A Simple Guide to Medical Conditions Series

Sexually transmitted diseases are transmitted through sexual intercourse with multiple partners. It is unlikely that monogamous relationship can pass on sexually transmitted disease. Sexually transmitted disease can be caused by 1.bacteria such as gonorrhea , chlamydia, syphilis 2.Viral infection such as HIV,herpes, human papilloma virus 3.parasite such as trichomonas Sexually transmitted disease is spread by infected people through contact with the penis, vagina, mouth, or anus. Prevention of sexually transmitted diseases is by: 1.The best way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse. 2.He or she should be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected. 3.Latex condoms, when used consistently and correctly, can reduce the risk of transmission of sexually transmitted diseases. 4.Any genital symptoms such as discharge or burning sensation during urination or unusual sore or rash should be a signal to stop having sex. 5.A person who has been diagnosed and treated for sexually transmitted diseases should notify a ll recent sex partners so they can also be treated. In this way there is less risk that the sexual partners will develop serious complications from sexually transmitted diseases. It will also reduce the person’s risk of becoming re-infected. 6.The person and all of his or her sex partners must avoid sex until they have completed their treatment for sexually transmitted diseases. TABLE OF CONTENT Chapter 1 Sexually Transmitted Diseases Chapter 2 Gonorrhea Chapter 3 Chlamydia Chapter 4 Trichomonasis Chapter 5 Human Papilloma Virus Chapter 6 Human Immunodeficiency Virus Chapter 7 Genital Herpes Chapter 8 Syphilis Chapter 9 Bacterial Vaginosis Chapter 10 Candidiasis Chapter 11 Hepatitis B virus Chapter 12 Pelvic Inflammatory Disease Chapter 13 Vulvitis Chapter 14 Bartholin Cyst Chapter 15 Cervicitis Chapter 16 Salpingitis Chapter 17 Urethritis Chapter 18 Balanitis Chapter 19 Epidymitis and Orchitis Chapter 20 Epilogue

Jaundice is the symptom of yellowish discoloration of the skin, mucous membrane and sclera due to accumulation of bile pigments in tissues associated with the increase in serum bilirubin level. Bilirubin is the breakdown product of hemoglobin during the end of life span of a red blood cells. The types of bilirubin are: 1. unconjugated bilirubin which is toxic, fat soluble and cannot be excreted by the kidneys 2. conjugated bilirubin which the hepatocytes in the liver has conjugated the unconjugated bilirubin and excretes in the bile. Conjugated bilirubin is water soluble and in high levels is also excreted in the urine as dark tea colored urine. What are the causes of Jaundice? The causes of jaundice are: 1. Hemolytic anemia is due to the break up of red blood cells Here the major form of bile pigment is unconjugated 2. Hepatocellular or liver causes: a. Acute: 1. viral hepatitis A to F, 2. alcoholism, 3. toxic chemical hepatitis including drugs and 4. bacterial infections such as leptospirosis. More of conjugated bilirubin at early stages followed by unconjugated bilirubin. b. Chronic liver cirrhosis - mostly unconjugated bilirubin 3. Obstructive jaundice: mainly conjugated bilirubin accumulates a.Intrahepatic cholestasis due to drug sensitivity b. Extra hepatic gallstones, carcinoma of biliary systems or adjacent organs. What are the effects of Jaundice? The effects of jaundice: 1. yellowing of the skin and white of eye and mucous membranes like inside of the lips 2. liver enlargement and palpable gallbladder in blockage 3. enlarged spleen especially in hemolytic anemia 4. dark colored urine due to presence of bilirubin in the urine 5. pale stools 6. prolonged tiredness from anemia, loss of blood, 7. encephalopathy from bilirubin affecting the brain 8. nausea and vomiting. 9. poor appetite Diagnosis of causes: 1. Hemolytic anemia a. bilirubin raised b. liver function tests normal c. urine and stools may be normal except for excess urobilinogen d. blood hemorrhage tests for hemolytic anemia 2. Hepatocellular a. liver function test normal except for increased liver enzymes, proteins normal but alkaline phosphates may be raised b. tests for infections such as hepatitis, mononucleosis, and cytomegalovirus c. antinuclear antibody 3. Obstructive: a. liver function tests-conjugated bilirubin raised, liver enzymes raised, alkaline phosphatase raised b. previous attacks of jaundice c. biliary colic Other tests include: 1. Utrasound of liver and gallbladder 2. cholecytograms 3. cholangiography 4. MRI of liver and abdomen 5. liver biopsy What is the treatment for Jaundice? Treatment usually includes: 1. supportive treatment like a. rest b. adequate fluids 2. adequate nutrition and vitamin B 3. treatment depends on the cause: a. blood transfusion or platelet transfusion for hemolytic anemia b. treatment of infections c. surgery for obstructive lesions Prognosis: depends on the underlying cause. Prevention: 1. Avoid seafood especially cockleshells which may cause hepatitis A 2. Avoid casual sex which can spread hepatitis B and C 3. Avoid reusage of syringes in drug addicts to prevent Hepatitis C and AIDS 4. Avoid medicine which can cause obstructive jaundice. TABLE OF CONTENT Chapter 1 Jaundice Chapter 2 Hepatitis Chapter 3 Hepatitis A Chapter 4 Hepatitis B Chapter 5 Hepatitis C Chapter 6 Liver Cirrhosis Chapter 7 Liver Cancer Epilogue

Hypertension, or high blood pressure, refers to a condition in which the blood is pumped around the body above normal pressure. It is a silent disorder and the only way to detect it is to have your blood pressure checked. When is it High Blood Pressure? Blood pressure is not fixed. It varies with time of day or night, physical activity and emotional factors. Therefore, blood pressure has to be taken under resting condition and on more than one occasion. A blood pressure reading of 120/80 is read as 120 over 80 millimetres of mercury. The top number is your systolic pressure. This is the pressure in your arteries when your heart pumps. The bottom number is your diastolic blood pressure. This is the pressure measured in your arteries when your heart relaxes between pumps. Blood pressure may vary from 100/60 in a young healthy woman to 130/80. Normal blood pressure is below 130/80; blood pressure between 130/80 and 139/89 is called "pre-hypertension", and a blood pressure of 140/90 or above is considered high. Hypertension is present when your blood pressure is persistently at or above 140/90. People with diabetes or kidney disease must strive to maintain their blood pressure at around 130/80 because they are at higher risk of complications of hypertension. What are the Causes of Hypertension? In 95% of cases, there is no definite known cause and it is known as essential hypertension. Older people and men are more likely to develop high blood pressure. It also tends to run in families. Although, you may inherit the tendency to get high blood pressure, other lifestyle choices (eating an unhealthy diet, smoking, not exercising) will often determine if you eventually get the disease. The other 5% of high blood pressure cases are due to kidney disease, glandular (hormone/endocrine) problems or a side effect of some medications and are called secondary hypertension. Listed below are some causes of secondary hypertension. 1. Adrenal gland tumors 2. Cushing's syndrome 3. Kidney disorders 4. Kidney failure 5. Use of medications, drugs, or other chemicals 6. Pregnancy or the use of oral contraceptives 7. Diabetes mellitus 8. Obesity TABLE OF CONTENT Chapter 1 Hypertension Chapter 2 Coronary Heart Disease Chapter 3 Atrial Fibrillation Chapter 4 Heart Failure Chapter 5 Congenital Heart Disease Chapter 6 Cardiogenic Shock Chapter 7 Pericarditis Chapter 8 Tachycardia Chapter 9 Bradycardia

I do not pretend to be an expert on sexual health. But today with the new permissive society there has been an increase in sexually transmitted diseases and division in the family with the divorces and family abuses. It is important to realize that the physical aspect of sexual intercourse is just as important to the couple as well as the loving and intimate relationship. Sexual Intercourse has been called a "two backed beast" by none other than Shakespeare in his play Othello. He was of course describing the normal position taken by an intimate couple using a missionary position. Sexual Intercourse is proven to relieve individuals of distress and bring numerous health benefits like improved cholesterol levels and increased blood circulation. The intimacy and touching in the sexual act relieves tension and other unwanted feelings. This breathing during the sexual intercourse improves blood circulation and massaging or touching certain parts of the body encourages the production of substances called endorphins, the body's natural painkiller. People who have a supportive sexual partner manage emotional or psychological distress better, live longer, and enjoy improved overall health. This kind of emotional intimacy in sex is good for one's emotional and physical health. People who have a monogamous sexual partner will be free of the fear of sexually transmitted diseases. Sex can also be a great stress reliever. Sex and orgasms promote a long-term calming effect and help keep psychological balance. Sex does not mean only the physical relationship a person has with his mate. More importantly is the bonding and the healthy physical and emotional relationship the person has with his soul mate that is called love. A healthy sex life is an important matter in one's life. Table of Content Chapter 1 Introduction Chapter 2 Sexual Health Chapter 3 Male Problems: Chapter 4 Premature Ejaculation Chapter 5 Erectile Dysfunction Chapter 6 Balanitis Chapter 7 Urethritis Chapter 8 Orchitis Chapter 9 Andropause Chapter 10 Female Problems: Chapter 11 Vaginismus Chapter 12 Vulvitis Chapter 13 Vaginitis Chapter 14 Pelvic Inflammatory Disease Chapter 15 Menopause Chapter 16 Sexual Transmitted Diseases Chapter 17 Age and Sex

A skin polyp is a growth on the surface of the skin. The skin polyps can be raised on a stalk (pendulated) or flat (sessile). Most skin polyps are benign, which means they are not cancerous. Besides skin polyps, there are polyps present in the mucosa of the ear, nose and throat. Other polyps are present in the stomach, colon, uterus, cervix, bladder and even in the gallbladder. Some types of polyps may be pre-cancerous or can become cancer. Flat polyps are smaller and harder to visualize but are more likely to be cancer than raised polyps. Most people with polyps do not have symptoms. Symptoms include blood on your underwear, on toilet paper, or in the stool. Other symptoms are constipation or diarrhea for more than a week or so. Most polyps are removed and tested for cancer. If there are symptoms or a family history of polyps or cancer, the patient should be tested for cancer. Total of Content: Chapter 1 Polyp Chapter 2 Skin Polyp Chapter 3 Ear Canal Polyp Chapter 4 Nose and Sinus Polyp Chapter 5 Throat Polyp Chapter 6 Colon Polyp Chapter 7 Stomach Polyp Chapter 8 Uterine Polyp Chapter 9 Cervical Polyp Chapter 10 Bladder Polyp Chapter 11 Gallbladder Polyp Epilogue

Bad Breath or Halitosis is the condition when a person suffers from chronic bad breath. What are the causes of Bad Breath? Halitosis is usually caused by the following: Infections: 1. bacterial infection of the gums, dental cavities.(600 types of bacteria present in mouth) 2. anaerobic infections of the mouth, 3. Infection of the tonsils, nose and sinuses(postnasal drip) Gastric problems and indigestion: 1. Indigestion of food in the stomach can cause the undigested food in the stomach to emit an offensive smell through the mouth 2. gastro esophageal reflux of food can also cause the smell of acid and undigested food in the mouth Certain food: 1. garlic and onions which has odious sulphur compounds can give rise to foul smell from the mouth 2. fish 3. cheese 4.alcohol Smoking: Cigarettes smokes contains 40 over chemicals which cause bad mouth smell Dry mouth: 1. Insufficient drinking of water 2. medications can cause dry mouth and produces a smell from the mouth Systemic diseases: 1. liver failure. 2. Lower respiratory tract infections 3. Renal infections and renal failure. 4. Carcinoma. 5. Trimethylaminuria ("fish odor syndrome"). 6. Diabetes mellitus. What are the causes of Bad Breath? Persons who has Bad Breath has the following Symptoms: 1. Bad breath 2. Dry mouth Signs: 1. discharge from nose or tonsils 2. furry tongue How is the diagnosis of Bad Breath made? Diagnosis can usually be made by : 1. History of bad breath 2. lick the back of the wrist, let the saliva dry for a minute, and smell the dried saliva. 3. scrape the posterior back of the tongue with a plastic disposable spoon and smell the drying residue. 4. Halimeter: a portable sulfide monitor to test for levels of sulfur emissions (especially hydrogen sulfide) from the mouth. 5. BANA test: find the salivary levels of an enzyme which shows the presence of certain halitosis-related bacteria 5. ß-galactosidase test: the presence of this enzyme in the saliva indicates presence of bad breath What is the treatment of Bad Breath? Treatment: 1. Appropriate Antibiotics, antifungal for infections of mouth 2. drinking several glasses of water a day prevents dryness of mouth 3. Eating a healthy breakfast helps clean the back of the tongue 4. Proper oral hygiene after eating: brushing of teeth and flossing. Dentures should be removed at bedtime and soaked overnight in antibacterial solutions. 5. Avoid smoking 6. Gargle mouth after every meal. Avoid the use of alcohol based mouth washes. Use instead oil based mouth washes. 7. Chewing sugarless gums helps to stimulate production of saliva and hence less bad breath 8. Treat underlying condition such as diabetes, liver, kidney and other conditions. What is the prognosis of Bad Breath? Prognosis is usually good with proper oral hygiene. Recurrence is quite common. TABLE OF CONTENT Chapter 1 Bad Breath Chapter 2 Dental Decay Chapter 3 Gingivitis Chapter 4 Stomatitis Chapter 5 Glossitis Chapter 6 Mouth Ulcers Chapter 7 Vincent’s Angina Chapter 8 Gastro esophageal Reflux Disease

Sleep is something which every one of us need. It helps to rest the mind and allows the body to rest and rejuvenate itself. Sleep is described as a state of consciousness or dynamic activity which gives the body time to rest and build up strength while the brains continue to work. Sleep has four phases. During the first stage N1, sleep is light and a person can be easily awakened. At this stage, the muscle activity and eyes move very slowly. Alpha waves of 8-13 Hz (awake stage) begin to change to the theta waves of 4-7 Hz on the EEG. Often when a person is awakened, sudden muscle contractions occur as if you are falling off the bed. At stage 2 or N2, eye movements stop and brain waves become slower with intermittent burst of rapid waves known as “sleep spindles”. Muscle activity as measured by EMG decreases, and conscious awareness of the external environment disappears. This stage occupies 45–55% of total sleep in adults. In stage 3 or N3, delta waves of 0.5 to 2 Hz start to appear. These are extremely slow brain waves interspersed with smaller, faster waves. They can be described as slow wave type of sleep. Sleep at stages 3 is considered deep sleep where there is no more eye movement or muscle activity. It is difficult to wake up some one who is in stage 3. People who are awakened during deep sleep experience temporary disorientation. It is also during deep sleep stage that children experience bedwetting, night terrors, or sleepwalking. REM sleep is the last stage where breathing becomes faster, shallow and irregular. The eyes jerk rapidly in different directions with the limb muscles getting paralyzed for a short period of time. During this stage, the heart rate increases, blood pressure rises, and penile erections occur among men. Dreams are experienced during REM sleep stage. These stages repeat in a cycle. A complete sleep cycle takes about 90 to 110 minutes on average. The first sleep cycle each night is characterized by short REM periods and long periods of deep sleep. But as the night goes by, REM sleep periods become longer while deep sleep periods get shorter. In the morning, people spend their sleep time in stages 1, 2, and REM sleep stages. According to research, people spend 50% of their sleep time in stage 2 sleep, about 20% in REM sleep, and 30% in other sleep stages. In comparison, infants spend half of their sleep time in REM sleep. Sleep and being awake are affected by different neurotransmitter signals in the brain. When food and medicine change the balance of these signals, a person begins to feel alert or sluggish. It also affects the way a person sleeps. Coffee and other caffeinated drinks as well as weight loss diet pills can cause insomnia by stimulating some parts of the brain. Others resort to alcohol which only leads to light sleep, but deprive them of REM and deeper, more restorative stages of sleep. Researchers at the Warwick and London have found that insufficient sleep can more than double the risk of death from cardiovascular disease but also that too much sleep can also be associated with a doubling of the risk of death, though not from cardiovascular disease TABLE OF CONTENT Chapter 1 Sleep Chapter 2 Insomnia Chapter 3 Obstructive Sleep Apnea Chapter 4 Snoring

Dementia is a disease in which brain tissue degenerates to the extent of loss of memory and other intellectual abilities serious enough to interfere with daily life. In Dementia there is a severe and progressive decline in mental function. It affects a person's ability to: 1. think, remember and reason 2. learn new information and skills 3. solve problems and make judgement What is the cause of Dementia? There are several different factors which may contribute to its development. They can be divided into: 1. Irreversible conditions a. Aging is one important risk factor. Alzheimer's Disease b. Stroke c. Parkinson's disease 2. Reversible conditions a. Hypothyroidism b. Vitamin B12 deficiency c. Alcohol dependence diseases Irreversible Dementia cannot be cured but it may be possible to slow down the progression of the disease. It may be possible treat the cognitive symptoms. Potentially reversible dementia may be curable. What are the Symptoms of Dementia? 1. Memory loss or Forgetfulness is often one of the earliest symptoms (Patients may forget dates, names of common objects and familiar people) 2. Confusion (Disorientation in time and place) 3. Trouble with organizing 4. Misplacing things, 5. Difficulty in expressing thoughts, 6. Difficulty performing familiar tasks 7. Difficulty understanding others 8. Poor or decreased judgment 9. Wandering and getting lost in familiar places 10. Changes in mood and behavior (They may become easily agitated or depressed) a. Changes in personality b. paranoia c. hallucinations d. agitation e. anxiety f. sleep problems How is Dementia assessed and investigated? Diagnosis can be based on: 1. History of depression, anxiety, hallucination, paranoia, agitation or sleep problems 2. Various tests may be done to exclude other conditions that may be causing the same problems: a. blood sugar, thyroid hormone, vitamin B12 level b. CT Scan or MRI of the brain to exclude tumors or stroke The family doctor can refer the patient to a psychiatrist for further assessment if dementia is suspected. TABLE OF CONTENT Chapter 1 Dementia Chapter 2 Alzheimer’s Disease Chapter 3 Aging Chapter 4 Epilogue

Hemorrhoids or piles are distended veins inside the anus which are swollen and inflamed. Hemorrhoids are either inside the anus (internal) or under the skin around the anus (external). What is the cause of hemorrhoids? Hemorrhoids usually result from straining to pass the stool out of anus. Other contributing factors include pregnancy, aging, chronic constipation or diarrhea. What are the symptoms of hemorrhoids? The most common symptom of internal hemorrhoids is 1, bleeding from the anus. Bright red blood may be seen covering the stool, on toilet paper, or dripping from the anus into the toilet bowl. 2. There may be pain too especially if the stool is hard. This could be due to the hard stools pressing on the swollen piles or due to a tear in the inner lining of the anus. 3. A painful swelling or a hard lump around the anus may occur when a blood clot forms. This condition is known as a thrombosed hemorrhoid. 4. In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching. How common are hemorrhoids? Hemorrhoids are very common in both men and women. About half of the population have hemorrhoids by age 50. Hemorrhoids are also common among pregnant women. The pressure of the fetus in the abdomen, as well as hormonal changes, causes the hemorrhoid vessels to enlarge. For most women, however, hemorrhoids caused by pregnancy are temporary. How are hemorrhoids diagnosed? 1. A thorough examination and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer. The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities. Closer evaluation of the rectum for hemorrhoids requires an exam with a proctoscope, useful for more completely examining the entire rectum. 2. To rule out other causes of gastrointestinal bleeding, the doctor may examine the rectum and the entire colon with colonoscopy. Colonoscopy is a diagnostic procedure that also involves the use of lighted, flexible tube inserted through the rectum. What is the treatment of hemorrhoids? a. Medical treatment of hemorrhoids is aimed initially at relieving symptoms. Measures to reduce symptoms include: 1. Tub baths several times a day in plain, warm water for about 10 minutes 2. application of a hemorroidal cream or suppository to the affected area. 3. medicines such as daflon to shrink the swollen blood vessel. b. surgical treatment: A number of methods may be used to remove or reduce the size of internal hemorrhoids. These techniques include 1. Rubber band ligation. A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, and the hemorrhoid withers away within a few days. 2. Sclerotherapy. A chemical solution is injected around the blood vessel to shrink the hemorrhoid. 3. Laser coagulation. A special device is used to burn hemorrhoidal tissue. 4. Hemorrhoidectomy. Occasionally, extensive or severe internal or external hemorrhoids may require removal by surgery known as hemorrhoidectomy. 5. A new method is the Longo technique. It involves using a circular stapling device which removes a ring of tissue in the lower anus pulling the enlarged piles up within the anus. The staples also interrupt the blood supply to the piles TABLE OF CONTENT Chapter 1 Hemorrhoids Chapter 2 Anal Fistula Chapter 3 Anorectal Abscess and Anal Fissure Chapter 4 Constipatio

An auto immune disease is a disease of the human body where the immune system of the body attacks its own cells in the joints as in Rheumatoid arthritis Or in the skin as in psoriasis Or in the muscles as in Myasthenia gravis Or throughout the body as in Systemic Lupus Erythematosis There are over 80 different types of auto immune diseases in the body What is the cause of Auto Immune Disease? Normally the body immune system which consists of the white blood cells will attack the harmful bacteria, cancer or other substances in the body and try to destroy them as antigens. In the auto immune disease the body's immune system attacks the normal body cells instead. Some of the organs or tissue damaged by the auto immune disease includes: 1. Bones and joints 2. Muscles 3. Blood vessels 4. Endocrine glands 5. Skin 6. Blood cells The cause of this behavior is not known but micro-organisms and toxins may trigger off these reactions in people who may have the genes to be affected by the abnormal immune response. What are the symptoms of auto immune diseases? Symptoms may be: 1. fatigue 2. fever 3. abnormal symptoms depending on the organ affected How is the diagnosis of an auto immune disease made? 1. antinuclear antibody test 2. C reactive Protein 3. Erythrocyte Sedimentation rate(ESR) What is the Treatment of Auto immune disease? The treatment depends on the specific disease and organ involved. The purpose of treatment is to: 1. boost the immune system of the body 2. treat the symptoms of the auto immune disease 3. control the severity of the auto immune process Medicines : Medicines prescribed for the control of the immune system are called immuno-suppressive drugs: 1. corticosteroids such as prednisolone 2. non steroid drugs such as methotrexate, cyclophosphamides Some auto immune diseases causes depletion of the red blood cells . In these conditions blood transfusions may be required Where the bones and joints are involved, supportive help with bones and joints are needed. What are the complications of the auto immune disease? There is at the moment no cure for these diseases. However the auto immune diseases can be controlled with medications. The condition can become worse or the side effects of the medications may cause infections. What is the prognosis of auto immune disease? The outcome depends on the disease. However most are chronic and cannot be easily cured. They however can be controlled with medications. TABLE OF CONTENT Chapter 1 What is Auto Immune Disease? Chapter 2 Addison's Disease Chapter 3 Celiac Disease Chapter 4 Myasthenia Gravis Chapter 5 Psoriasis Chapter 6 Rheumatoid Arthritis Chapter 7 Systemic Lupus Erythematosis Chapter 8 Epilogue

Water-borne diseases are illnesses in developing countries which are caused by drinking or coming in contact with water contaminated by human or animal feces, which have pathogenic microorganisms. Infection commonly results during bathing, washing, drinking, in the preparation of food, or the consumption of food which are infected in this way. Micro-organisms which can cause water borne disease are: 1. Protozoal infections Amoeba Giardia 2. Parasitic infections Schistosomiasis Enterobiasis(threadworms) 3. Bacterial infections Cholera Dysentery Leptospirosis Typhoid fever 4. Viral infections Hepatitis A Water-related human health issues have become increasingly important with the emergence of new water-related infection diseases and the re-emergence of already known ones. Most of the information is available for some water-, sanitation- and hygiene-related diseases such as salmonellosis, cholera, and shigellosis. For others such as schistosomiasis or legionellosis, the data still is incomplete. How are water borne diseases spread? Water borne diseases are usually spread by the contamination of drinking water systems with the urine and feces of infected animal or people. This happens where public and private drinking water systems get their water from surface waters such as rain, creeks, rivers or lakes which can be contaminated by infected animals or people. Dirty water from landfills, septic fields, sewer pipes, residential or industrial developments can also sometimes contaminate surface water. This has resulted in many outbreaks of fecal-oral (from feces to mouth) diseases such as cholera and typhoid. Other ways fecal material can reach the mouth may be from the dirty hands or contaminated food. Contamination of food is the most common way in which people become infected. The germs in the feces can cause the diseases by even minimum contact and spread. Contamination may also occur due to floodwaters, water overflow from landfills, septic fields, and sewer pipes. Ways to prevent contact with contaminated food include: 1. improve the people’s hygienic behavior 2. provide them with clean drinking water, washing, bathing facilities and proper sanitation. Clean water plays a very important part for reducing the spread of water-borne diseases. It is well recognized that the prevalence of water-borne diseases can be greatly decreased by providing clean drinking water and ensuring safe disposal of feces. Water is disinfected to kill any pathogens present in the water supply and also from growing again in the water supply Disinfection is then used to prevent the growth of pathogenic organisms and to protect public health and the choice of the disinfectant depends upon the individual water quality and water supply system. Without disinfection, the risk from waterborne disease is increased. The two most common methods to kill microorganisms in the water supply are: 1. oxidation with chemicals such as chlorine, chlorine dioxide or ozone 2. irradiation with Ultra-Violet rays The other way is to boil water to 100 degrees centigrade and cook food with high temperature. TABLE OF CONTENT Chapter 1 Water Borne Diseases Chapter 2 Amoebiasis Chapter 3 Giardiasis Chapter 4 Schistosomiasis Chapter 5 Cholera Chapter 6 Typhoid Chapter 7 Dysentery Chapter 8 Leptospirosis Chapter 9 Hepatitis A Infection

Refractive Eye Disease is an eye disease occurring as a result of error in the focusing of light by the eye. It results in poorer eye vision. These are : 1. Myopia or short sightedness where light comes to focus in front of the retina instead of on the retina. 2. Hypermetropia or Long sightedness where light comes to focus behind the retina instead of on the retina. 3. Presbyopa or Far sightedness where the ability to focus up close becomes more difficult due to age. As the eye ages, the lens can not change shape easily to allow the eye to focus close objects clearly. 4. Astigmatism where the eye can not focus light evenly onto the retina. This can cause images to appear blurry and stretched out. Who is at risk for refractive errors? All refractive errors can affect both children and adults. People with parents having certain refractive errors are more likely to get a refractive error. What are the signs and symptoms of refractive errors? Blurred vision is the most common symptom. Double vision Glare or halos around bright lights Eye strain How are refractive errors treated? Refractive errors can be corrected with eyeglasses, contact lenses, or surgery. Eyeglasses are the simplest and safest way to correct refractive errors. TABLE OF CONTENT Chapter 1 Refractive Eye Disease Chapter 2 Myopia Chapter 3 Hypermetropia Chapter 4 Presbyopia Chapter 5 Astigmatism Chapter 6 Lasik Surgery Epilogue

A genetic disease is a disease caused by a abnormal form of a gene called a variation or a change of a gene called a mutation. Genetic disorders can be caused 1. by a mutation in one gene (monogenetic disorder) Monogenetic disorders are relatively rare and are caused by a mutation in a single gene. The mutation may be present on one or both chromosomes (one chromosome inherited from each parent). Examples of monogenic disorders are: sickle cell disease, cystic fibrosis, polycystic kidney disease, and Tay-Sachs disease. A mutated gene can be inherited through a family. Each generation of children can inherit the gene that causes the disease. Monogenic disorders can be: a. Dominant diseases are caused by the presence of the disease gene on just one of the two inherited parental chromosomes. In dominant diseases, the chance of a child inheriting the disease is 50 percent. In a family situation, for example, if the parents have four children, it may be possible that two of those children inherit the disease gene. Examples of dominant diseases are Huntington's chorea and Marfan syndrome. b. Recessive diseases require the presence of the disease gene on both of the inherited parental chromosomes. In this case, the chance of a child inheriting a recessive disease is 25 percent. In the family example, if the parents have four children, it may be more likely that only one child will develop the disease. Examples of recessive diseases include cystic fibrosis and Tay-Sachs disease. 2. by mutations in multiple genes (multifactorial inheritance disorder) Most genetic disorders, however, are "multifactorial inheritance disorders," meaning they are caused by a combination of inherited mutations in multiple genes, often acting together with environmental factors. Behaviors are also multifactorial, involving multiple genes that are affected by a variety of other factors. Researchers are learning more about the genetic contribution to behavioral disorders such as alcoholism, obesity, mental illness and Alzheimer's disease. 3. by a combination of gene mutations and environmental factors Multifactorial inheritance disorders are caused by a combination of small inherited variations in genes, often acting together with environmental factors. Heart disease, diabetes, and most cancers are examples of such disorders. 4. by damage to chromosomes (changes in the number or structure of entire chromosomes, the structures that carry genes) Chromosome disorders are caused by an excess or deficiency of the genes that are located on chromosomes, or by structural changes within chromosomes. In Down syndrome there is an extra copy of chromosome 21. (called trisomy 21), although no individual gene on the chromosome is abnormal. A specific form of blood cancer (chronic myeloid leukemia, CML) may be caused by a chromosomal translocation, in which portions of two chromosomes (chromosomes 9 and 22) are exchanged. Nearly all diseases have a genetic component. Some diseases are caused by mutations that are inherited from the parents like sickle cell disease. Other diseases are caused by acquired mutations in a gene or group of genes that occur during a person's life. Such mutations are not inherited from a parent, but occur either randomly or due to some environmental exposure (such as cigarette smoke). These include many cancers, as well as some forms of neurofibromatosis. Rarely, one of these monogenic diseases can occur spontaneously in a child when his/her parents do not have the disease gene, or there is no history of the disease in the family. This can result from a new mutation occurring in the egg or sperm that gave rise to that child. TABLE OF CONTENT Genetic Diseases Chapter 1 Down’s Syndrome Chapter 2 G6PD Deficiency Chapter 3 Hemophilia Chap

Alternative Medicine is other forms of therapies other than conventional Western Medicine. They are: 1. Whole medical systems 2. Mind-body medicine 3. Biologically based practices 4. Manipulative and body-based practices 5. Energy medicine 1. Whole medical systems A system isn't just a single practice or remedies but many practices that center on a philosophy, such as the power of nature or the presence of energy in your body. Examples of whole medical systems include: a. Ancient healing systems such as ayurveda from India and traditional Chinese medicine. b. Homeopathy which uses minute doses of a substance that causes symptoms to stimulate the body's self-healing response. c. Naturopathy which natural treatments to help the body do its own healing and uses practices, such as massage, acupuncture, herbal remedies, exercise and lifestyle counseling. 2. Mind-body medicine Mind-body techniques improve the communication between the body and the mind. The mind and body must be in harmony for a person to be healthy. Examples of mind-body medicine include meditation, prayer, and relaxation therapy. 3. Biologically based practices These biological practices include a. dietary supplements include selenium, glucosamine sulfate b. herbal remedies include ginseng, ginkgo and echinacea Herbs and supplements can be taken as teas, oils, syrups, powders, tablets or capsules. 4. Manipulation and body-based practices These methods depend on a practitioner to manipulate a specific part of the body. They include: a. chiropractor manipulation b. massage. 5. Energy medicine An invisible energy force flows through the body. When this energy flow is blocked or unbalanced a person can become sick. This energy is called chi, prana and life force. The goal of the energy therapists is to unblock or re-balance the energy force. Energy therapies include qi gong, reiki and magnet therapy. TABLE OF CONTENT Chapter 1 Alternative Therapies Chapter 2 Spa Therapy Chapter 3 Aromatherapy Chapter 4 Antioxidants Therapy Chapter 5 Acupuncture Treatment Chapter 6 Ayurveda Treatment Chapter 7 Homeopathy Chapter 8 Massage Therapy Chapter 9 Meditation Chapter 10 Naturopathy Chapter 11 Reiki Therapy Chapter 12 Hypnotherapy Chapter 13 Yoga therapy Chapter 14 Chiropractor Chapter 15 Epilogue

The eyelids protect the eye, but they also can be prone to problems. Because the eyelids protect the eye they are in the first line of defense of the eye 1. Bacterial and viral infections Eyelids can breed bacterial and viral activity particularly where there is sweat, rubbing or poor hygiene. Examples of this are stye and chalazion eyelid infections. Patients with acne rosacea are also more likely to get eyelid infections. 2. Eyelid Hair Infections Blepharitis is an eyelid hair infection where the eye lashes become infected from exposure to dirt, dust, and germs 3. Eyelid allergies Chemicals used in eye cosmetics have a tendency to cause eyelid allergy. In addition medicines and food allergies can often cause swelling of the eyelids particularly the upper eyelids. What are the best ways to prevent Eyelid infections? 1. Clean hands and good hygiene are necessary to prevent dirty hands from touching the eye. 2. Regular cleansing of the eyes with a clean warm cloth is important. 3. Sunglasses and hats to protect the eyes and eyelid skin from the harsh sun. Eyelids which are droopy may be due to nerve disorder. Eye lids with eye lashes which turn inwards also known as a disease called entropion can cause pain in the eye due to the sharp points of the eye lashes touching the conjunctiva. The opposite is ectropion which is the turning out of the eyelid usually the lower eyelid so that the inner surface is exposed. Some bumps and lesions that are growing in size, are pigmented or cause loss of lashes should be examined by an eye specialist to rule out a malignant lesion TABLE OF CONTENT Chapter 1 Eyelid Diseases Chapter 2 Stye Chapter 3 Chalazion Chapter 4 Blepharitis Chapter 5 Droopy Eyelids Chapter 6 Entropion Chapter 7 Ectropion Chapter 8 Epilogue

Depression is a medical condition in which feelings of persistent sadness, loss, emptiness, anger, or frustration interfere with everyday life for at least 2 weeks or longer. There are 3 types of Depression: 1. Major depression Major depression is characterized by a combination of symptoms that last for at least two weeks in a row, including sad and irritable mood that interfere with the ability to work, sleep, eat, and enjoy activities which used to give pleasure. There may be difficulties in sleeping or eating. 2. Dysthymia Dysthymia is a less severe illness but usually longer-lasting type of depression than major depression (2 years or more). It involves long-term symptoms that do not stop but at the same time prevent the affected person from functioning properly or feeling good. People with dysthymia can also have episodes of major depression. This combination of these two types of depression is often referred to as double-depression. 3. Bipolar disorder (manic depression) Another type of depression is bipolar disorder This involves a group of mood swing disorders that were formerly called manic-depressive illness or manic depression. These conditions may be inherited. It is not as common as the other types of depressive disorders. Bipolar disorders have cycles of mood changes that include at least one episode of mania or hypomania and episodes of depression as well. Bipolar disorders are long lasting and recurring. Sometimes, the mood swings are fast and dramatic . More often they are gradual. During the depression episode, the person can experience any or all of the symptoms of a depressive disorder. In the manic cycle, mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. What are the causes of Depression? 1. The cause of depression is not known. In recent years, many researchers believe it is caused by 2. chemical changes in the brain. Neurotransmitters are released by a neuron directly onto a recipient cell, while hormones typically reach their target cell via the bloodstream. 3. the genes, 4. certain stressful events. 5. More likely, it's a combination of all. Some types of depression are familial. But depression can also occur even if you have no family history of the illness. Anyone can develop depression of all ages even kids 8% of teens and 2% of preteens.. Who is at risk of Depression? The following may play a role in depression: 1. Alcohol or drug abuse 2. Some medical conditions, including underactive thyroid, cancer, or long-term pain 3. Certain medications such as steroids 4. Sleeping problems 5. Stressful life events, such as: a. Breaking up with a girlfriend or boyfriend b. Failing a class c. Death or illness of someone close d. Divorce e. Childhood abuse or neglect f. Job loss g. Social isolation especially in the elderly What are the symptoms of Depression? Symptoms: 1. a persistent sad mood 2. loss of interest or pleasure in most activities together with following accompanying symptoms 1. more negative attitude, disbelief that any problem or situation can be solved in a positive way. 2. Feelings of helplessness and hopelessness 3. Feelings of worthlessness, self-hate, and guilt 4. Becoming withdrawn or isolated 5. Loss of interest or pleasure in activities which were once enjoyable 6. Restlessness, irritability and agitation, 7. Great change in appetite, often with weight gain or loss 8. Very difficult to concentrate 9. Fatigue and Tiredness 10. Thoughts of death or suicide 11. Trouble sleeping or excessive sleeping 12. Anger and discouragement sometimes, rather than feelings

Eating disorders is defined as the persistent refusal to eat resulting in marked loss of weight. It is a psychological problem with patient becoming obsessed with his or her so called obesity with intent to lose weight as a result. This condition is more prevalent in women than in men. Onset usually occurs in puberty. What are the types of Eating disorders? Eating disorders include: 1. Anorexia nervosa, 2. Bulimia 3. Binged eating with induced vomiting The most common cause is ostensible fear of obesity resulting in excessive dieting. There is this distorted image of the body size related to psychosexual conflicts. Other causes are: 1. Anxiety 2. Depression 3. Low self esteem 4. troubled family and personal relationships 5. History of physical or sexual abuse 6. Cultural and social norms that value people on basis of physical appearance and not inner qualities and strength 7. Sometimes it may be hereditary What are the symptoms of Eating disorders? Symptoms: 1. Progressive and excessive weight loss 2. Loss of muscle mass 3. Loss of bone mass with osteopenia, osteoporosis 4. Damage to esophagus, lining of stomach, gastritis, bloating 5. Associated induced endocrine changes (amenorrhea, hirsutism) 6. Stunted growth due to malnutrition 7. Weakened immune system with icy hand and excess hairs (body too cold) 8. Anemia and Induced vitamin deficiency due to poor nutrition 9. Fainting spells, sleep disruptions, mental confusion, seizures 10. Low blood sugar with chills, giddiness, shaking and restlessness 11. Disruption of body fluid mineral balance especially potassium can affect the heart with irregular heart beat and cardiac arrest 12. Kidney and liver damage 13. Constipation, urinary and anal incontinence 14. Mental development may be affected What is the treatment of Eating disorders? 1. Hospitalization is necessary when the condition becomes life threatening 2. Weight restoration to improve mood and health 3. Correction of nutrition and metabolic deficiency 4. Psychotherapy and counseling of individual to develop healthy ways of controlling one's life 5. Use of antidepressant and serotonin blockers 6. Support groups to help family and nutritional counseling What is the prognosis of Eating disorders? Prognosis 1. Good in mild cases 2. Poor in severe cases, may be fatal TABLE OF CONTENT Chapter 1 Eating Disorders Chapter 2 Anorexia Nervosa Chapter 3 Bulimia Nervosa Chapter 4 Binge Eating Disorders Chapter 5 Epilogue

Vitamins and Minerals are important hormones and catalysts in the general nutrition of the body. Vitamins are organic substances which are made by plants or animals. Minerals are inorganic substances that come from the earth; soil and water and are absorbed by plants. Humans absorb minerals and vitamins from the plants and animals they eat. It is important therefore to eat a balanced diet because a balanced diet will provide all the vitamins and minerals that a person need. The five foods groups are: 1. Bread, cereals, rice, pasta, noodles Contains carbohydrate, iron, thiamin mainly Other nutrients are protein, fat, fiber, magnesium, zinc, riboflavin, niacin equivalents, folic acid and sodium. 2. Vegetables, legumes Contains vitamin A (beta-carotene) Other Nutrients are carbohydrate, fiber, magnesium, iron, vitamin C, folic acid and potassium. 3. Fruit Contains vitamins, especially vitamin C Other Nutrients are carbohydrate, fiber, and folic acid. 4. Milk, yoghurt, cheese Contains calcium and protein Other Nutrients are fat, cholesterol, carbohydrate, magnesium, zinc, riboflavin, vitamin B12, sodium and potassium.. 5. Meat, fish, poultry, eggs, nuts, legumes. Contains protein, iron, zinc Other Nutrients are fat, cholesterol, niacin and vitamin B12.. Vitamins and minerals are nutrients that help the body to grow and develop normally. To get adequate vitamins and minerals, eat a wide variety of nutritious foods Eat plenty of vegetables, legumes and fruits; plenty of cereals; lean meat, fish, poultry; milks, yoghurts, cheeses and drink plenty of water TABLE OF CONTENT Chapter 1 Vitamins, Minerals And Health Chapter 2 Vitamin A Chapter 3 Vitamin C Chapter 4 Vitamin D Chapter 5 Vitamin E Chapter 6 Vitamin K Chapter 7 Vitamin B1 Chapter 8 Vitamin B2 Chapter 8 Vitamin B3 Chapter 10 Vitamin B5 Chapter 11 Vitamin B6 Chapter 12 Vitamin B7 Chapter 13 Vitamin B12 Chapter 14 Folic Acid(B9) Chapter 15 Minerals

Blindness is the inability to see. What are the causes of Blindness? The causes of blindness are: 1. cataract 2. glaucoma Glaucoma is due to a build-up of pressure within the eye which causes damage to the cells in the optic nerve transmitting visual information from eye to the brain. The damage is progressive with loss of peripheral vision which is followed by reduction in central vision leading to blindness. 3. age-related macular degeneration Age-related Macular degeneration (AMD) is a degenerative disorder affecting the macula at the back the eye. Early diagnosis and treatment by an eye specialist is the key to prevent blindness. 4. corneal opacities 5. diabetic retinopathy Retinal detachment occurs with ageing. However, inflammation of the retina or myopia (nearsightedness) may cause the retina to be pulled and can lead to its detachment. 6. trachoma, 7. accidents (such as chemical burns, fireworks or sports injuries) 8. leprosy 9. Vitamin A deficiency Vitamin A is needed to keep the outer surface of the eye moist and healthy. Vitamin A deficiency leads to decreased production of a photosensitive pigment in the rods of the eye resulting in night blindness results. Left untreated, the patient may become irreversibly blind. 10. Infections of the eye especially the cornea Three-quarters of all blindness can be prevented or treated. What are the symptoms of Blindness? Blindness is a lack of vision. It may also refer to a loss of vision that cannot be corrected with glasses or contact lenses. 1. Partial blindness means that the person has very limited vision. 2. Complete blindness means that the person cannot see anything or no perception of light. 3 People with a vision worse than 20/200 are considered legally blind. What is the treatment of Blindness? Treatment 1. Blindness due to some causes such as infection, Vitamin A deficiency or glaucoma can be prevented through early detection and appropriate treatment. 2. Although vision loss cannot be restored, but medical and surgical treatment can help the disease from further progressing and resulting in complete blindness. 3. Most serious forms of vision loss are painless and the absence of pain in no way diminishes the urgent need to get medical care. Many forms of vision loss will need to be treated early to prevent blindness. Prevention of blindness 1. Vitamin A deficiency should be treated promptly to prevent scarring of the eye and the ensuing blindness 2. Achieving a good control of Diabetes and going for regular eye examinations 3. Ninety percent of eye injuries can be prevented by becoming aware of safety practices and using proper eye protection. At home take these steps to ensure to keep your eyes safe from injury: 4. Ensure good lighting and install handrails along stairs to prevent tripping and falling especially among the elderly. 5. Sharp corners and edges of furniture may be padded or cushioned. 6. When using lawn equipment, fertilizers and pesticides use protective eye glasses. 7. Avoid toys with sharp points, shafts, spikes, rods and shard edges to prevent eye injuries in children. TABLE OF CONTENT Chapter 1 Blindness Chapter 2 Cataract Chapter 3 Glaucoma Chapter 4 Corneal Ulcers Chapter 5 Advanced Macular Degeneration Chapter 6 Retinal detachment Chapter 7 Uveitis Chapter 8 Eye Injury Epilogue

The Thyroid gland produces the thyroid hormone which plays an important part in the metabolism of our body. The thyroid hormones regulate how the body breaks down the food we eat. It uses that energy instantly or stores it for the future. The pituitary gland in the brain actually controls how the thyroid works. It is located at the base of the brain and produces thyroid-stimulating hormone (TSH). The blood carries TSH to the thyroid gland where it directs the thyroid to produce more thyroid hormones if required. The thyroid hormone also regulates the metabolism of the food in organs all over the body by consuming the oxygen in the body and stimulating the production of heat. Thyroid Diseases occur when there is: 1. excessive thyroid hormones or Hyperthyroidism 2. reduced production of thyroid hormones or Hypothyroidism 3, autoimmune disease of the thyroid gland where the body cells react abnormally to the thyroid cells causing a condition called Hashimoto’s Disease 4. benign tumors or cyst of the thyroid gland due to over growth of the thyroid gland tissues. They are called thyroid nodules or cysts 5. Thyroid Cancer – a malignant growth of the thyroid gland due to abnormal thyroid cells mutating in the thyroid gland A Goiter just means a diffuse enlarged thyroid gland and may mean any of the above diseases above. Iodine is one of the ingredients for producing thyroid hormone. People with low iodine in their bodies tend to have goiters. Treatment of Thyroid gland disorders is by taking medications or surgery Prognosis or outlook for most thyroid diseases is good TABLE OF CONTENT Chapter 1 Thyroid Diseases Chapter 2 Hyperthyroidism Chapter 3 Hypothyroidism Chapter 4 Goiter Chapter 5 Thyroid Nodules Chapter 6 Thyroiditis Chapter 7 Thyroid Cancer

Heel pain is the pain which is felt in the heel either when standing too long or when walking. It occurs more in women than in men maybe because they tend to wear high heel shoes more than in men. What are the causes of Heel Pain? 1. The most common cause is Plantar fascilitis which is an inflammation of the fascia stretching in the sole of the foot from the heel to the toes. 2. A calcaneal spur is the protrusion of the calcaneun bone due to constant weight or pressure. It appears as a sharp protrusion of the bone on its front and lower end of the calcaneum bone or the upper and back end of the bone. The front lower end protrusion is sharp and can press into the tissues or nerve causing pain on contact with the floor when walking or standing. It can be typically seen as a sharp protrusion on X- rays. 3. Over weight or Obesity is another factor which can occur to cause heel pain because of the excessive weight on the heels. 4. Poor blood circulation of the foot typically results in a blood clot at the heel which is most painful when a person wakes up in the morning and steps on the floor resulting in the swollen blood clot pressing against the heel tissue causing heel pain. After walking a bit, the heel pain disappears because the blood clot becomes dissipated and the blood starts flowing normally again. Soaking in warm water before sleep and wearing warm socks usually helps to prevent this blood clot to form so easily at night. 5. Pain in the heel may occur as part of the pain incurred in all arthritis of the ankle including osteoarthritis, gouty arthritis or rheumatoid arthritis. 6.Injury to the heel including falls leading to fractures of the calcaneal bone What are the symptoms of Heel Pain? The symptoms are usually: 1. pain in the heel while walking or standing 2. pain in the heel when stepping on the floor and improvement after walking causing the blood clot to dissipate. 3. pain in the upper part of the back of the heel during walking due to the protrusion hitting the nerve in the Achilles tendon area. Signs 1. local heel tenderness in the area of inflammation or pressure on the calcaneal spur. 2. Direct pressure at the painful region causes pain. How is Heel Pain diagnosed? 1.Involvement of pain at the heel region 2. X-rays of the foot may show the presence of calcaneal spurs. What is the treatment of Heel Pain? Conventional Medicine: 1.Use of tapes and relief pads 2. Use of cushions and heel cups for the heel 3. Exercises of the heel muscle may help after the acute pain has subsided. 4. Loss of weight will reduce the weight on the foot and calcaneal spur 5. Exercise in warm will help in cases of blood clot in thee heel region 6. Wearing warm socks and raising the foot above the ground when sitting or on a pillow while lying in bed will reduce pressure on the heel bone. 7. A local anesthetic with steroid into the painful area will reduce inflammation and relieved pain and swelling Pain killers such as NSAIDs can temporarily relieve pain Surgery Surgical removal of the calcaneal spur will help relieve the pain . TABLE OF CONTENT Chapter 1 Heel Pain Chapter 2 Plantar Fascilitis Chapter 3 Achilles Tendonitis Chapter 4 Flat Foot Chapter 5 Arthritis of Ankle and Foot Chapter 6 Foot Care

Urinary Stones are small, solid stones which occur when salts or minerals in the urine become solid crystals inside the kidney. Urinary Stones are formed usually because of the accumulation of salts and minerals especially calcium in the urine. Usually the stones may be so small that they pass out through the urine without the knowledge of the patient. Some however become bigger due to accumulation of the salts and minerals and the concentration of the urine. The bigger stones may remain in the tubes of the kidney and are called renal stones. Some smaller stones may move out of the kidney and passes through the ureters which are the tubes bringing urine from the kidney to your bladder. These are called ureteric stones. If a ureteric stone gets stuck in the ureter, this can cause blockage of the urine and severe pain.(ureteric colic) Different kinds of Urinary stones form from different salts in the urine. 1. Calcium stones forms about 80% of the urinary stones. 50% are made up of calcium oxalate and the rest are calcium phosphate. They are spiky or large and smooth 2. Uric acid stones are caused by accumulation of excess amounts of uric acid which can be due to eating a lot of meat. They are smooth, brown and soft 3. Struvite stones (infection stones) are produced when there is too much ammonia in the urine occurring especially in urinary tract infection. The bacteria that cause these urinary infections can generate ammonia. They are usually large and have a horn-like shape This kind of kidney stone is most often found in women. 4. Cystine stones occur when there are high levels of cystine in the urine. A hereditary disorder called cystinuria is the source of high cystine in the urine. They are yellow and crystalline Who is at risk of Urinary stones formation? Risk factors include: 1. Men get urinary stone more commonly than women 2. a previous history of kidney stone - 50% will develop another one within five years. 3. a family history of kidney stones 4. Age between 20 and 40 5. Not drinking enough water 6. eating a diet high in protein 7. taking certain medicines such as diuretics (water tablets), antacids and thyroid medications 8. having only one kidney, or an abnormally shaped kidney What causes Urinary Stones? Urinary Stones are caused by 4 main factors: 1. Insufficient water in the urine leading to concentration and stagnation of urine flow: a. Insufficient intake of water b. Intake of alcohol causing concentration of the blood volume 2. Excess Urinary Constituents: a. Calcium: High calcium intake (includes calcium tablets and high calcium milk) Primary Hyperparathyroidism leading to high blood calcium High Vitamin D intake cause high adsorption of calcium Medical conditions such as cancer, some kidney diseases, or sarcoidosis are more likely to develop calcium stones. b. Oxalates: High oxalate intake (cabbage, spinach, tomatoes, chocolates) in diet leads to high concentration of oxalates in urine c. Uric Acid: Gout or High Uric Acid can form crystals which may lead to stones Treatments such as chemotherapy can also increase the risk of getting uric acid stones. d: Cystine: Hereditary cystinuria leads to high cystine in the urine and formation of cystine stones About one in a hundred urinary stones are due to this illness. Cystine stones tend to appear earlier in life between the ages of 10 and 30 years. 3. Infection of urine: Clumps of bacteria can form the nucleus of the stone. Bacteria also produce ammonia which can promote formation of stones 4. Congenital deformity of the kidney and urinary tract: These block the passage of concentrated urine and causes formation of stones. TABLE OF CONTEN

A female from birth is different from a male because of the different sex hormones. A girl usually matures physically and mentally faster than a boy At the age of puberty (11years for girls) the girl is usually taller than her male counterpart. She will have her menarche (the beginning of her menses). Emotionally and physically she will be more mature than her male counterpart. However she will have problems with her menses (the monthly flow of blood which results from the shedding of the lining of the womb every month) such as irregular flow of blood, excessive shedding of blood and pain before, during and after the menstruation. At the same time the breast tissues start to form. She can become very conscious of this formation and feels tingling sensation on contact with her clothes. She may have to wear a bra. Emotions may be heightened and she may feel very sensitive to minor irritants and have mood swings. Thus is due to the sexual hormones being produced in her. However with counseling from her mother and friends she will quickly adapted herself to the new way of life. Unlike a boy the girl will have to go through this phase to become a woman. Soon she will become a woman confident and capable of taking care of a family. She will give birth to children and become a mother just like the women in the family before her. As time passes she will slowly grow older and at the age of forty five years onwards, her menses will stop and she will enter the stage of menopause when the female hormones began to drop. As she aged she will have to look after her health particularly her bones health and her body in general and take good care of herself because this is the time when chronic diseases like hypertension, diabetes and high cholesterol strikes. She will need to live a healthy lifestyle with adequate nutrition, a balanced diet and sufficient mental and physical exercise TABLE OF CONTENT Chapter 1 Women’s Health Menses: Chapter 2 Amenorrhea Chapter 3 Dysmenorrhea Chapter 4 Menorrhagia Chapter 5 Premenstrual Tension Chapter 6 Menopause Chapter 7 Postmenopausal Bleeding Pregnancy: Chapter 8 Birth Control Chapter 10 Pregnancy Chapter 11 Miscarriage Women's Infections: Chapter 12 Vulvitis Chapter 13 Salpingitis Chapter 14 Cervicitis Chapter 15 Mastitis Chapter 16 Bartholin Cyst Other Diseases Chapter 17 Endometriosis Chapter 18 Polycystic Ovarian Syndrome Chapter 19 Fibroid Chapter 20.Uterine Prolapse Chapter 21 Vaginal fistula Women's Cancers: Chapter 22 Cancer of Breast Chapter 23 Cancer of the Uterus Chapter 24 Cancer of the Ovary Chapter 25 Cancer of the Cervix Sexual Health Chapter 26 Sexual Health

What is Deafness? Deafness is the inability to hear. What are the causes of Deafness? The causes of Deafness are: A. Conductive hearing loss Here sound waves cannot be transmitted from the external environment to the cochlea. The problem may lie in 1. the external ear canal a. obstruction caused by wax b. obstruction caused by foreign body c. obstruction caused by infection (otitis externa) d. obstruction caused by ear polyps 2. eardrum a. perforation caused by trauma b. perforation caused by infection c. scarred eardrum from injury or infection 3. middle ear bones a. dislocation of the bones from injury or infection b. damage to the bones from injury or infection c. fixed bones or osteosclerosis (hardening of the bones from aging) 4. middle ear infection infection of the middle ear occurs with fluid in the middle ear cavity preventing sound from passing through B. Sensorineural Hearing Loss a. damage to hearing organ or cochlea which send nerve impulse to the hearing nerve and on to the brain b. damage to the hearing nerve (auditory nerve)from loud sounds, infection or injury Common causes of hearing loss are: 1. aging (presbycusis) 2, acute or chronic exposure to loud noise can cause damage to sensory cells of cochlea 3. infection of the inner ear by viruses and bacteria such as mumps, measles or influenza 4. Meniere's disease - a disease with tinnitus, deafness and dizziness 5. Acoustic neuroma - tumor of the vestibular nerve which lies near to the auditory nerve and affects its function 6. Ototoxic drugs which can damage the nerves involved in hearing or sensory cells in the cochlea such as: a. antibiotics especially gentamycin and vancomycin b. diuretics such as frusemide c. chemotherapy drugs What are the symptoms of Deafness? 1. Deafness is a lack of hearing. The hearing loss is gradual or sudden and can affect one or both ears. There is difficulty in holding a normal conversation in a noisy environment. People may complain the affected person does not respond when called or speak louder than usual 2. tinnitus (ringing in the ear) may be present 3. vertigo (spinning sensation) may be associated with it 4. pain and discharge from ear is associated with ear infections How is Deafness diagnosed? Diagnosis: 1. complete history, ENT examination 2. examination of ear canal and eardrum 3. endoscopy examination of nose and nasopharynx 4. neurological examination 5. hearing test (audiogram) can confirm the presence and severity and type of hearing loss 6. Tympanogram may be performed to detect problems of eardrum and middle ear. 7. X-rays, CT scan or MRI may used to exclude acoustic neuroma or brain tumors. What is the treatment of Deafness? Treatment Medical treatment depends on the underlying problem. 1. Removal of wax and foreign body in the ear Ear polyps can be dissolved away with medicines. 2. Antibiotics oral and topical may be necessary in severe external ear infections. 3. In the case of eardrum perforation, once the underlying infection is cleared and the perforation still do not close after 3 months, then surgical repair of the perforation may be needed. 4. If the cause of deafness is due to medication, then the medication should be stopped or changed. 5. If the cause is prebycusis (due to aging) no medical treatment is needed. The deaf person is assessed to see whether hearing aids will help. TABLE OF CONTENT Chapter 1 Deafness Chapter 2 Chronic Suppurative Otitis Media Chapter 3 Ear Drum Perforation Chapter 4 Ear Infections Chapter 5 Acoustic Neuroma Chapter 6 Menieres Disease Chapter 7 Ear injury

A male child becomes a boy and matures into a man. He must learn to take care of his family just his father before him. As he grows he will find that he must learn to be: 1. Physically fit 2. Mentally strong 3. Emotionally balanced A man learns as he grows. He is not afraid to admit his mistakes. He learns from them. He is willing to help all those who need his help. He cares about those around him: his family, his friends and his colleagues. He is willing to impart his knowledge to others and learns from others. He is willing to learn everything: cooking, sewing, carpentry, painting. He explores things and the world around him. He is willing to find what make things works by breaking open a clock to see how it works, the parts of a personal computer or a telephone or even a television. He is willing to work hard in order to support his family or himself. He is good at his job. He puts his whole heart into his work. A man loves his wife his soul mate. He revels in her nakedness. He loves the sight of her breast, the contour of her body and her sexuality. He is faithful to his wife and family. He is willing to die for them. That is what makes a man. As he grows older, he grows in wisdom and takes good care of his health. TABLE OF CONTENT Chapter 1 Men's Health Chapter 2 Erectile Dysfunction Chapter 3 Premature Ejaculation Chapter 4 Phimosis Chapter 5 Balanitis Chapter 6 Urethritis Chapter 7 Epididymitis and Orchitis Chapter 8 Benign Prostate Hypertrophy Chapter 9 Urinary Incontinence Chapter 10 Prostate Cancer Chapter 11 Male Menopause Chapter 12 Sexual Health

Childhood Infectious Diseases are common infectious diseases caught and spread by children but can also occur in adults. With a childhood vaccination regime, many of these infectious diseases common in the past are now rare. Common infectious diseases in children in the past are: 1. Measles 2. Rubella 3. Mumps 4. Diphtheria 5. Croup 6. Pertussis 7. Poliomyelitis 8. Chickenpox 9. Hand Mouth Foot Disease 10. Roseola Infantum 11. Scarlet Fever 12. Erythema Infectiosum or Fifth Disease All these diseases are rare now-a-days because of vaccination except for Hand Mouth Foot Disease, Roseola Infantum, Fifth Disease and Scarlet Fever (which recently makes a comeback as a epidemic in Hong Kong) Some of the diseases like measles, rubella and poliomyelitis are also making a comeback. TABLE OF CONTENT Chapter 1 Childhood Infectious Diseases Chapter 2 Measles Chapter 3 Rubella Chapter 4 Mumps Chapter 5 Diphtheria Chapter 6 Croup Chapter 7 Pertussis Chapter 8 Poliomyelitis Chapter 9 Chickenpox Chapter 10 Hand Mouth Foot Disease Epilogue

The Posture and Disease Diagnosis The backbone, or spine, is made up of 26 bone discs called vertebrae. It consists of: 1. 7 cervical or neck vertebrae 2. 12 thoracic or chest vertebrae 3. 5 lumbar or lower back vertebrae 4. 1 sacrum (triangular-shaped bone at the bottom of the spine). 5. 1 coccyx or tip of the spine The first cervical vertebra allows rotation on the atlas in movement of the head. The rest of vertebra allows for flexion, dorsiflexion and lateral rotation. In a normal person, the posture of the spine is straight with flexion and rotation capability. The vertebrae protect the spinal cord which is the thick cord of nerve tissue within the spinal canal, which in man gives rise to 31 pairs of spinal nerves, and together with the brain forms the central nervous system. The spinal cord is surrounded by a clear fluid called Cerebral Spinal Fluid (CSF), that acts as a cushion to protect the delicate nerve tissues against damage from banging against the inside of the vertebrae. The spine allows a person to stand and bend. The spine, or backbone, is made up of small bones (vertebrae) stacked with intervertebral discs one on top of another. A healthy spine when viewed from the side has gentle curves to it. The curves help the spine absorb stress from body movement and gravity. When viewed from the back, the spine should run straight down the middle of the back. What is Posture? A good normal spinal posture is usually a straight flexible spine with an anterior convex curve in the neck and lumbar region, convex posteriorly in the thoracic region and convex anteriorly in the sacral region. Webster's New World Medical Dictionary defines the neutral posture as the stance that is attained "when the joints are not bent and the spine is aligned and not twisted An ideal posture is one that has proper alignment of the body’s segments such that the least amount of stress is placed on the body’s tissues My observations of the postures of patients who entered my consultation room are those with: 1. Normal posture 2. Pushed forward head posture common among people who do a lot of desk and computer work. When the head is pushed forward, it pulls against the neck, back, shoulders and chest. 3. Kyphosis in old ladies with an angulated posture usually due to compression fracture of the spine. 4. Some older men and women with milder angulated posture whom I advised to wear a corset to prevent further angulation of the back 5. Ankylosing spondolysis is common in young adult males with a stiff and painful back. 6. Stiffness of the back due to injury or sprain of back muscles are common in other adults with a stiff back who wish to stand instead of sitting in the consultation chair. 7. Scoliosis is present in young girls and boys with a S concavity of their spine. The young adolescents can have their scoliosis prevented by braces or traction. There are also older patients whose scoliosis are already present and cannot be treated without surgery 8. Torticollis can be present in young adults with wry neck (due to painful stiff neck muscles on 1 side) 9. Patients with neck collars round the neck either due to injury or severe cervical spondylosis. 10. Lordosis of the back is common in many pregnant women. 11. Sciatica or pain in 1 leg prevents the patient from sitting or standing properly. Sciatica is due to pressure on the nerve from spinal stenosis or herniated disc. 12. There are also patients who have their body bend over because of menses cramp and abdominal cramps from diarrhea. 13. Sloping of the shoulders may occur in patients who are depressed or tired TABLE OF CONTENT Chapter 1 The Posture and Disease Diagnosis Chapter 2 The Spine Diseases Chapter 3 Lordosis Chapter 4 Kyphosis Chapter 5

Backache is one of the most common complaints by patients seen in a family doctor's clinic. The complaint may be: 1. Constant aching, pain or stiffness that occurs anywhere along your spine, from the base of the neck to the hips. 2. Sharp pain in the neck, upper back, or lower back, especially after lifting heavy objects or other strenuous activity. 3. Chronic ache in the middle or lower back, especially after sitting or standing for long period of time. More men suffer from it than women. Backache is most common among people in their middle age. Backache also occurs among young people aged 16 - 24 years. What are the causes of Backache? The doctor usually asked for a history of: 1. back strain from the lifting of a heavy object, 2. from a fall, 3. Prolonged sitting with poor posture can also lead to chronic backache such as slouching in a couch when watching TV. If the bad posture is prolonged, backache may occur. 4. wearing high heeled shoes also put a lot of strain on the back muscles 5. associated pain in legs or weakness and tingling in the legs or back. 6. pain increases when you cough or bend forward at the waist. 7. Back pain radiates into the legs, sciatica. This could be a sign of a herniated disk. 8. dull pain in one area of your spine when trying to lie down or getting out of bed, especially if you are over 50 years of age. You may be suffering from osteoarthritis 9. pain is felt in both thighs when walking. This can be a symptom of spinal stenosis (the narrowing of the lower spinal canal). 10. persistent backache may also be an indication of an undetected cancer of the colon, ovary, bladder or prostate. 11.gynaecological problems (such as ovarian tumors, fibroids) and pregnancy. How is Backache diagnosed? Diagnosis: 1. Full medical examination especially of movement of the back , any deformity of the spine, abdominal swelling, straight leg raising test 2. X-ray of the Spine: to exclude fracture, osteoarthritis, dislocation, 3. X-ray of abdomen to exclude any tumors in the abdomen pressing against the spine 4. MRI of spine for slipped disc, tumors, fracture 5. Bone density test to exclude osteoporosis 6. Blood tests for calcium, protein, kidney function, cancer markers, RA factor 7. Urine and stool tests for blood, What is the treatment of Backache? Symptomatic: 1. Painkillers and muscle relaxants 2. Ice packs or heat treatment 3. Physiotherapy to strengthen muscles 4. Good posture and firm mattress 5. Avoid aggravating factors like high heels, overstretching muscles, excessive strenuous activities Curative: The cause must be found and treated. Examples are fractures due to injury. Causes like cancer and aged related illness (osteoarthritis) may not be able to be cured but may improved with treatment. How is Backache prevented? Prevention 1. Maintain the correct posture at all times. When standing or sitting, ensure that your back is kept straight instead of a slouched position. 2. support your back and use a cushion when necessary. 3. Correct furniture can also help to prevent the occurrence of backache. Use chairs of a proper height in relation to the table or desk. 4. Sleep on a firm mattress 5. Do not wear high heels 6. Keep your back straight when carrying heavy item. Keep the item close to the body. 7. Do not bend the back to carry heavy objects. Bend the knees keep the back straight Exercise is another good way to prevent backache by strengthening the back muscles. However, if you have had back injuries before such as a slipped disc, do be cautious when you exercise. TABLE OF CONTENT Chapter 1 Backache Chapter 2 Osteoarthritis Chapter 3 A

What is Malabsorption syndrome? Malabsorption syndrome is a disease resulting from impaired intestinal absorption of nutrients. What are the causes of Malabsorption syndrome? Malabsorption syndrome is usually caused by the following: A. Intraluminal defects 1. Pancreatic enzymes or bile salt deficiencies 2. Gastric or intestinal resection as a result of cancer or obstruction 3. Bacterial overgrowth in the intestine resulting in less nutrient absorption 4. Acid hypersecretion (Zollinger-Ellison) syndrome B. Intestinal Mucosal Defects 1. Tropical or non tropical sprue characterized by abnormalities of the intestinal villi resulting in poor absorption of food 2. Parasitic disease of the intestinal such as tape-worms which feeds through the mucosa of the intestine 3. Tuberculosis of the intestine can cause damage to inner lining of intestine impeding absorption of food 4. Chemotherapy, drug abuse, radiation can damage the mucosa of the intestines C. Intestinal lymphatic abnormalities 1. Lymphanigiectasia 2. Congestive heart failure 3. Constrictive pericarditis What are the symptoms of Malabsorption syndrome? A person who has Malabsorption syndrome has the following symptoms: 1. Weight loss 2. Anorexia or loss of appetite 3. Abdominal distension and bloating 4. Muscle wasting 5. Steatorrhea (pale bulky frothy stools) usually frequent Signs: 1. Vitamin deficiency especially vitamin B12 and K and folic acid 2. Mineral deficiencies and anemia How is the Diagnosis of Malabsorption syndrome made? Diagnosis can usually be made by: 1. History of weight loss 2. Steatorrhea - measurement of fecal fat is low 3. D-xylose test is abnormal indicating poor carbohydrate absorption 4. Pancreatic function tests by duodenal aspiration 5. Tests for bacterial overgrowth such as: a. bile acid breath test b. jejunal cultures c. urinary tryptophan metabolites 6. Intestinal biopsy What is the treatment of Malabsorption syndrome? Treatment depends on the cause: Non-medicinal: 1. Intravenous fluids, electrolytes, minerals, vitamins 2. Intravenous nutrients and feeding 3. Gluten free diet 4. Restriction of dietary fat 5. Medium chain triglycerides 6. Lactose free diet Medicinal: 1. Symptomatic treatment of abdominal pain (anticholinrgics) and diarrhea (Imodium) 2. Pancreatic enzymes for pancreatic deficiency 3. Folic acid, vitamins and minerals replacements 4. Antibiotics and antiparasitics for intestinal infections What is the prognosis of Malabsorption syndrome? Prognosis depends on the underlying cause. Most patients usually recover if appropriately treated Recurrence is quite common. What are the preventive measures for Malabsorption syndrome? Avoid Chemotherapy and drugs which affect the mucosa of the intestine Avoid food in the tropics Avoid gastritis or excessive acid in the stomach TABLE OF CONTENT Chapter 1 Malabsorption Chapter 2 Celiac Disease Chapter 3 Crohn’s Disease Chapter 4 Giardiasis Chapter 5 Pancreatic Cancer Chapter 6 , Tropical Sprue

Backache is one of the most common complaints by patients seen in a family doctor's clinic. The complaint may be: 1. Constant aching, pain or stiffness that occurs anywhere along your spine, from the base of the neck to the hips. 2. Sharp pain in the neck, upper back, or lower back, especially after lifting heavy objects or other strenuous activity. 3. Chronic ache in the middle or lower back, especially after sitting or standing for long period of time. More men suffer from it than women. Backache is most common among people in their middle age. Backache also occurs among young people aged 16 - 24 years. What are the causes of Backache? The doctor usually asked for a history of: 1. back strain from the lifting of a heavy object, 2. from a fall, 3. Prolonged sitting with poor posture can also lead to chronic backache such as slouching in a couch when watching TV. If the bad posture is prolonged, backache may occur. 4. wearing high heeled shoes also put a lot of strain on the back muscles 5. associated pain in legs or weakness and tingling in the legs or back. 6. pain increases when you cough or bend forward at the waist. 7. Back pain radiates into the legs, sciatica. This could be a sign of a herniated disk. 8. dull pain in one area of your spine when trying to lie down or getting out of bed, especially if you are over 50 years of age. You may be suffering from osteoarthritis 9. pain is felt in both thighs when walking. This can be a symptom of spinal stenosis (the narrowing of the lower spinal canal). 10. persistent backache may also be an indication of an undetected cancer of the colon, ovary, bladder or prostate. 11.gynaecological problems (such as ovarian tumors, fibroids) and pregnancy. How is Backache diagnosed? Diagnosis: 1. Full medical examination especially of movement of the back , any deformity of the spine, abdominal swelling, straight leg raising test 2. X-ray of the Spine: to exclude fracture, osteoarthritis, dislocation, 3. X-ray of abdomen to exclude any tumors in the abdomen pressing against the spine 4. MRI of spine for slipped disc, tumors, fracture 5. Bone density test to exclude osteoporosis 6. Blood tests for calcium, protein, kidney function, cancer markers, RA factor 7. Urine and stool tests for blood, What is the treatment of Backache? Symptomatic: 1. Painkillers and muscle relaxants 2. Ice packs or heat treatment 3. Physiotherapy to strengthen muscles 4. Good posture and firm mattress 5. Avoid aggravating factors like high heels, overstretching muscles, excessive strenuous activities Curative: The cause must be found and treated. Examples are fractures due to injury. Causes like cancer and aged related illness (osteoarthritis) may not be able to be cured but may improved with treatment. How is Backache prevented? Prevention 1. Maintain the correct posture at all times. When standing or sitting, ensure that your back is kept straight instead of a slouched position. 2. support your back and use a cushion when necessary. 3. Correct furniture can also help to prevent the occurrence of backache. Use chairs of a proper height in relation to the table or desk. 4. Sleep on a firm mattress 5. Do not wear high heels 6. Keep your back straight when carrying heavy item. Keep the item close to the body. 7. Do not bend the back to carry heavy objects. Bend the knees keep the back straight Exercise is another good way to prevent backache by strengthening the back muscles. However, if you have had back injuries before such as a slipped disc, do be cautious when you exercise. TABLE OF CONTENT Chapter 1 Backache Chapter 2 Osteoarthritis Chapter 3 A