept clean and free from dust.

All flies and other insects should be kept out of rooms where food is handled. This is best done by screening windows and installing self-closing screen doors. Public eating places are required to comply with state laws and regulations and with the local ordinances of the city or county. Health department inspectors visit such places as frequently as time will pennit, but not on a regular schedule. Thus proprietors do not know when to expect their visits. Even so, unsanitary conditions sometimes develop in such places. If you notice what seem to be unsanitary meat. The red interior of "rare" steaks or roasts cannot be considered as safely cooked.

Most of what was noted above about the handling, preparing, and serving of vegetable foods also applies in a general way to animal foods. The usual precautions are even more important in the case of animal foods, however, because of the greater ease with which germs multiply in them.


Milk is a very important food. It contains generous amounts of carbohydrate, protein, and fat. It also contains an adequate supply of calcium and phosphorus, necessary constituents for bones and teeth. It is not only the best food for babies and small children but also a good food for teenagers and adults. nutritionists generally recommend that each child and teen ager drink about a quart (liter) of milk a day. Adults will do well to take at least half as much, either as a beverage or in combination with other foods.

Some people argue that milk is suitable only for babies and very young children. They point out that very little milk has been or is being used in certain very populous parts of the earth, notably China. They also argue that the young of lower orders of mammals thrive without milk after the first few weeks or months of life. It would no doubt be possible for humans to do likewise if we had some practical way to supply them with the amount of calcium and phosphorus which carnivorous animals get from bones, and which herbivorous animals get from herbage and whole grains. But milk is a much more convenient source and has been widely used throughout the course of human history.

Unfortunately, milk serves as a ready medium for the multiplication of germs. Germs of diarrhea, tuberculosis, food infection, scarlet fever, septic sore throat, undulant fever, diphtheria, and other diseases are easily carried in milk. In the days before modem public-health departments controlled the handling of milk,many epidemics were traced directly to the distribution of contaminated milk.

The production of safe and wholesome milk requires careful cooperation between the dairy and the health department. The first step in producing good milk is to make sure that all cows in the dairy herd are healthy. State and local health officials cooperate in making periodic tests on each cow, eliminating diseased animals.

The second step in producing good milk is to make sure that the dairy is kept clean. In most places adequate laws regulate this matter. Floors must be smooth and easily cleaned. There must be enough windows to provide abundant light and ventilation. The cows should be given only pure water to drink, and they should be washed with pure water before being milked. Flies must be kept away from the  milk during all stages of its processing.

Prior to the days when the handling of milk was so carefully guarded, many epidemics were spread by diseased dairy workers. Now dairies are required to keep a careful health check on each employee. Dairy workers must have frequent physical examinations. One who becomes sick is not allowed to work until well again. Those who work in dairies are carefully instructed on keeping their bodies and clothes clean, thus reducing the danger of germs in the milk.

As soon as milk is taken from the cow, it should be removed to a separate milk room, a screened area kept spotlessly clean. As the milk arrives in the milk room, it should be chilled and kept cold from then on except while it is being pasteurized. Keeping milk at a low temperature prevents germs, if any, from multiplying rapidly.

More than 90 percent of the milk now marketed in the United States has been pasteurized. In some areas it is close to 100 percent. Pasteurization can be accomplished in either one of two ways:

  • Heating the milk to a temperature of 145F° (63C°) for thirty minutes or
  • Heating it to 161F° (72C°) for fifteen seconds.

Most germs are killed by this amount of heat, and the kinds not thus killed seldom cause disease. After being pasteurized, milk should again be quickly cooled and kept cold until it is delivered to the customer. Some families still keep one or more cows for their own milk supply. It is not safe to continue using such milk raw. Boiling it would make it free from living disease germs, but boiling it or even heating it nearly to the boiling point spoils its taste for most people.

A good method of home pasteurization is as follows: Get an accurate thermometer of the sort used to test the temperature of hot liquids. Use a heavy kettle preferably of stainless steel. Heat the milk slowly over low heat. It is best to put a thin asbestos pad between the kettle and the heat. While the milk is heating, stir it constantly. Bring the milk to 165 F° (74 C°), and be sure it holds that temperature for about five minutes, still stirring constantly. (Extra temperature and extra time compensate for open-kettle method.) Then take the kettle from the stove and cover it.

Cool the milk quickly by setting the kettle in a large pan of cold water, preferably with ice in the water. Then put it in the refrigerator until time to serve it, keeping it covered. This procedure will make the milk as safe as pasteurized market milk, and it is not likely to give it an objectionable taste. Questions are often asked about the effect of pasteurization on the nutritional qualities of milk. Only two constituents of milk are adversely affected by pasteurization vitamin BI and vitamin C.

The loss of these vitamins is of little consequence because milk does not contain much of either one, and other foods can easily supply all that is needed. Only in cases where milk is used as the main food, as in infant feeding, does a deficiency of vitamin C constitute a problem. The lack is then made up easily by giving the baby a supple mental food rich in vitamin C, orange juice or tomato juice most often being used.

Most market milk is now homogenized. Homogenization does not take the place of pasteurization. It does not kill germs. Rather it breaks up the globules of fat into much smaller globules so that no cream line forms in the bottle or carton. It is easier to use such milk in cooking or infant feeding, since all parts of it contain the same percentage of milk fat. As a matter of fact, most market milk is both homogenized and pasteurized, as the wording printed on the containers will show.

Local health inspectors take frequent samples of milk at dairies, at processing plants, and at markets where milk is offered for sale. Laboratory tests are run on the samples to determine whether or not they show evidences of contamination by disease germs. If such evidences are seen, the milk is condemned until the cause of the trouble is located and corrected.


Strangely, in the United States, generally considered to be a land of plenty, fresh water is becoming a major problem. Of the 12,000 billion gallons of water per day which flow toward the ocean through our rivers, we are now salvaging only about 325 billion gallons for domestic and commercial uses. At first this may seem like an abundant supply; but changing conditions have resulted in a continually increasing per capita demand for water.

Individual homes supplied with running water require from sixty to a hundred gallons (225 to 375 liters) per day per person. This need represents only a small part of the overall demand. Consider irrigation. We are using nearly half of our fresh-water supply to grow crops. Almost as much is required for industrial purposes. Three basic reasons for our growing need for water are:

  • Rapid increase in population,
  • Shift of population to urban areas where homes have modern plumbing
  • Increased industrialization.

When we speak of pure water, we do not mean water free from all extraneous chemical substances. Acceptable water may contain enough minerals to make it "hard." Even "soft" water may contain certain impurities. Water free from disease producing germs and from chemical substances harmful to the body is considered "pure" from the point of view of health. ow that the volume of sewage discharged into streams or lakes has so greatly increased, the problem of obtaining pure water for domestic use has become more complicated. However, most modern communities use sewage disposal plants to purify sewage before it goes into streams or lakes. Also, water purification plants are used to make sure that domestic water supplies are free from disease producing germs.

But a further complication is that many streams are now polluted by chemical substances discharged from industrial plants. Many of these substances stay in solution and are carried along by the water for many miles. Some are actually poisonous. In the notable example of the animals River, a tributary of the Colorado River, the water became temporarily polluted by radioactive substances originating in a uranium mill.

Another source of chemical pollution of water is the increasing amount of pesticides now used for the control of insects, as in crop dusting. These include poisonous chemicals, sometimes carried away from cultivated areas by runoff from rainfall. To date, the amount of these pesticides entering the usual sources of water supply.

is not measurably dangerous to humans,but this may not always remain true. Some commercial fertilizers also contain soluble substances that can pollute ground-water supplies and eventually become a health hazard. This is especially true of the nitrogen containing compounds in the fertilizers. If these are not already present in the form of nitrates, they are likely to be more or less slowly converted into nitrates by oxidation; and all nitrates are soluble and remain in the water as it percolates downward through the soil and deeper strata. In a few cases ground-water sources have already been found to contain nitrates in sufficient 'concentrations to be harmful, especially to babies.

Detergents sometimes find their way into water supplies. With the widespread use of automatic clothes washers and dish washing appliances, the amount of detergents introduced into sewage has become enormous. The usual treatment of sewage in purification plants does not remove detergents from the water, and this water may eventually be discharged into streams or lakes which supply water for domestic use. In rural areas where cesspools or septic tanks are used for sewage disposal, the detergent chemicals seep slowly into the subsoil and eventually into the underground water reservoirs.

When water is obtained from these reservoirs by the drilling of wells, traces of detergent chemicals appear in the water. Contamination with detergents may cause domestic water to produce suds when drawn from the faucet. When detergents were first marketed they contained considerable quantities of compounds of phosphorus. The phosphorus in such detergents, when it found its way into the soil, promoted the growth of algae.

More recently the amount of the compounds of phosphorus in detergents has been reduced and it may now be said that the amounts of detergent in domestic water are relatively harmless either to individuals or to the soil that absorbs such water. In most water purification plants, the incoming water is first allowed to settle in large tanks or reservoirs, and then it is run through a sand filter. Filtering the water through sand takes out most of the foreign matter, as well as most of the germs. In some plants, chemicals are added to the water to aid the settling process or for other reasons.

No chemicals harmful to human health are used which cannot be removed from the water before it is distributed into the mains. To ensure that the germs are killed, a small amount of chlorine is usually added to domestic water as it leaves the purification plant. It takes only one part of chlorine to a million parts of water to kill disease-producing germs. This amount of chlorine does not injure those who drink the water. We cannot tell whether or not water is pure simply by looking at it. Some people consider all clear running water safe to drink. This is not always true, for disease-producing germs may be found in swiftly running water as well as in stagnant pools. The water in a beautiful mountain stream may be clear and colorless and yet carry the germs of typhoid fever or dysentery, especially if people are free to roam about in the vicinity.

People living or traveling in an area where the source of the water is unknown or unprotected should employ a means of purifying their drinking water. Also, there are times following disasters, such as earthquakes or tidal waves, when a city's water supply may be contaminated by broken water mains or overflowing sewers. The usual and safest way to make questionable water safe to drink is to boil it vigorously for at least a full minute. Then it should be kept in a covered utensil while it is cooling and until it is used. Other methods approved by the United States Public Health Service for making water reasonably safe for drinking are as follows:

  • Iodine or chlorine tablets, designed for the purification of water, are available in most drug stores. When using them, follow the directions printed on the packages
  • Tincture of iodine from the medicine chest may be used to purify water. After adding three drops of the standard tincture to a quart (liter) of water and mixing well, allow to stand for half an hour before using.
  • Chlorine bleach solution from the home laundry may also be used to purify water.

After being mixed well, the water must stand at least half an hour before it can safely be used. For purifying muddy or turbid water, twice the amount of the chemicals listed above should be used.

Fluoridation of Domestic Water

Within recent years accumulated scientific evidence seems to indicate that a small amount of the element fluorine (the active form of fluorinecalled fluoride ion) is necessary in the body's tissues in order to ensure proper development and health of the teeth. The United States Public Health Service has made comparative studies of communities where the water supply naturally contains an adequate amount of fluorine and those where fluorine is wholly or nearly absent. In the communities where an adequate amount of fluorine is present, children are remarkably free from dental caries (cavities in the teeth), in contrast to the high incidence of caries in communities where fluorine is deficient.

Furthermore, careful investigation has shown that when fluorine is naturally present in much more than the desirable amount, no damage to the health of the water users is detected aside from the somewhat unsightly mottled appearance of the enamel of the teeth. These findings have prompted the practice of adding fluoride to the domestic water (one part of fluoride to one million parts of water) in areas where fluoride is naturally deficient.

Some oppose the practice, fearing possible poisoning by fluorine gas and some of its compounds. But there is no more danger in this procedure than in adding iodine to salt in areas where iodine is deficient. In both cases the compounds used are not those which are poisonous in ordinary amounts, and the amounts used arc always very small. As a result of continued studies made by national health organizations, two conclusions may now reliably be drawn with respect to the use 34 of fluoride in domestic water:

  • The presence of fluorine as fluoride ion in domestic water in concentrations of approximately one part per million is effective in reducing the incidence of dental caries as much as 60 to 70 percent
  • The addition of fluorine to domestic water has produced no harmful results in the general health of those using such water.

Sewage Disposal

The disposal of human excreta is a most important problem in sanitation. Water and sewer systems in modern cities take care of this problem for individual households. There was a time when such sewer systems discharged their waste directly into nearby rivers or lakes; but now most municipalities operate disposal plants where sewage is treated and made safe before being discharged into a
body of water used for domestic or irrigation purposes. When a house has a supply of running water piped into it, but no city sewer available, a flush toilet with a septic tank can be installed. Local building codes and health department regulations must be consulted in this case.

Swimming Pools

The water in swimming pools may become a health hazard, entirely apart from the danger of drowning. It not only comes in contact with the swimmer's skin but also gets into his eyes and ears and some of it may accidentally be swallowed. As a general rule, civic regulations govern the sanitation of public swimming pools; and inspectors make frequent checks on cleanliness and possible disease germs, taking water samples for laboratory examination. But private pools, the number of which is rapidly growing, are usually less carefully supervised, perhaps receiving no attention at all except that which the owners may give them spasmodically or on rare occasions.

Defenses Against Insects and Vermin

A hundred years ago, cities throughout the world were dirty. Garbage was not carried away quickly. Rats thrived in the litter scattered in alleys and backyards. Flies swarmed over exposed refuse and then flew into people's houses, carrying disease-producing germs. Now most modern cities provide for frequent collection of garbage and rubbish. Officers from health departments inspect streets and alleys and require that they be kept cl~an. This policy goes far in controlling flies, mice, rats, and the fleas carried by rats. Flies, fleas, and mosquitoes are the worst insects for carrying disease germs. Ticks, not true insects, are also dangerous carriers. In controlling these pests, it is important to kill those that already exist; but it is even more important to prevent the propagation of the young.

Ticks are more difficult to combat than flies, fleas, or mosquitoes. The most dangerous ones are found in the wilds or out of the way places, where they live on wild animals. Clearing and burning brush at certain seasons of the year, destroying wild rodents, and the periodic spraying of sheep and cattle will help to reduce the number of ticks. Flies will breed in filth of almost any kind, but the ordinary housefly prefers the filth of an ill-kept stable or barnyard. The control of flies, therefore, consists essentially of maintaining sanitary conditions where animals are kept and where refuse of any kind is deposited. All refuse, as well as fertilizer, should be kept in tightly covered containers. Make sure that flies have no access to the interior of buildings. Careful screening and the use of traps and sticky paper will help in this objective.

The control of disease-carrying fleas consists in large part in exterminating rats. As long as food is available to them, rats will breed freely. Even methods of trapping and poisoning them only partially succeed as long as the rats can obtain food. Rats thrive on most kinds of human food and on feed for poultry and domestic animals. All buildings should be carefully rat proofed. When in doubt as to the best means of doing this, consult building inspectors for the techniques of rat proofing, and health department representatives for methods of controlling rat breeding grounds.

Piles of lumber, plywood, or rubbish often serve as living quarters for rats. Mosquitoes can be most easily destroyed in the larval or pupal stage. Periodic oiling of standing water will suffocate the larvae. Dusting the surface of standing water with DDT will poison the immature mosquitoes, but may also poison any fish in the water. Certain varieties of small fish feed on the larval or pupal forms of mosquitoes. Stocking ponds with such fish is often effective in checking the propagation of mosquitoes.

Vegetation growing in the water of such ponds should be cleared away so the fish can find the mosquito larvae. Stagnant ponds and marshes should be drained if possible. Some species of mosquitoes breed in very small amounts of water, such as in empty cans, broken dishes, flowerpots, roof gutters, and even in knotholes in trees.

In controlling mosquitoes, both individual effort and community cooperation are necessary. Such measures as the draining or filling of swamps and ponds are of permanent value. Other measures may have to be repeated year after year, and sometimes several times a year. When people find it necessary to live in an area where community wide control of mosquitoes has not been accomplished, they will have to combat mosquitoes the best they can on their own premises. Having a house on a breezy elevation, well

away from known breeding places, will help. Vines and bushes should not be planted in the immediate vicinity of a house. Adequate screens on windows and doors, as well as the use of bed nets, will protect against mosquitoes. Remaining indoors after sunset is also a help in preventing mosquito bites. The Problem of Air Pollution Current population growth everywhere, with accompanying shift of population to urban areas, has in recent years increased the problem of  air pollution. Industries, for the most part, have cooperated in trying to prevent pollution of the atmosphere. But some, by their very nature, continue to discharge smoke and chemical fumes into the air in spite of the most modern means of prevention.

Also the exhaust fumes from an ever-increasing number of cars and trucks pollute the air and irritate eyes and air passages. Air may be polluted by soot, smoke, gases, dust, finely divided chemical particles, and offensive odors. For this reason some large cities prohibit the use of incinerators and other air polluting equipment. Also in some areas smog-control devices are required
on automobiles and trucks.

Heavily polluted air impairs health. Evidence for this generally accepted opinion comes partly from known interference of polluted air with the growth of plants and partly from statistics indicating that certain diseases are more prevalent, and death rates from them higher, in urban areas than in rural areas, especially in urban areas where the air is frequently heavily polluted. Several cases are on record where air pollution became both extreme and persistent, and a sharp increase in deaths from respiratory ailments resulted.

Every person living in areas where the air is easily polluted should do his best to promote health by curtailing those activities that pollute the atmosphere. Your Health Department It is easy to take for granted the many services of city, county, and state health departments. We reap the benefits of modem medical and scientific achievements without realizing how much governmental agencies do to secure our relative freedom from disease.
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