Classification and stages of xerophthalmia

Classification of stages of xerophthalmia 
The ocular signs of vitamin A deficiencies include nightblindness, conjunctival xerosis, Bitot's spots, corneal xerosis, and keratomalacia. The classification proposed for general use is as follows:
Classification X1A 
Signs -primary
Conjunctival xerosis-dryness or lack ofluster, loss of ability to re­tain moisture no matter whether tears are present or absent, loss of transparency, thickening, wrin­kling, pigmentation, accumula­tion of debris.
Classification X1B
Signs -primary
Bitot's spot with conjunctival xe­rosis-a small plaque with a sil­very gray hue and a foamy surface; it is quite superficial and is raised above the general level of the conjunctiva
Classification X2
Signs -primary
Corneal xerosis-follows con­junctival xerosis. The corneal sur­face has a rough, fine pebbly appearance and lacks luster. Later, cellular infiltration of the corneal stroma contributes to the intense haziness of the cornea, which frequently has a bluish, milky appearance
Classification X3A
Signs -primary
Corneal ulceration wi th xerosis­involving loss of substance of a part or of the whole of the corneal thickness
Classification X3B
Signs -primary
Keratomalacia - consists of a characteristic softening of the en­tire thickness of a part or, more often, the whole of the cornea, leading to deformation or destruc­tion of the eyeball. The process is a rapid one, the corneal structure melting into a cloudy gelatinous mass which may be dead white or dirty yellow in color
Classification XN
Signs -secondary
Night blindness-impairment of the ability to adapt to the dark
Classification XF
Signs -secondary
Xerophthalmia fundus-multiple lesions, sometimes glaring white, scattered profusely along the course of the vessels
Classification XS
Signs -secondary
Corneal scars-resulting from the healing of irreversible corneal changes
Classification XB
Signs -secondary
Bitot's spot with conjunctival xe­rosis-a small plaque with a sil­very gray hue and a foamy surface; it is quite superficial and is raised above the general level of the conjunctiva
Stage XN, or night blindness, indicates a functional impairment ofthe retina and is difficult to diagnose in the young child (1-4 yr) unless the mother is aware that the child cannot see well at night. As a method of screening, the child may be asked to walk into a darkened room.
The first sign of xerophthalmia is xerosis of the con­junctiva (stage X1A). This dryness and dullness associated with the stability of the precorneal film is considered complete alteration of the reflection of light from the conjunctiva. Night blindness (XN) and Bitot's spots (ac­cumulation of debris and fatty material near the edge of the eye) are frequently present at stage X1B. At stage X2, when there is xerosis of the cornea itself, the pre corneal film fails to cover the cornea, which now appears dry and opaque. Small erosions or perforations begin to occur if treatment with massive doses of vitamin A (100,000 IU/day, orally or intramuscularly) is not provided within 1 to 3 days of inception, and irreversible damage will soon result. However, if treated, the corneal xerosis will clear up within a short period of time.
Irreversible damage occurs once deeper layers of the cornea are involved, as in stage X3A. The cornea may liquety and melt away, resulting in large perforations and extrusion of the iris, the lens, and the vitreous (X3B). The permanent scarring effects (stage X5) may differ depend­ing on whether or not intraocular pressure was restored at stage X3B. It is essential that medical and paramedical personnel be alert to the signs of xerophthalmia and that treatment be instituted immediately when symptoms are recognized in order to prevent blindness.

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Posted in Diseases

What is Ovarian Cancer?

Ovarian Cancer 
Ovarian cancer is often "silent," showing no obvious signs or symptoms until late in its development. The most common sign is enlargement of the abdomen, which is caused by the accumulation of fluid. Rarely is there abnormal vaginal bleeding. In women over 40, vague digestive disturbances (stomach discomfort, gas, distention) that persist and cannot be explained by any other cause may indicate the need for a thorough evaluation for ovarian cancer.
Risk for ovarian cancer increases with age. The highest rates are for women over age 60. Women who have never had children are twice as likely to develop ovarian cancer as those who have. Early age at first pregnancy, early menopause, and the use of oral contraceptives, which reduces ovulation fre­quency, appear to be protective against ovarian cancer. If a woman has had breast cancer, her chances of developing ovar­ian cancer double. Certain rare genetic disorders are associated with increased risk. With the exception of Japan, the highest in­cidence rates are reported in the more industrialized countries.
Early detection requires periodic, thorough pelvic exami­nations. The Pap smear, useful in detecting cervical cancer, does not reveal ovarian cancer. Women over age 40 should have a cancer-related checkup every year. Testing for the level of tumor marker CA-125, a protein antigen, is helpful.
Surgery, radiation therapy, and drug therapy are treatment options. Surgery usually includes the removal of one or both ovaries (oophorectomy) (o-ah-fah-rek'tah-me), the uterus (hysterectomy) (his"ter-ek'to-me), and the uterine tubes (sal­pingectomy) (sal-pin-jek'to-me). In some very early tumors, only the involved ovary is removed, especially in young woman. In advanced disease, an attempt is made to remove all intra-abdominal disease to enhance the effect of chemotherapy.

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Posted in Diseases , Women Health

Affect of smoking on Heart and Pregnant Women

Does Cigarette Smoking Affect the Heart? 
Yes. Smoking cigarettes increases the risk of heart disease, which is America's number one killer. About 150,000 Ameri­cans die each year from heart attacks and other forms of heart disease caused by smoking. Smoking, high blood pressure, high blood cholesterol, and lack of exercise are all risk factors for heart disease. Smoking alone doubles the risk of heart dis­ease. When a person smokes and has other risk factors, his or her chance of getting heart disease increases dramatically. For example, if smoking is combined with high blood pressure or high cholesterol, then the risk goes up four times. Put all three together-smoking, high blood pressure, and high choles­terol-and the risk goes up eight times. Smokers who have al­ready had one heart attack are also more likely than nonsmokers to have another attack.
Is There Any Risk for Pregnant Women and Their Babies? 
Pregnant women who smoke endanger the health and lives of their unborn babies. When a pregnant woman smokes, she re­ally is smoking for two because the nicotine, carbon monox­ide, and other dangerous chemicals in smoke enter the mother's bloodstream and then pass into the baby's body. Women who smoke during pregnancy risk having a miscar­riage, or a premature or stillborn baby. Their babies are also more likely to be underweight, by an average of 1/2 pound
Does Smoking Cause Any Special Health Problems for Women?
Yes. Nonsmoking women who use oral contraceptives ("the Pill") double their chances of having a heart attack. However, when women use the Pill and smoke, they are 10 times more likely to suffer a heart attack than nonsmoking women who don't take the Pill. Women who smoke and use the Pill have an increased risk of stroke and blood clots in the legs as well. Women who smoke also run the risk of having trouble getting pregnant; the more they smoke, the more likely it is that they will have difficulty. Some studies show that female smokers, espe­cially the elderly, are at a higher risk for osteoporosis (a disease that weakens the bones and makes them more likely to break) than nonsmoking women. In addition, women who smoke in­crease their chances of getting cancer of the uterine cervix.

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Posted in Diseases , Smoking , Women Health

Constipation! What is it?

Constipation 

The colon of the large intestine has four regions: the as­cending colon, the transverse colon, the descending colon, and the sigmoid colon. Water is removed from the nondigestible remains that enter the ascending colon from the small intestine. At this point, bacteria begin their action; they use cellulose as an energy source as they produce fatty acids and vitamins that can also be used by their host. They also re­lease hydrogen gas and sulfur-containing compounds that contribute to human flatulence (gas). Feces, which consist of nondigested remains, bacteria, and sloughed-off intestinal cells, begin to form in the transverse colon. From there, they are propelled down the descending colon toward the rectum by periodic, firm contractions. When sufficient feces are in the rectum (130-200 grams), a defecatory urge is felt. The defeca­tion reflex contracts the rectal muscles and relaxes the internal anal sphincter, a ring of muscle that closes off the rectum. Then, feces move toward the anus. A pushing motion, along with relaxation of the external anal sphincter, propels feces from the body. Since these activities are under voluntary con­trol, it is possible to control defecation. 

Defecation normally occurs from three times a week to three times a day; therefore, some variation in occurrence is nothing to worry about. However, if the frequency of defecation declines and if defecation becomes difficult, then constipation is present. If constipation is a continuing problem, a physician can help record the movement of materials through the large in­testine via several tests. The patient swallows about 20 small markers that will show up on an X ray. At intervals during the following week, X rays are taken, and the number and locations of the markers are noted. If muscle contraction of the intestinal wall is insufficient, the markers move slowly along their course. Injured nerves, certain drugs, and prolonged overuse of stimula­tory laxatives can bring about this difficulty. On the other hand, markers may move normally at first and then slow down con­siderably in the descending colon and rectum. Habitual disre­gard of the defecatory urge may have caused this problem, or a cancerous polyp might be obstructing normal movement. If the former is the case, it is possible to retrain the rectum to work properly. Sitting on the toilet about 20 minutes each morning can encourage a return of the reflexes that have disappeared, but straining is not recommended. 

Temporary constipation due to traveling, pregnancy, or medication can sometimes be relieved by increasing dietary fiber, drinking plenty of water, and getting moderate amounts of exercise. The use of oral laxatives (agents that aid emptying of the intestine) is a last resort. Bulk-forming laxatives, such as those that contain bran, psyllium, and methyl cellulose, are considered best because they promote the defecation reflex. Laxatives that contain osmotic agents, such as carbohydrates or salts (lactulose, milk of magnesia, or Epsom salts), cause water to move into rather than out of the colon. Stool soften­ers (mineral oil or those that contain docusate) should be used sparingly. Mineral oil reduces the absorption of fat-soluble vitamins, and docusate can cause liver damage. Laxatives that contain chemical stimulants (such as phenolphthalein in Ex­Lax and Feen-A-Mint) can damage the defecation reflex and lead to a dependence on their use. Aside from laxatives, rectal suppositories are sometimes helpful in providing lubrication. 

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Posted in Biology , Diseases