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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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Podocytes structure and function in Kidney

The podocyte is the largest cell in the glomeruli. It has a highly specialized three dimensional structure and a unique molecular profile closely related to the basic functions it performs. Podocytes are large octopus shaped cells similar to GBM.

Transmission of Electronic Microscopy and Scanning Electron Microscope (SEM) presented its unique and complex structure. Three main structural domains have been identified: cell body, cellular processes and foot processes. The body of a cell is usually located in a valley created by the reflection.of adjacent capillary loops.

The body of the cell contains the nucleus and other organelles as abundance of the endoplasmic reticulum, the large Golgi apparatus, mitochondria and excessive amount of lysosomes . Sometimes the rudimentary cilia are also present protruding from the surface. The body of the cell is not based directly on GIN. It is separated from the CBM by the subpodocyte space and layer on foot processes.

Subpodocyte space can be a dynamic compartment that can vary in volume, limit the movement of the ultrafiltrate in the urinary space, and provide a mechanism for the involvement of podocytes in the modulation of Capillary permeability and podocyte response to injury. Long, thin, arborizing cellular processes projecting from the cellular bodies.

 Podocytes structure and function in Kidney

These processes contain several organelles but are rich in microtubules and intermediate filaments that are parallel to the longitudinal axis. They can branch into secondary or tertiary cellular processes before investing several capillary loops. Cellular processes ultimately lead to finite structures called foot processes or pedicels.

It is difficult to differentiate the function of podocytes as they are still mysterious type of cells. Normally, they are categorized as modified form of pericytes having specialized intracellular junctions e.g slit diaphragm. As a supportive cell it also contributes in para-cellular permeability control. The most import function  is acting as barrier of glomerular filter.

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Hyperpyrexia Symptoms, Causes, Treatment, Management and Guidelines

Hyperpyrexia is an emergency condition where the body temperature rise above normal. Another name fore hyperpyrexia is hyperthermia. This happens when the body temperature of an infected person rise abnormally to a temperature range of about 106.7℉ and which is not due to any physical or mechanical activities. At most time, the increase in temperature happens when the part of the brain that controls the body temperature is unable to function to it best, as a result of infection, cerebral injury, trauma or due to side effect of some drugs. This increase in temperature triggers raise in muscle tightening, and therefore causes a feeling of cold in such a person experiencing hyperpyrexia.

Typically, body temperature is being regulated within a narrow range, which fluctuates predictably continusoly to adjust accordin to ambient temperature. Compensatory mechanisms for temperature regulation provide a thermal homeostasis via autonomic nervous control e.g altered muscle tone, shunt blood flow to and from peripheral vascular beds, and causing heat or heat seeking behavior.

Exogenous substances as components of the bacterial cell wall (lipopolysaccharides ), degradation products, bacterial endotoxins, drugs, immune complexes and complement factors induce activated polymorphonuclear cells to release a group of endogenous pyrogens cytokines . These cellular mediators, known as interleukins (IL) -1 and IL-6, tumor necrosis factor (TNF), and interferon G induce the production of prostaglandin E2 (PGE2) by endothelial cells. In the vascular region of the prepoptic nucleus of the anterior hypothalamus, PGE2 diffuses the short distance between the neurons of the temperature control center.

Hyperpyrexia Symptoms, Causes, Treatment, Management and Guidelines

Hyperpyrexia Symptoms

Symptoms of Hyperpyrexia include an uncontrollable increase in the body’s temperature due to inability of the body to regulate the body temperature to its normal state. Other symptoms include cold, loss of appetite, pains in the whole body or some body joints, headache and some unusual circumstances like vomiting (this usually happens in children of tender age.

Hyperpyrexia Causes

Hyperpyrexia is mainly caused by the inflammation in part of the brain called hypothalamus, which is responsible for the regulation of the body temperature. This inflammation may be associated with infection, cerebral injury, mechanical injury, trauma or accidental damage. Hyperpyrexia may also be idiopathic in nature mean it belong to unknown origin. However, it is commonly observed that some drugs like anesthetics, deploarizing agents and

Hyperpyrexia Treatments

Hyperpyrexia is an emergency medical condition. Treatment goes for the lessening of the body temperature to 39℃. Patient should be covered with wet sheets or towels and splashed with icy water while air is blown or fanned over him to advance evaporative cooling. As an option, the patient might be drenched in chilly water. The appendages are delicately kneaded to advance dissemination. At the point when the body temperature fall to 38 degrees, the patient should be shifted to a cool room and looked for further ascent of temperature.
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Xanthochromia csf Definition, Test, Timing, Guidelines, Interpretation

The presence of red blood cells in cerebrospinal fluid (CSF), WBC's, increased protein concentration in CSF and xanthochromia are important findings for the detection of vascular neurological disorders. However, diagnostic information from these results is often insufficiently matched despite the addition of other clinical data. The introduction of cranial CT-Scan is an extremely useful for the detection of vascular lesions, including intracranial hemorrhage and stroke.

Unfortunately, the necessary equipment is quite complicated and expensive and for now it is only available in larger medical centers. Moreover, bleeding near bone structures such as subarachnoid hemorrhage (SAH) may escape diagnosis and hemorrhagic component in cerebral infarctions may be difficult to detect by CT-Scan. Xanthochromia of CSF microscopically observed as discoloration of the Yellowish supernatant with variations to a reddish or brownish color and is generally accepted as a sign of lesion bleeding.

Xanthochromia  of cerebrosponal fluid develops for several hours after bleeding in older children and adults.It is commonly observed that adults with sub-arachnoid hemorrhage develops xanthochromia within 12 hours of ictus or stroke. The identification of xanthochromia in newborns has not been systematically studied well but it happened Slower than older patients.

This slow change may refer to a delay in the induction of the oxyanganase enzyme, which is present in the subarachnoid membrane and is responsible for the conversion of hem to bilirubin, the major pigment of xanthochromia in CSF. In a recent study it has been observed that activity of hem oxygenase reached peak Values ​​at 6 to 12 hours after injection of hem in the subarachnoidial space . Determining the presence of xanthochromia in newborn is sometimes difficult in the presence of elevated serum bilirubin.

Xanthochromia  Test, Timing, Guidelines, Interpretation

Xanthochromia as pink or yellow tint in the cerebrospinal fluid does not rule out the possibility of subarachnoid hemorrhage (SAH). Xanthochromia may reflects hemoglobin degradation and is present anywhere from 6 to 12 hrs after sub-arachnoid hemorrhage. The absence of xanthochromia does not rule out the possibility of sub-arachnoid hemorrhage if the patient presents more than 2 weeks after the onset of headache.

Xanthochromia is measured by visual inspection or by spectrophotometry. Most hospitals measure by visual inspection, which is obviously a much less sensitive test. Xanthochromia happened due to hyperbilirubinemia, accidental hemorrhage or encephalitis might require further unnecessary diagnostic studies. Additional cerebrospinal  studies should be kept in considered in case of ambiguous findings, especially if the patient has been in an endemic area or has compromised immune system.

Xanthochromia visibility in CSF might be due to the following:
  1. Oxyhemoglobin as a result of lysis of red blood cells 
  2. Bilirubin (bilirhachia) in patients with jaundice.
  3. CSF protein levels above 150 mg / dL, which are also present in bloody traumatic taps or pathological conditions such as complete spinal blockade or spinal stenosis, poly-neuritis, and meningitis.
  4. Merthiolate disinfectant contamination 
  5. Carotenoids in people with hypercarotenemia (i.e., hypervitaminosis A).
  6. Melanin (brown) of meningial metastatic melanoma.
  7. Rifampin therapy (red-orange).
Spectrophotometry can also help to distinguish hemoglobin from other xanthochromic pigments with maximum absorption peaks.
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Hemiballism Definition, Symptoms, Causes, Treatment | Hemiballismus vs Chorea

Hemibalism is a form of chorea characterized by rigorous and frequent movements of the limbs on one side of the body. Less often, both sides (biballismus) and legs (paraballismus) can be affected. Unlike chorea, the movements are intermittent during waking and the overwhelming involvement of the proximal muscles in their  their flailing nature.

However, the difference is not obvious because proximal ballismic movements may exist along with distal chorea, symptoms may be intermittent in more severe cases, and in many patients a change of ballismus to chorea can be seen readily or in response to treatment.

Hemibalism is a one sided ballism, a disorder of a frequent hyperkinetic movement that has a large amplitude with vigorous irregular movements. Hemibalism overlaps with clinical hemichorea ("violent chorea"). The hemiballismus-hemichorea is sometimes used to reflect this overlap. Hemiballismic states may cause loss of normal muscle tone.

Neuroanatomically, hemobalism is most commonly associated with lesions of the contralateral subthalamic nucleus of Luys or efferent pathways, although there are separate reports of its outward appearance with diseases of the caudal nucleus, globus pallidus, thalamus, and even with ipsilateral lesions. Neuropathologically, vascular events like ischemia and haemorrhage are common underlying causes of hemibalism.

Hemiballism Definition, Symptoms, Causes, Treatment  Hemiballismus vs Chorea

Hemiballism Symptoms

Ballism is characterized by rigorous, high amplitude, waving like movements primarily by the activity of the proximal appendicular muscles of the shoulder and pelvis. Movements cease during sleep. There is a reduction in muscle tone. These symptoms are exposed unilaterally with a lesion in the subthalamic nucleus in contralateral position.

Since clinical ballism is almost always happening on the one side only and is usually due to a vascular accident, it is also known as hemiballism. Symptoms associated with dysfunction of the basal ganglia are usually observed bilaterally. However, as hemiballism, lesions on one side appear on other side, as the basal ganglia output is directed to the ipsilateral cerebral cortex, whose descending pathways predominantly innervate lower motoneurons on the contralateral side.

Hemiballism Causes

Some causative factors include occupational lesions, inflammation due to encephalitis, systemic lupus erythematosus,  demyelination, metabolic causes like hyperosmolal non ketogenic hyperglycemia, infection like toxoplasmosis , medicines especially oral contraceptives and head trauma.

Pathophysiological, hemibalism is believed to be the result of reduced conduction of the short path within the basal ganglia thalamocortical motor chain (as well as other involuntary movements such as hyperkinetic choreoathetosis). Hemiballismus associated with vascular system improves spontaneously, but drug therapy with neuroleptics may be beneficial. Other drugs that are sometimes useful include anti-psychotic drugs and anticonvulsant drugs.

Hemiballism Treatment

In an acute period when movements are most destructive and potentially harmful, some cases need treatment. Neuroleptics have long been identified as effective and remain the first choice among most clinicians, but no specific drug has been identified as superior to others. Clozapine has been reported to be useful, when other neuroleptics have failed.

Presynaptic dopamine-depleting medications  have also been reported to be beneficial. Others have been reported that are useful for the management of Hemiballism include valproic acid, gabapentin, topiramate, sertraline, and combinations of neuroleptics. Those patients who are not responding to psychotic drugs or other medications functional surgery might be the next option.
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Sialorrhea ICD-10, Definition, Symptoms, Causes, Treatment

Sialorrhea, consisting of the involuntary release of passive saliva from the mouth due to the inability to deal with oral secretions, is often a finding of ALS patients and an important source of social stress. This is not caused by an increase in saliva production that has actually decreased, but due to gradual paralysis and lack of coordination of the muscles related to orofacial and palatolingual area during saliva production.

Sialorrhea is normal in infants and young children. Mild to moderate drooling may continue in infancy and have been reported in children up to 5 years of age. Hyper-salivation or sialorrhea  that goes beyond this period is usually considered pathological and is most common in patients with neurological disorders.

Drooling is often sharpened by a dental malocclusion, poor oral closure or psychogenic control of oral cavity and limited head or trunk control connected with neurological malfunctioning. For example, hyper-salivation is reported in 10% to 37% of children with cerebral palsy. Sialorrhea management is recommended when it represents some kind of clinical implications in a patient.

Sialorrhea or hypersalivation can be part of many diseases. Sialorrheais often a part of parkinson disease, as it has an excessive production of saliva in combination with a reduction in swallowing. Other neurological conditions may also produce hypersalivation such as cerebral palsy, stroke conditions, traumatic brain injuries or neurodegenerative diseases such as ALS.

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

Symptoms of sialorrhea

Some commonly observed symptoms of sialorrhea are

  • Nausea
  • vomiting
  • Dysphagia
  • change in taste
  • Pooling of saliva in mouth
  • Drooling

Sialorrhea Causes

Mild to moderate kind of sialorrhea might be associated with minor irritation orally or denture  or braces fitting problems. Episodic sialorrhoea can be a treacherous manifestation of a gastroesophageal reflex (GERD). Increased salivation is produced as a protective mechanism for buffering in patients with GERD. This is called  water brash.

A similar saliva state whose underlying cause is unknown called idiopathic paroxysmal salivation. Increased salivary flow consists of episodes occurring 1 or 2 times per week for 2-5 minutes in duration. Episodes are preceded by a multi symptomatic response consisting of nausea or pain in the epigastrium, but without progressing vomiting. These might be variants of the same clinical problem. Hypersalivation may also be associated with obstruction of the esophagus (foreign body, cancer and strictures), infection and nasogastric intubation.

Sialorrhea Treatment

Sialoreia is socially uncomfortable and can interfere with oral hygiene and is a risk factor for bronchial aspiration. Increased saliva management might be done with gum or hard candy to induce swallowing. If this is not enough then injections of toxins like botulinum helps to improve this socially uncomfortable condition. Botulinum toxin injections are considered only effective in the treatment of Parkinson related sialorrhea or hypersalivation.

Sialorrhea ICD-10

ICD-10   H15         Disorders of sclera                      Billable
ICD-10   H15.8      Other disorders of sclera            Billable
ICD-10   H15.89    Other disorders of sclera            Billable
ICD-10   H15.9      Unspecified disorder of sclera    Billable
ICD-10   Q13.5      Blue sclera                                    Billable
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Nulliparity Meaning, Definition, cancer risk | Nulliparity vs Primiparity

nulliparus or nullipara women is one, who never had a child, and this state of non productiveness is called nulliparity. Nulliparity is a recognized risk factor for cervical cancer. Most studies show a double or triple risk for women than those have given birth. The assumption that infertility is a risk factor for cervical cancer is supported by studies that show a higher risk for unmarried women than for married women. Several studies have found that infertile women have an increased risk cancer of reporductive organs due to nulliparity.

Mechanisms that can mediate the risks associated with infertility include anovulatory menstrual cycles (prolonged estrogen exposure without sufficient progesterone), elevated levels of androstenedione (ie, excess androstenedione is available for estrogen conversion) and the lack of monthly sloughing of the lining of the endometrium (i.e the residual tissue can become hyper).

In addition, nulliparity associated with lower levels of globulin bound serum sex hormone (SHBG) causing an increase in bioavailability of estrogen. In most studies, the risk of uterine cancer decreases with increasing parity, especially among women pre-tmenopausal . Several recent studies have shown that past births at the end of reproductive life may reduce the risk of uterine cancer. Although this reflects the unique hormonal profiles of women who can conceive at a later age.

The hypothesis is consistent with the observations that the risk of uterine cancer increases with time as the latest pregnancy . Additional support for this hypothesis comes from several studies that show a reduction in the risk of users of intrauterine devices. However, it is also possible that these devices may affect the risk of causing structural or biochemical changes that alter the sensitivity of the endometrium to circulating hormones.

Nulliparity Meaning, Definition, cancer risk | Nulliparity vs Primiparity

Nulliparity Cancer Risk

In most studies, the risk of uterine cancer decreases with increasing parity, especially in women having pre-menopausal phase. Because pregnancy and breastfeeding reduces the number of women's menstrual cycles in her lifetime, that's why birth is associated with lower cumulative exposure to endogenous hormones.

In addition, pregnancy and breastfeeding make breast cells differentiation and mature them for production of milk. There is a hypothesis, from some researchers, that this differentiation makes breast cells more resistant to transformation in cancer cells than cells that have not undergone such differentiation. Some statistics show that nulliparity (never having had children) is associated with a three times higher risk of breast cancer.

Nulliparity vs Primiparity

A nulliparus or nullipara women is one, who never had a child, and this state of non productiveness is called not nulliparity while Parity is the condition of being able to have children, and when the woman becomes pregnant for the first time enters the state of primiparity, and is called primiparity woman, and primipara or primigravida. Similarly mulitple birth is termed as multiparity.

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Podophyllin Dose, Side effects, Mechanism of action, Uses for warts

Podophyllin has been the basis for the management of external warts since the 1942 Centers for Disease Control recommends the application of external lesion not exceeding 0.5 ml and limited to 10 cm or less per session. After the initial application the patient is re-examined and repeated at weekly intervals. The patient should wash the treated area for 2-4 hours after each topical application.

If no improvement is noted after one month, it should be considered as alternative treatments. However, the most successfully treated lesions respond in two to four days. The effectiveness of the treatment varies between 22-98%. Topical podophyllotoxin as 0.5% Solution or gel (Podoillox) is one of the most commonly used ablation therapy for genital warts which is also a major use of podophyllin resin.

But because of the potential Toxicity of this Podophyllotoxin is a ligand present in an active crude podophyllin resin and exhibits activity at concentrations of 0.5 to 10.0% in the treatment of genital HPV infection. The ability to apply a particular concentration according to a chemical ingredient leaves treatment for patients administered as a way to treat genital warts.

The reported 0.5 mg solution of podophyllotoxin is effective in the treatment of penile warts and is well tolerated in the self-administered regimen. It also offers the potential benefits in terms of safety and cost in relation to the treatment of genital warts, podophyllin resin.

Podophyllotoxin is applied to external warts twice daily for three consecutive days. Treatment is then performed for four days, and the cycle is repeated up to four weeks. Patient's instructions should include the following burning of the application may be expected but excessive burning, pain or swelling should be reported, wash hands after use and avoid contact during treatment days.

Podophyllin Dose, Side effects, Mechanism of action, Uses for warts

Podophyllin Side effects

  • Burning
  • Meatitis
  • Systemic toxicity
  • pain at application site
  • Redness
  • Skin irritation
  • Skin allergy

Podophyllin Mechanism of action

Podophyllotoxin is a purified podophyllin derivative with cytolytic effects. Its mechanism of action includes antimitosis, inhibition of nucleoside transport, stimulation of macrophage proliferation, and production of IL-1 and IL-2. Podophyllotoxin is prescribed as a treatment.

Podophyllin Uses/Indications

Podophyllin is recommend  to treat warts like perigual warts, plantar wrats etc. It should not be used on irritated on wounded skin as it may cause intense burning. Moreover, it is not suitable to apply over urethral warts.
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Corpectomy ICD-10, cage, recovery, complications | Lumbar & Cervical Corpectomy

A corpectomy is an operation that removes all or part of the vertebral body (Latin: corpus vertebrae, therefore called corpectomy), usually as a way of decompressing the spinal cord and nerves. Corpectomy is often performed in conjunction with some form of discectomy.

When the spinal vertebrae has been removed, the surgeon performs a spinal fusion. As the space in the column left after operation, it needs to be filled with a block of bone taken from the pelvis or one of the legs of the bone or manufactured. This bone graft keeps separation between these vertebrae and holds them firm and tight. As it heals, the vertebrae develop together and fuse.

Anterior cervical corpectomy and fusion (ACCF) is performed in patients with symptomatic progressive cervical spinal stenosis and myelopathy. It is done to remove large arthritic osteophytes  that are causing compression of the spinal cord and spinal nerves. However, in order to do this it is usually removed spinal body and the disc that need to be replaced by a part of the bone graft and connected together to firmly to maintain stability.

The operation is performed by means of general anesthesia. A breathing tube (endotracheal tube) is placed and the patient inhales through artificial ventilation system during surgery. Preoperative antibiotics are given intravenously. Patients are lying down (lying on the back), usually using a standard flat table. The surgical zone (neck) is cleaned with a special cleansing solution. Sterile drapes are placed and surgically sterile surgical gowns and gloves are used to keep the bacteria-free environment.

Corpectomy ICD-10, cage, recovery, complications | Lumbar & Cervical Corpectomy

Corpectomy Recovery

Recovery after corpectomy may take months but it highly depends upon surgical approach being uitilized at the time of operation, incision size, number of vertebral disc removed etc. Post-operative care is much important in this whole scenario because of  infection risk and spine comfortability. Moreover, right body posture and improved diet may be required to speed up the process of recovery.

Corpectomy Complications

Some commonly observed post-operative complications of corpectomy are

  • Infection
  • Dysphagia
  • Graft dislocation
  • Screw losening
  • Injury to spinal cord
  • Cervical malalignment
  • postoperative epidural hematoma
  • Pseudoarthrosis

Corpectomy Cages

Several types of inter body cages are used in spinal surgery e.g the titanium mesh cage, stackable cage systems and expandable cages . The use of expandable cages has increased in popularity due to their ease of placement and ability to correct segmental deformity. After selecting an appropriate size, the expandable cage cell is placed in the disk and the ends of the cage are aligned with the frontal planes of the spinal vertebral body above and below the corpectomy level.

Corpectomy ICD-10

M43.22 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes
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What is iPLEDGE program - Complete information about iPLEDGE program

Like some of the other mandatory programs in the United States, IPLEDGE program is a kind of distribution program that is primarily based upon the use of medication specifically during the pregnancy. The intentions of the IPLEDGE program is to make it sure that the medications should not be used during the pregnancy so as to prevent the birth defects. The use of isotretinoin in extremely harmful during the pregnancy period, the focus of IPLEDGE program is to make it sure that all the stakeholders should have all the related knowledge about the isotretinoin. All the doctors and the pharmacists are required to get registered onto the website designed by IPLEDGE program.

Why IPLEDGE program registration is designed?

The IPLEDGE program is comprehensively designed to provide a secure and safe method of isotretinoin usage. In particular Risk Evaluation Mitigation Strategy can actually highlight the risk that have the direct connection with the use of isotretinoin. The whole process involves series of steps, the steps are precisely designed by the experts, and there is an involvement of the doctor and the patient along with the pharmacist. As all the doctors that advise the patients to take isotretinoin must have to get registered through the IPLEDGE program, once the doctor is registered it is easier of the authorities to keep an eye onto the medical practitioners and their cases.

What is the point of having isotretinoin risk evaluation and mitigation strategy?

There is a clear view provided by the development of sotretinoin risk evaluation and mitigation strategy. Primarily there are some goals that are to be achieved. First of the patients are to be guided about the concept of isotretinoin. Moreover the dosage and the composition of the medicine are also important. As far as the use is concerned it is also core part of sotretinoin risk evaluation and mitigation strategy. There are some harmful effects of isotretinoin onto the pregnant females. It is obvious that the medicines are to be taken in controlled quantity; any fetal consumption of the isotretinoin can be very damaging for the health. The strategy is to highlight the safer use and methodologies.


Why isn’t IPLEDGE program developed earlier?

Very few people are aware of the fact that the concept of IPLEDGE program is quite old. The programs that were launched earlier failed to give the required results. One of the prime reasons is that the most of the females have already consumed enough isotretinoin that has caused the damage. Even after the registration of the earlier program there are thousands of the cases that were registered against the controlled use of isotretinoin. Keeping in view the new strategy was developed in order to guide the doctors and the patient’s right from the start. Now IPLEDGE program is successfully handling and monitoring the safer use of isotretinoin.

Why IPLEDGE program is criticized?

Some people are of the view that the procedure developed by the authorities in order to take the dosage is too complex. It takes lot of time to meet all the requirements of IPLEDGE program.  Moreover there are some serious questions raised by the people about the privacy of the IPLEDGE program.  Most of the females complained about the hectic and long procedures during and after the pregnancy. There are questions asked about the administrators of the IPLEDGE program. The website of the IPLEDGE program clearly mentions the privacy policy followed in every detail that is fetched from the patients during the whole procedure.

IPLEDGE registration & login procedure

Registration step:

For IPLEDGE Registration there is a two-step process adopted. The first step is the registration process. The prescribers can use any of the two options. One is through online from the official website or by calling 1-866-495-0654. The form is to be mailed after signing and reading the document. As soon as the details are received by the IPLEDGE program, the prescribers are enrolled into the program.

Receiving mail:

On the registration form, there are email addresses that are to be shared by the users. As soon as the registration process is complete the IPLEDGE directly sends a confirmation email to the address provided by the prescriber. The content of the email also provide the details like your IPLEDGE username and the password. IPLEDGE assigns a system-generated number to every application that is received.  There are other instructions given along with the login details. The program related material is also sent to the user so as to give a clear idea of the concept of the program.

Login procedure:

The login procedure is quite simple. As soon as the email is received by the prescriber, there are details shared. These details are extremely confidential. The activation details are given in the emails. Prescriber just needs to note down the login and the password. Prescribers can go to the official IPLEDGE link to use the email and password provided.  After activation, there is another mail send to the prescriber along with the patient’s kits.


There are some strict rules that are defined by the IPLEDGE authorities.  The idea behind designing the rules is to make it sure that the users are prevented from the birth defects and other pregnancy issues after the use of isotretinoin. The intention is to make it sure that there are checks and the balances against the fetal use of isotretinoin. The rule is that everyone regardless of the gender should enroll into the iPLEDGE program. All the doctors and the pharmacies must have to get registered with iPLEDGE program.
IPLEDGE Instructions for users and doctors

-Instructions for doctors:

If a doctor advises patient to take isotretinoin, it is to be ensured that the patient has all the related knowledge about the usage of the isotretinoin. The doctors then have to give patient ID number and ID card.

-Instructions for patients:

As soon after getting registered by the doctor, the patient receives an email from the IPLEDGE. There are 3 types in which the patients are classified. These are following
  • FCBPs
  • Females not of child-bearing potential (FnCBPs)/Males

Before starting medicines all patients have to go for pregnancy tests prescribed by doctors for the two consecutive months. After getting negative results in the tests, the FCBP are asked to take the online test through IPLEDGE. After this procedure, the patients are allowed to take the drugs from a registered pharmacy.


In order to get registered with the IPLEDGE program, there are some frequent questions that are asked by the potential users. The idea is to give the required details to the users. The questions that are frequently asked by the users are mostly connected with the technical assistance. Other than that there are questions asked about the registration processes used. Users often ask about the pharmacy rules and the registration process.  Questions that are frequently asked majorly cover the prescribed process. Minor details like the activation and the co-ordination are primarily focused on questions asked. The larger portion of frequently asked questions is related to the privacy policy followed by the IPLEDGE program.
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