• A urinary tract infection (UTI) is an infection that occurs when bacteria enters into any part of the urinary tract, including the kidneys, ureters, bladder, or urethra.
• Risk factors for urinary tract infections include being female, menopause, wiping from back to front after a bowel movement, sexual intercourse, some types of birth control, douches, diabetes, urinary catheters, kidney stones, genitourinary surgery, or structural abnormalities of the urinary tract.
• UTI symptoms and signs include
  • pain or burning when urinating,
  • frequent urination,
  • sudden urge to urinate,
  • frequent urge to urinate without much urine passing, and
  • urine that is milky/cloudy/bloody/foul smelling.
• See a health-care provider for diagnosis because some types of UTIs can be serious to life-threatening conditions.
• UTIs are usually treated with antibiotics.
• Most cases of UTIs go away with treatment, but in some cases, people may have recurrent urinary tract infections.
• Serious UTIs may lead to scarring of the urinary tract or pyelonephritis (kidney infection).

What Is the Definition of a Urinary Tract Infection (UTI)?

 A urinary tract infection is an infection that can occur in any area of the urinary tract, including the ureters, bladder, kidneys, or urethra. Bladder infections (cystitis) and urethra infections (urethritis) are most common.

Picture of the urinary tract

Urinary tract infections can be categorized as either simple or complicated.

• Simple UTIs occur in healthy people with normal urinary tracts. This is the type of UTI that occurs most frequently in women.
• Complicated UTIs occur in individuals with abnormal urinary tracts or when underlying medical conditions make treatment failure more likely. Men and children are more likely to have this type of UTI.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling and complex illness.

People with ME/CFS are often not able to do their usual activities. At times, ME/CFS may confine them to bed. People with ME/CFS have overwhelming fatigue that is not improved by rest. ME/CFS may get worse after any activity, whether it’s physical or mental. This symptom is known as post-exertional malaise (PEM). Other symptoms can include problems with sleep, thinking and concentrating, pain, and dizziness. People with ME/CFS may not look ill. However,

• People with ME/CFS are not able to function the same way they did before they became ill.
• ME/CFS changes people’s ability to do daily tasks, like taking a shower or preparing a meal.
• ME/CFS often makes it hard to keep a job, go to school, and take part in family and social life.
• ME/CFS can last for years and sometimes leads to serious disability.
• At least one in four ME/CFS patients is bed- or house-bound for long periods during their illness.

Anyone can get ME/CFS. While most common in people between 40 and 60 years old, the illness affects children, adolescents, and adults of all ages. Among adults, women are affected more often than men. Whites are diagnosed more than other races and ethnicities. But many people with ME/CFS have not been diagnosed, especially among minorities.

Scientists have not yet identified what causes myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). It is possible that ME/CFS has more than one cause, meaning that patients with ME/CFS could have illness resulting from different causes (see below). In addition, it is possible that two or more triggers might work together to cause the illness.

Some of the areas that are being studied as possible causes of ME/CFS are:

Primary Symptoms:

Also called “core” symptoms, these occur in most patients with ME/CFS. The three primary symptoms required for diagnosis are:

• Greatly lowered ability to do activities that were usual before the illness. This drop in activity level occurs along with fatigue and must last six months or longer. People with ME/CFS have fatigue that is very different from just being tired. The fatigue of ME/CFS:
  • Can be severe.
  • Is not a result of unusually difficult activity.
  • Is not relieved by sleep or rest.
  • Was not a problem before becoming ill (not life-long).
• Worsening of ME/CFS symptoms after physical or mental activity that would not have caused a problem before illness. This is known as post-exertional malaise (PEM). People with ME/CFS often describe this experience as a “crash,” “relapse,” or “collapse.” It may take days, weeks, or longer to recover from a crash. Sometimes patients may be house-bound or even completely bed-bound during crashes. People with ME/CFS may not be able to predict what will cause a crash or how long it will last. As examples:

• Attending a child’s school event may leave someone house-bound for a couple of days and not able to do needed tasks, like laundry.
• Shopping at the grocery store may cause a physical crash that requires a nap in the car before driving home or a call for a ride home.
• Taking a shower may leave someone with severe ME/CFS bed-bound and unable to do anything for days.

• Sleep problems. People with ME/CFS may not feel better or less tired, even after a full night of sleep. Some people with ME/CFS may have problems falling asleep or staying asleep.

In addition to these core symptoms, one of the following two symptoms is required for diagnosis:

• Problems with thinking and memory. Most people with ME/CFS have trouble thinking quickly, remembering things, and paying attention to details. Patients often say they have “brain fog” to describe this problem because they feel “stuck in a fog” and not able to think clearly.
• Worsening of symptoms while standing or sitting upright. This is called orthostatic intolerance. People with ME/CFS may be lightheaded, dizzy, weak, or faint while standing or sitting up. They may have vision changes like blurring or seeing spots.

Other Common Symptoms:

Many but not all people with ME/CFS have other symptoms.

Pain is very common in people with ME/CFS. The type of pain, where it occurs, and how bad it is varies a lot. The pain people with ME/CFS feel is not caused by an injury. The most common types of pain in ME/CFS are:

• Muscle pain and aches
• Joint pain without swelling or redness
• Headaches, either new or worsening

Some people with ME/CFS may also have:

• Tender lymph nodes in the neck or armpits
• A sore throat that happens often
• Digestive issues, like irritable bowel syndrome
• Chills and night sweats
• Allergies and sensitivities to foods, odors, chemicals, or noise

Treatments:

There is no cure or approved treatment for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). However, some symptoms can be treated or managed. Treating these symptoms might provide relief for some patients with ME/CFS but not others. Other strategies, like learning new ways to manage activity, can also be helpful.

1.Depression, Stress, and Anxiety

Pulmonary hypertension is a type of high blood pressure that affects the arteries in the lungs and the right side of your heart.

Pulmonary hypertension begins when tiny arteries in your lungs, called pulmonary arteries, and capillaries become narrowed, blocked or destroyed. This makes it harder for blood to flow through your lungs, and raises pressure within your lungs’ arteries. As the pressure builds, your heart’s lower right chamber (right ventricle) must work harder to pump blood through your lungs, eventually causing your heart muscle to weaken and eventually fail.

Pulmonary hypertension is a serious illness that becomes progressively worse and is sometimes fatal. Although pulmonary hypertension isn’t curable, treatments are available that can help lessen symptoms and improve your quality of life.

Symptoms:

The signs and symptoms of pulmonary hypertension in its early stages may not be noticeable for months or even years. As the disease progresses, symptoms become worse.

Pulmonary hypertension symptoms include:

• Shortness of breath (dyspnea), initially while exercising and eventually while at rest
• Fatigue
• Dizziness or fainting spells (syncope)
• Chest pressure or pain
• Swelling (edema) in your ankles, legs and eventually in your abdomen (ascites)
• Bluish color to your lips and skin (cyanosis)
• Racing pulse or heart palpitations

Causes:

Your heart has two upper and two lower chambers. Each time blood passes through your heart, the lower right chamber (right ventricle) pumps blood to your lungs through a large blood vessel (pulmonary artery). In your lungs, the blood releases carbon dioxide and picks up oxygen. The oxygen-rich blood then flows through blood vessels in your lungs (pulmonary arteries, capillaries and veins) to the left side of your heart.

Ordinarily, the blood flows easily through the vessels in your lungs, so blood pressure is usually much lower in your lungs. With pulmonary hypertension, the rise in blood pressure is caused by changes in the cells that line your pulmonary arteries. These changes cause extra tissue to form, eventually narrowing or completely blocking the blood vessels, making the arteries stiff and narrow. This makes it harder for blood to flow, raising the blood pressure in the pulmonary arteries.

Idiopathic pulmonary hypertension

When an underlying cause for high blood pressure in the lungs can’t be found, the condition is called idiopathic pulmonary hypertension (IPH).

Some people with IPH may have a gene that’s a risk factor for developing pulmonary hypertension. But in most people with idiopathic pulmonary hypertension, there is no recognized cause of their pulmonary hypertension.

Secondary pulmonary hypertension

Pulmonary hypertension that’s caused by another medical problem is called secondary pulmonary hypertension. This type of pulmonary hypertension is more common than is idiopathic pulmonary hypertension. Causes of secondary pulmonary hypertension include:

• Blood clots in the lungs (pulmonary emboli)
• Chronic obstructive pulmonary diseases, such as emphysema
• Connective tissue disorders, such as scleroderma or lupus
• Sleep apnea and other sleep disorders
• Heart abnormalities you’re born with (congenital heart defects)
• Sickle cell anemia
• Chronic liver disease (cirrhosis)
• AIDS
• Lung diseases such as pulmonary fibrosis, a condition that causes scarring in the tissue between the lungs’ air sacs (interstitium)
• Left-sided heart failure
• Living at altitudes higher than 8,000 feet (2,438 meters)
• Climbing or hiking to altitudes higher than 8,000 feet (2,438 meters) without acclimating first
• Use of certain stimulant drugs, such as cocaine

Eisenmenger syndrome and pulmonary hypertension

Eisenmenger syndrome, a type of congenital heart defect, causes pulmonary hypertension. It is most commonly caused by a large hole in your heart between the two lower heart chambers (ventricles), called a ventricular septal defect (VSD). This hole in your heart causes blood to circulate abnormally in your heart. Oxygen-carrying blood (red blood) mixes with oxygen-poor blood (blue blood). The blood then returns to your lungs instead of going to the rest of your body, increasing the pressure in the pulmonary arteries and causing pulmonary hypertension.

 Treatments:

Medications:

• Blood vessel dilators (vasodilators). Vasodilators open narrowed blood vessels. One of the most commonly prescribed vasodilators for pulmonary hypertension is epoprostenol (Flolan). The drawback to epoprostenol is that its effects last only a few minutes. This drug is continuously injected through an intravenous (IV) catheter via a small pump that you wear in a pack on your belt or shoulder. This means that you’ll learn to prepare your own medication mixture, operate the pump and care for the IV catheter. You’ll need comprehensive follow-up care. Potential side effects of epoprostenol include jaw pain, nausea, diarrhea, leg cramps, as well as pain and infection at the IV site.Another form of the drug, iloprost (Ventavis), avoids many of these problems. Iloprost can be inhaled every three hours through a nebulizer, a machine that vaporizes your medication, making it far more convenient and less painful to use. And because it’s inhaled, it goes directly to the lungs. Side effects associated with iloprost include chest pain — often accompanied by headache and nausea — and breathlessness.
• Endothelin receptor antagonists. These medications reverse the effect of endothelin, a substance in the walls of blood vessels that causes them to narrow. One of these medications, bosentan (Tracleer), may improve your energy level and symptoms. The drug isn’t for pregnant women. If you take bosentan, you’ll need monthly liver monitoring, because the drug can damage your liver. Ambrisentan (Letairis) is another medication that stops the narrowing of your blood vessels. This drug can cause serious liver damage if not taken appropriately, and it shouldn’t be taken by pregnant women. Before taking the drug, tell your doctor about any liver condition you have.
• Sildenafil and tadalafil. Sildenafil (Revatio, Viagra) and tadalafil (Cialis, Adcirca) are sometimes used to treat pulmonary hypertension. These drugs work by opening the blood vessels in the lungs to allow blood to flow through more easily. Side effects include upset stomach, dizziness and vision problems.
• High-dose calcium channel blockers. These drugs help relax the muscles in the walls of your blood vessels. They include medications such as amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and nifedipine (Adalat, Procardia). Although calcium channel blockers can be effective, only a small number of people with pulmonary hypertension respond to them.
• Anticoagulants. Your doctor is likely to prescribe the anticoagulant warfarin (Coumadin, Jantoven) to help prevent the formation of blood clots within the small pulmonary arteries. Because anticoagulants prevent normal blood coagulation, they increase your risk of bleeding complications. Take warfarin exactly as prescribed, because warfarin can cause severe side effects if taken incorrectly. If you’re taking warfarin, your doctor will ask you to have periodic blood tests to check how well the drug is working. Many other drugs, herbal supplements and foods can interact with warfarin, so be sure your doctor knows all of the medications you’re taking.
• Diuretics. Commonly known as water pills, these medications help eliminate excess fluid from your body. This reduces the amount of work your heart has to do. They also may be used to limit fluid buildup in your lungs.
• Oxygen. Your doctor may suggest that you sometimes breathe pure oxygen, a treatment known as oxygen therapy, to help treat pulmonary hypertension, especially if you live at a high altitude or have sleep apnea. Some people with pulmonary hypertension eventually require constant oxygen therapy.

Surgeries

• Atrial septostomy. If medications don’t control your pulmonary hypertension, this open-heart surgery may be an option. In an atrial septostomy, a surgeon will create an opening between the left and right chambers of your heart to relieve the pressure on the right side of your heart. Atrial septostomy can have serious complications, including heart rhythm abnormalities (arrhythmias).
• Transplantation. In some cases, a lung or heart-lung transplant may be an option, especially for younger people who have idiopathic pulmonary hypertension. Major risks of any type of transplantation include rejection of the transplanted organ and serious infection, and you must take immunosuppressant drugs for life to help reduce the chance of rejection.

It is a well known fact that bones in the elderly population are quite fragile and are at increased risk for developing various forms of fractures. One such fracture which is quite common in the elderly population is the Femoral Neck Fracture. This fracture may be quite common in the elderly but it may render the individual disabled and virtually dependent on others. It may take many months for people to recuperate from this type of injury and resultant fracture and people require prolonged rehabilitation which may stretch to several months. Since such people are mostly confined to their beds they become prone to other infections and pressure sores from prolonged lying in bed. Studies reflect that more than 100,000 people of which most are elderly sustain Femoral Neck Fracture requiring prolonged hospitalization. They are usually caused due to a fall. To understand Femoral Neck Fracture, it is vital to understand the anatomy of the femoral bone. The femoral bone is attached to the hip bone in a ball and socket fashion. When Femoral Neck Fracture occurs then it is often treated with a procedure called as hemiarthroplasty in which the femoral neck is replaced by prosthesis.

The main cause of Femoral Neck Fracture is a medical condition called Osteoporosiswhich causes the bones to become thin and weak due to loss of bone mass. This condition is quite common in the elderly population, specifically females, and hence they are more prone to fractures even due to minor injuries or falls. Talking about the younger generation, Femoral Neck Fracture can be caused due to a motor vehicle crash or a sporting injury like rugby or other contact sports. A spontaneous fracture in this area can occur in cases of carcinomas and is known by the name of pathologic fractures.

Femoral Neck Fracture has been classified into four parts which are mentioned below:

Stage I Fracture of Femoral Neck: This type of femoral neck fracture is incomplete and nondisplaced.

Stage II Fracture of Femoral Neck: These types of femoral neck fracture is nondisplaced but are complete.

Stage III Fracture of Femoral Neck: These types of fractures are complete and minimally displaced femoral neck fracture.

Stage IV Fracture of Femoral Neck: These type of fractures are complete fractures which are totally displaced femoral neck fracture.

Symptoms:

• Severe pain in and around the hip area.
• Extreme difficulty with ambulation.

Hernia: A hernia is the protrusion of an organ through the wall of the cavity that normally contains it. The main risk is strangulation, which is a surgical emergency. Asymptomatic hernias can be safely observed, but severe pain is a symptom of strangulation. The most common hernias develop in the abdomen, when a weakness in the abdominal wall evolves into a localized hole, or “defect”, through which adipose tissue, or abdominal organs covered with peritoneum, may protrude. Another common hernia involves the spinal discs and causes sciatica. A hiatus hernia occurs when the stomach protrudes into the mediastinum through the esophageal opening in the diaphragm.

Hernias can be classified according to their anatomical location:

Hernia Examples include:

• abdominal hernias
• diaphragmatic hernias and hiatal hernias (for example, paraesophageal hernia of the stomach)
• 
• pelvic hernias, for example, obturator hernia
• anal hernias
• hernias of the nucleus pulposus of the intervertebral discs
• intracranial hernias

A sportman’s hernia is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring of the inguinal canal, although a true hernia is not present.

Since many organs or parts of organs can herniate through many orifices, it is very difficult to give an exhaustive list of hernias, with all synonyms and eponyms.

Hernia Symptoms:

• Constipation – Because a hernia is often created by a portion of the small intestine pressing through the abdominal wall, it can negatively affect the digestive system. By constricting the small intestine, a hernia can cause constipation and other digestive problems.
• Lumps – While there is not always an external lump or bulge with a hernia, it is the most common indicator that a hernia is present. Often, hernia bulges in women are less visible than in men, especially when lying down, complicating a hernia diagnosis. Other times, a lump is only present in times of stress, like when coughing. If there is a bulge that feels rigid or will not go back into the body, this is referred to as a strangulated hernia, and it requires immediate medical attention.
• Pain – The earliest warning sign that a patient may be suffering from a hernia is if they feel persistent pain in their lower abdomen or groin. Hernia sufferers usually first experience pain after some sort of singular movement like lifting, coughing, or twisting that puts strain on the abdominal wall. Often this pain will slowly subside and then come back immediately the next time that motion or action is repeated. Persistent pain is the easiest determinant of a chronic problem like a hernia.

Hernia Repairs:

Most physicians believe people avoid treating their hernias because they fear painful surgery. Today, there is little reason to fear. Hernia surgery is usually performed on an outpatient basis and patients are able to return to most normal activities in a matter of a few days.

It is generally advisable to repair hernias quickly in order to prevent complications such as organ dysfunction, gangrene, and multiple organ dysfunction syndrome. Most abdominal hernias can be surgically repaired, and recovery rarely requires long-term changes in lifestyle. Uncomplicated hernias are principally repaired by pushing back, or “reducing”, the herniated tissue, and then mending the weakness in muscle tissue (an operation called herniorrhaphy).

Hernias usually need to be surgically repaired to prevent intestinal damage and further complications. The surgery takes about an hour and is usually performed on an outpatient basis (which means the patient can go home the same day of the procedure). This surgery may be performed by an open repair (small incision over the herniated area) or by laparoscopic surgery (minimally invasive). Your surgeon will determine the best method of repair for your individual situation.

Most patients will be able to go home a few hours after surgery. If needed, a 23-hour extended recovery area is available. Typically, most patients feel fine within a few days after the surgery and resume normal eating habits and activities. Strenuous activity and exercise are restricted for 4 to 6 weeks after surgery.