Gangrene is a condition that occurs when body tissue dies. It is caused by a loss of blood supply due to an underlying illness, injury, and/or infection. Fingers, toes, and limbs are most often affected, but gangrene can also occur inside the body, damaging organs and muscles. There are different types of gangrene and all require immediate medical attention.

Gangrene Causes

Blood plays a very important role in your health. Not only does it transport oxygen and nutrients throughout your body to feed cells, it delivers disease-fighting antibodies that protect your body from infection. When blood cannot travel freely throughout the body, your cells cannot survive, infection can develop, and tissue can die from gangrene. Any condition that affects blood flow increases your risk of gangrene, including:

• Diabetes
• Atherosclerosis
• Peripheral arterial disease
• Smoking
• Trauma or serious injury
• Obesity
• Raynaud’s phenomenon (a condition in which the blood vessels that supply the skin become intermittently narrowed)
• Weakened immune system

Gangrene Types

There are two main types of gangrene:Dry gangrene: More common in people with blood vessel disease,  diabetes, and autoimmune diseases, dry gangrene usually affects the hands and feet. It develops when blood flow to the affected area is impaired, usually as a result of poor circulation. In this type, the tissue dries up and may be brown to purplish-blue to black in color and often falls off. Unlike other types of gangrene, infection is typically not present in dry gangrene. However, dry gangrene can lead to wet gangrene if it becomes infected.Wet gangrene: Unlike dry gangrene, wet gangrene almost always involves an infection. Injury from burns or trauma where a body part is crushed or squeezed can rapidly cut off blood supply to the affected area, causing tissue death and increased risk of infection. The tissue swells and blistersand is called “wet” because of pus. Infection from wet gangrene can spread quickly throughout the body, making wet gangrene a very serious and potentially life-threatening condition if not treated quickly.

Types of wet gangrene include:Internal gangrene: If gangrene occurs inside the body due to blocked blood flow to an internal organ, then it is referred to as internal gangrene. This is usually related to an infected organ such as the appendix or colon.Gas gangrene: Gas gangrene is rare but dangerous. It occurs when infection develops deep inside the body, such as inside muscles or organs, usually as a result of trauma. The bacteria that causes gas gangrene, called clostridia, release dangerous toxins or poisons that wreak havoc throughout the body, along with gas which can be trapped within body tissue. As the condition progresses, the skin may become pale and gray, and make a crackling sound when pressed, due to the gas within the tissue. Gas gangrene warrants immediate medical treatment. Without treatment, death can occur within 48 hours.

Fournier’s gangrene: Also a rare condition, Fournier’s gangrene is caused by an infection in the genital area. Men are affected more often than women. If the infection gets into the bloodstream, a condition called sepsis, it can be life-threatening.

Gangrene Symptoms

You may notice the following symptoms at the site of the dry gangrene:

• Dry and shriveled skin that changes color from blue to black and eventually sloughs off
• Cold and numb skin
• Pain may or may not be present

Symptoms of wet gangrene may include:

• Swelling and pain at the site of infection
• Change in skin color from red to brown to black
• Blisters or sores that produce a bad-smelling discharge (pus)
• Fever and feeling unwell
• A crackling noise that comes from the affected area when pressed

Internal gangrene usually is painful in the area of the gangrene. For example, a person with gangrene of the appendix or colon would be expected to have severe abdominal pain in the vicinity of the gangrene.

Gangrene Warning

If infection from gangrene gets into the blood, you may develop sepsis and go into septic shock. This can be life-threatening if not treated immediately. Symptoms of sepsis may include:

• Low blood pressure
• Rapid heartbeat
• Shortness of breath
• Change in body temperature
• Light-headedness
• Body pain and rash
• Confusion
• Cold, clammy, and pale skin

If you think you or a loved one may have sepsis, go to the emergency room immediately.

Gangrene Treatments

Treatment for gangrene involves removing the dead tissue, treating and preventing the spread of infection, and treating the condition that caused gangrene to develop. The sooner you receive treatment, the better your chance of recovery. Depending on the type of gangrene, treatment may include:

Surgery. Also called debridement, the dead tissue is surgically removed to prevent the spread of infection. In some situations, amputation (removal of the affected limb, finger or toe) may be required.

Maggot therapy. Believe it or not, maggots still play a role in modern medicine. Maggots provide a non-surgical way to remove dead tissue. When used to treat gangrene, maggots from fly larvae (specially bred in a laboratory so they are sterile) are placed on the wound, where they consume the dead and infected tissue without harming healthy tissue. They also help fight infection and speed up healing by releasing substances that kill bacteria.

Antibiotics. Antibiotics are used to treat and prevent infections. These are usually given by intravenous injection into a vein.

Oxygen therapy. Hyperbaric oxygen therapy may be used in some cases of wet gangrene or ulcers related to diabetes or peripheral artery disease. During treatment, the patient is put in a specially designed chamber filled with oxygen at a higher pressure than oxygen found in the outside air. The theory is that this high level of oxygen saturates the blood and encourages healing of the dying tissue. Oxygen therapy may also reduce the growth of bacteria that cannot thrive in an oxygen-rich environment.

In order to prevent gangrene from occurring again, the cause of any blood supply blockage must be determined so that the underlying condition can be treated. Often vascular surgery, such as bypass surgery or angioplasty, is needed to restore blood flow. Medication to prevent blood clots may be used in some cases.

Gangrene is a serious medical condition that requires immediate medical treatment. While most people with dry gangrene recover fully with treatment, gangrene that involves an infection can be life-threatening. The sooner you get treatment, the better your chances of recovery. If you have ongoing and unexplained pain in any area in your body, fever, a wound that is slow to heal, or you notice a change in skin color, make an appointment to see your doctor right away or go to the emergency room.

Dyspepsia, also known as indigestion, is a term that describes discomfort or pain in the upper abdomen. It is not a disease.

The term refers to a group of symptoms that often include bloating, discomfort, nausea, and burping.

In the majority of cases, indigestion is linked to eating or drinking. It can also be caused by infections or the use of certain medications.

What is dyspepsia?

Dyspepsia is a group of symptoms rather than a specific condition.

Most people with indigestion feel pain and discomfort in the stomach or chest. The sensation generally occurs soon after consuming food or drink. It may make a person feel full or uncomfortable during a meal, even if they have not eaten a large amount of food.

Dyspepsia symptoms

The following symptoms of dyspepsia are also common:

• nausea
• belching
• pain
• a feeling of fullness, or satiety
• feeling bloated

In very rare cases, indigestion may be a symptom of stomach cancer.

Mild dyspepsia rarely needs further investigation, and should not be a cause for concern. A visit to a doctor is only needed if symptoms continue for more than 2 weeks.

Seek emergency treatment if the pain is severe and any of the following also occurs:

• loss of appetite or weight loss
• vomiting
• inability to swallow
• black stools
• yellow coloring in the eyes and skin
• chest pain during exertion
• shortness of breath
• sweating
• chest pain that spreads to the jaw, arm, or neck

Heartburn and dyspepsia are often confused for one another, but they are two separate conditions despite regularly occurring at the same time. Heartburn is a symptom of acid reflux, described as a burning feeling behind the breastbone that usually occurs after eating.

Causes

Indigestion is usually caused by the lifestyle of an individual and the foods they eat. It can also be related to an infection or other digestive conditions.

The symptoms are normally triggered by stomach acid coming into contact with the mucosa. Stomach acids break down the mucosa, causing irritation and inflammation. This triggers the uncomfortable symptoms of indigestion.

Common causes of indigestion include:

• eating too much or too rapidly
• eating fatty, greasy, or spicy foods
• drinking too much caffeine or alcohol
• consuming too much chocolate or soda
• emotional trauma
• gallstones
• gastritis, or inflammation of the stomach
• hiatus hernia
• infection, especially with a bacteria called Helicobacter pylori (H. pylori)
• nervousness
• obesity
• pancreatitis, or inflammation of the pancreas
• peptic ulcers
• smoking
• certain medications, such as antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs)
• stomach cancer

When a doctor cannot find a cause for indigestion, the individual may have functional dyspepsia. This is a type of indigestion without any structural or metabolic disease to explain the symptoms. It may be caused by an impairment of the stomach that prevents it from accepting and digesting food in a normal way.

Diagnosis

Dyspepsia is mild and infrequent for most people with symptoms. In such cases, no treatment is needed.

People who experience regular indigestion or severe abdominal pain should see a primary care physician.

A doctor will ask the person experiencing dyspepsia about their symptoms. They will also find out about their medical and family histories and examine the chest and stomach. This may involve pressing down on different areas of the abdomen to find out whether any are sensitive, tender, or painful under pressure.

If the doctor suspects an underlying cause, they can use the following diagnostic tests to identify any underlying health problems:

• Blood test: If the person with indigestion also has any symptoms of anemia, the doctor may order a blood test.
• Endoscopy: People who have not responded to previous treatment for dyspepsia may be referred for a more detailed examination of the upper gastrointestinal (GI) tract. A long thin tube with a camera at the end is inserted through the mouth and into the stomach. This produces clear images of the mucosa. The doctor can also perform a biopsy during this procedure to test for cancer.
• Tests to diagnose H. pylori infection: These may include a urea breath test, a stool antigen test, and a blood test. An endoscopy would also identify H. pylori as well as any peptic ulcers that are present. Peptic ulcers are often caused by H. pylori.
• Liver function test: If the doctor suspects a problem with the bile ducts in the liver, they may request a blood test to assess how the liver is working.
• X-rays: X-ray images are taken of the esophagus, stomach, and small intestine.
• Abdominal ultrasound: High-frequency soundwaves make images showing movement, structure, and blood flow in the abdomen. A gel is applied to the abdomen and a hand-held device pressed against the skin. The device gives off sound waves, and the doctor can see a detailed picture of the inside of the abdomen on a monitor.
• Abdominal CT scan: This may involve injecting a dye into the veins. The dye shows up on the monitor. The CT scan takes a series of X-ray images to produce a 3D image of the inside of the abdomen.

Further examinations are often only used in severe cases.

Complications

Dyspepsia is mild and infrequent in most cases. However, severe indigestion can occasionally cause the following complications.

Esophageal stricture: Acid reflux can cause indigestion. This is a condition in which stomach acids leak back up into the esophagus and irritate the sensitive lining of the stomach, known as the mucosa. The irritation can scar the esophagus, which then becomes narrow and constricted.

People with esophageal stricture may start to find swallowing difficult. Food can get stuck in the throat, causing chest pain. Esophageal dilatation is sometimes needed to widen the esophagus.

Pyloric stenosis: This occurs when stomach acid causes long-term irritation of the lining of the digestive system. The pylorus is the passage between the stomach and the small intestine. In pyloric stenosis, it becomes scarred and narrowed. As a result, food is not properly digested.

Surgery may be required to widen the pylorus.

Treatments

Treatment for indigestion depends on the cause and severity of symptoms.

If symptoms are mild and infrequent, lifestyle changes will probably ease them. This usually involves consuming fewer fatty and spicy foods and less caffeine, alcohol, and chocolate. Sleeping for at least 7 hours every night may also help to ease mild indigestion.

Exercising regularly and quitting smoking are also important lifestyle changes in treating indigestion.

Medications

In severe or frequent cases of indigestion, a doctor may prescribe medication.

Antacids: These counter the effects of stomach acid. Examples include Alka-Seltzer, Maalox, Rolaids, Riopan, and Mylanta. These are over-the-counter (OTC) medicines that do not need a prescription. A doctor will usually recommend an antacid medication as one of the first treatments for dyspepsia.

H-2-receptor antagonists: These reduce stomach acid levels and last longer than antacids. However, antacids act more quickly. Examples include Zantac, Tagamet, Pepcid, and Axid. Some of these are OTC, while others are only available on prescription.

Some people may experience nausea, vomiting, constipation, diarrhea, and headaches after taking these. Other side effects may include bruising or bleeding.

Proton pump inhibitors (PPIs): Examples include Aciphex, Nexium, Prevacid, Prilosec, Protonix, and Zegerid. PPIs are highly effective for people who also have gastroesophageal reflux disease (GERD). They reduce stomach acid and are stronger than H-2-receptor antagonists.

Speak to a doctor about possible side effects.

Dyspepsia diet

A high-fiber diet is a good way to manage digestive health. It has the effect of clearing out the intestine and making digestion a smoother, cleaner process.

Fruits, nuts, legumes, and wholegrain foods are packed with fiber and an excellent choice for protecting against indigestion. Many yogurts and cereals have also been fortified with fiber.

Eating a balanced diet that excludes spicy or greasy foods is key. Be sure to consume fluids with every meal, as this helps to move food through the digestive tract.

Consuming four or five smaller meals in a day as opposed to three larger ones can also help the digestive system.

 

A stroke occurs when a blood vessel (an artery) that supplies blood to a certain area of the brain bursts or becomes clogged by a blood clot. Within minutes, the nerve cells  from that that area are affected and are lacking oxygen and they die within minutes – hours (depending on the severity of  obstruction). As a result, that part of the body that is controlled by the stroke affected area of the brain can not function properly.
If you notice any symptoms of a stroke you must know that it is a medical emergency and immediate treatment is required, just as in the case of a myocardial infarction (a part of the heart muscle dies due to the lack of blood supply to that area). If medical treatment is started soon after the onset of stroke symptoms, the fewer brain cells will die or be affected by the lack of oxygen.

Stroke Causes

Ischemic stroke is caused by a blood clot that blocks the blood flow to the brain, the blood clot can develop in a narrowed artery that supplies blood  to the brain or may reach the cerebral circulation after it migrated from the heart or  from any other region of the body. Blood clots usually occur as a result of other disorders that cause modifications to the normal blood flow, such as:

• Hardening of the arteries also known as atherosclerosis and it is caused by high blood pressure, diabetes and high cholesterol blood levels
• Atrial fibrillation, or other cardiac arrhythmias (irregular heart rhythms)
• Certain heart valve disorders, such as the presence of an artificial heart valve, a repaired heart valve, valvular heart disease and mitral valve stenosis (narrowing of valvular orifice)
• Heart valve infection (endocarditis)
• The presence of foramen ovale, which is a congenital heart defect (a hole through which blood can enter the left atrium from the right atrium
• Vessel clogging disorders
• Inflammation of blood vessels (vasculitis)
• Myocardial infarction.

Though in rare rare cases low blood pressure (hypotension) may also be the cause of an ischemic stroke. Low blood pressure leads to reduced blood flow to the brain, can be caused by a narrowing of the arteries or damage of heart attack, massive blood loss or a severe infection.
Some surgeries (such as endarterectomy) or other procedures (such as angioplasty) used to treat narrowed carotid arteries may lead to a blood clot at the site where it occurred, causing a subsequent stroke.

Causes Of Hemorrhagic Stroke

Hemorrhagic stroke is caused by rupture of blood vessels and bleeding inside the brain (also called intracerebral hemorrhage) or into the space around the brain (called subarachnoid hemorrhage). Elevated values of the blood pressure for long periods can be the cause of a stroke. Bleeding in the space around the brain can be caused by a ruptured aneurysm or blood pressure that was not kept under control.
Other  less common  causes of hemorrhagic stroke,are

• Inflammation of blood vessels, which may occur in syphilis or tuberculosis
• Hemophilia
• Injurys to the neck or head that can affect the blood vessels that can be found in these areas
• Radiation therapy treatments used for treating neck or brain cancers
• Cerebral amyloid angiopathy (a disorder in which blood vessels degenerate).

Stroke Risk Factors

The stroke riks factors are changable risk factors and unchangeble risk factors. Certain conditions are proven to increase the risk of stroke, if these conditions can be kept under control, the risk of stroke may decrease.

The stroke risk factors that can be controlled are:

• High blood pressure (hypertension) is the second most important risk factor after age
• Diabetes. About a quarter of people with diabetes die from a stroke. The presence of diabetes doubles the risk of stroke due to damage to the blood vessels that occurs in this disease.
• Elevevated bad blood cholesterol levels (HDL) can lead to coronary artery disease and myocardial infarction which damages the heart muscle (myocardium) which may increase the risk of a stroke
• Coronary artery disease that can lead to a heart attack and a stroke
• Other heart disease such as atrial fibrillation, endocarditis, heart valve disease, cardiomyopathy, patent foramen ovale
• Smoking, including passive smoking
• Physical inactivity
• Obesity
• Certain drugs such as oral contraceptives – especially in women who smoke or who have other bleeding disorders – and anticoagulants or corticosteroids. It seems that women in menopause that follow a hormone replacement treatment have a lower risk of stroke
• Increased consumption of alcohol, because  people who drink alcohol excessively, especially those with acute alcohol intoxication have a higher risk of stroke.
• Cocaine usage or other illicit drugs.

Uncontraollabe risk factors:

• Age. The risk of stroke increases with age, each ten years double the stroke risk after the age of 55. At least 66 percent of all people with stroke were aged 65 or more.
• Race. Black and Hispanic Americans have a higher risk than people of other races. Compared with whites, young black Americans, both women and men have a risk of 2 to 3 times more likely to make a stroke and die from this cause.
• Sex. Stroke is more common in men than in women up to 75 years, but after this age women are more affected. At all ages, more women than men will die from a stroke.
• Family history. The risk of stroke is greater if a parent, brother or sister had a stroke or transient ischemic attack present in the past.

Stroke Symptoms

Keep in mind that these symptoms of stroke require immediate medical care:

• State of numbness, weakness or paralysis of the face, arm or leg, usually on one side
• Blurred vision in one eye or in both eyes, spots, double vision (diplopia) or blindness
• Confusion, trouble speaking or understanding words spoken by others
• Gait, dizziness, loss of balance or coordination
• Severe headache
• The ischemic stroke symptoms differ from those of hemorrhagic. Symptoms also depend on the location of blood clot or bleeding and expansion of the affected region.
• Symptoms of ischemic stroke (caused by a clot that has blocked a blood vessel) usually occur in the opposite side of the body. For example, a stroke in the right brain gives symptoms in the left side of the body.
• Symptoms of a hemorrhagic stroke (caused by bleeding in the brain) may be similar to those produced by a ischemic stroke, but differ in symptoms related to high blood pressure in the brain, such as severe headaches, nausea and vomiting, stiff neck , dizziness, convulsions, irritability and confusion
• Symptoms of a stroke may progress over several minutes, hours or days, often gradually. For example, mild weakness may progress to an inability to move the arm and leg on one side.

If the stroke is caused by a large blood clot (ischemic) symptoms appear suddenly, within a few seconds, but if an artery already narrowed by atherosclerosis  is blocked, symptoms usually develop gradually, raging from a few minutes to hours or less, in a few days.
In time, if  there are more small strokes, the person may experience a gradual change of thinking, behavior, balance or movement (multi-infarct dementia). The symptoms of a small stroke are not always easily recognized. They can be attributed to wrong conditions that can mimic the stroke symptoms.

Stroke Treatment

Initial treatment of a stroke differs because it depends on the cause – whether it was caused by a blood clot (ischemic stroke) or bleeding in the brain (hemorrhagic stroke). Before starting the treatment a head computerized tomography (CT), or a magnetic resonance imaging (MRI) to see the type of stroke. Other tests can determine the location of the clot or bleeding to assess the extent of the brain lession. While determining treatment options, blood pressure will be carefully monitored and oxygen will be administrated if necessary. Initial treatment focuses on restoring the blood flow (for ischemic stroke) or hemorrhage control (in hemorrhagic stroke). As with heart attack, permanent damage due to a stroke often develops in the first few hours.

Ischemic stroke

Emergency treatment for an ischemic stroke depends on the location and cause of clot formation. Measures to stabilize vital signs, including drugs are taken. If the stroke is diagnosed within 3 hours after the onset of symptoms, drugs that dissolve the clots are administrated called tissue plasminogen activator (t-PA) drugs, which could increase the chances of survival and recovery. However, t-PA can not be safely administered to any patient. If the stroke is hemorrhagic, the use of t-PA is extremely dangerous. Choosing to use or not to use t-PA must be evaluated in the emergency room quickly. Aspirin alone or in combination with another antiplatelet drugs can be administrated. However, aspirin is not recommended within 24 hours after administration of t-PA. Other drugs to control blood glucose levels (glucose) or fever and convulsions may be administrated. Generally hypertension is not treated immediately unless systolic pressure is greater than 220 (mm Hg) and diastolic is above 120.

Hemorrhagic stroke

Initial treatment for hemorrhagic stroke is very difficult, efforts are being made to control bleeding, to lower intracranial pressure and stabilize vital signs, especially blood pressure values. Several drugs are administered in the case of a hemorrhagic stroke. Drugs to control blood pressure, decreased brain swelling, blood sugar levels, fever or seizures. Signs of increased intracranial pressure, psychomotor restlessness, confusion, difficulty to perform commands and headaches are closely monitored. Usually surgery is not recommended for controlling mild or moderate bleeding. However, if there was a large amount of bleeding and if the person’s general condition deteriorates rapidly, surgery may be needed to remove the accumulated blood in the brain and decrease the intracranial pressure . If the bleeding is caused by a rupture of an aneurysm, surgery to repair the aneurysm is the only option.

• A metal clip for clipping the aneurysm in order to prevent a new bleeding
• Endovascular embolization, a procedure which involves inserting a small coil inside the aneurysm and block it

Ssurgery decision depends on the location and general condition of the person after stroke.

Ongoing treatment

After receiving emergency treatment and the general condition has stabilized, a treatment aimed at recovery and preventing another stroke is started. It is important to control stroke risk factors such as high blood pressure, atrial fibrillation, elevated cholesterol levels and diabetes. Aspirin or other antiplatelet drugs are recommended. In the case of an ischemic stroke (caused by a blood clot), anticoagulants to prevent another stroke are needed. Also drugs such as statins to lower cholesterol or drugs to control blood pressure are needed.

Drugs that lower blood pressure include:

• Inhibitors of angiotensin converting enzyme (ACE)
• Angiotensin II receptor blockers
• Beta blockers
• Diuretic
• Calcium channel blockers.

Pancolitis: Pancolitis is also known as ulcerative colitis which is an idiopathic chronicinflammatory disorder of the colon and rectum and involves the entire thickness of the colon. More detailed information about the symptoms, causes, and treatments of Pancolitis is available below.

Symptoms of Pancolitis

The list of signs and symptoms mentioned in various sources for Pancolitis includes the 5 symptoms listed below:

• Frequent episodes of rectal bleeding occur, with or without mucus. The characteristic feature is blood in each bowel movement.
• Urgency and tenesmus
• Abdominal cramps
• Weight loss in severe cases
• Extracolonic manifestations- iritis, erythema nodosum, pyoderma gangrenosum, sacroilitis, episcleritis, aphthous ulcers.

List of causes of Pancolitis:

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Pancolitis) that could possibly cause Pancolitis includes:

• Autoimmune phenomenon
• Genetic susceptibility
• Smoking
• Environmental factors
• Immune-mediated phenomena

The list of treatments mentioned in various sources for Pancolitis includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

• TNF- inhibitors- Infliximab
• Corticosteroids
• 5-aminosalicylic acid derivative- sulfasalazine
• Balsalazide
• Total colectomy
• Treatment of ulcerative colitis is complex and management depends on the type, duration and severity of symptoms, the specific area of the colon that is involved, and complications arising from the disease and treatment.

Treatments include:

• Smoking cessation
• Medications – may be administered orally and/or rectally, depending on the site of the disease
• Symptomatic treatment
  • 5-Aminosalicylates – Sulfasalazine, mesalazine, olsalazine, balsalazide
  • Corticosteroids – used to control active inflammation, role in maintaining remission limited
• Disease modifying treatment
  • Azathioprine
  • Mercaptopurine
  • Cyclosporin
• Infliximab – for severe ulcerative colitis unresponsive to conventional therapy
• Antibiotics – limited role in ulcerative colitis but may avert life threatening sepsis associated with severe colitis
• Other agents being trialled
  • Thalidomide
  • Tacrolimus
  • Mycophenolate mofetil
  • Nicotine
  • Clonidine
  • Fish oil
  • Cytokine antibodies other than infliximab
• Dietary treatment
  • Parenteral nutrition – useful in severe disease and in children
  • Probiotics
  • Adequate nutrition including management of deficiencies such as iron, calcium, and fat soluble vitamins. Parenteral B12 supplementation may be needed in patients with disease of the terminal ileum
• Psychological support as effects of this chronic disease can be debilitating physically and mentally
• Surgical care – indicated for persistent disease despite high dose steroid therapy, fistulae unresponsive to medical management, toxic megacolon, strictures, intra-abdominal abscesses, cancer and bleeding
• Management of complications such as osteoporosis, chronic pain syndromes, and nutritional deficiencies

Causes:

The causes of critical congenital heart disease (CCHD) among most babies are unknown. Genetic and environmental factors appear to play roles and studies into causes are continuing.

Approximately 10% of babies with heart defects have these conditions because of changes in their genes or chromosomes. Scientists have identified 10 genemutations, or changes, not involved with other birth defects that can impact congenital heart defects.  Babies who are found to have CCHD may be evaluated by a clinical geneticist. This could help identify genetic syndromes associated with CCHDs. Some of the genetic conditions that are common in children with CCHD include Noonan syndrome, velecardiofacial syndrome, Down syndrome, and Turner syndrome. Not all children who have CCHD will also have a genetic condition.

Environmental factors, such as drugs, illnesses, or chemicals, that a pregnant women is exposed to during pregnancy can affect how the baby’s heart develops. Some examples include infection with Rubella (German Measles), smoking, maternal obesity, maternal diabetes, and use of Accutane (taken to treat acne), Dilantin (used to treat seizures) or cocaine. Exposure to certain substances in the environments, such as paints, chemical solvent, and pesticides can contribute to congenital heart defects.

Symptoms:

Signs of critical congenital heart disease in infants include:

• Loss of healthy skin color
• Cyanosis (a bluish tint to the skin, lips, and fingernails)
• Rapid or troubled breathing
• Swelling or puffiness in the face, hands, feet, legs, or areas around the eyes
• Shortness of breath or tires easily during feedings
• Sweating around the head, especially during feeding
• Poor weight gain

Treatment: Treatment for critical congenital heart disease (CCHD) depends on the type of heart defect present. If a CCHD is detected, you will meet with a pediatric cardiologist to talk about the findings and treatment options. Most heart defects can be corrected or improved with surgery, procedures and/or medications. The following are a few of the more common treatments used.

Catheter Procedures

Catheter procedures are easier and less invasive than surgery. This procedure involves threading a long tube, called a catheter, through the blood vessels to the heart. This allows the doctor to take measurements and repair the problem in the heart.  Catheter procedures are used to repair simple heart defects, and the process varies with each defect.

Surgery

Surgery may be necessary if the heart defect cannot be fixed using catheter procedures. Sometimes one surgery is enough to repair the defect, but occasionally several surgeries are needed to fix the problem. Cardiac surgeons can use surgery to close holes in the heart, repair heart valves, widen arteries or openings to the heart valves, and repair other complex defects.

One of the most common ways people hurt their knees is by injuring their ACL (anterior cruciate ligament). This is one of the bands of tissue that holds the bones together within your knee. It also helps to keep your knee stable. You can stretch or tear your ACL if you make a sudden movement or quick, sharp turn when you’re running or jumping. It’s often painful, and can make it hard to walk or put pressure on the injured leg.

How Does It Happen?

Athletes often get ACL injuries when they stop and quickly change directions while they’re running. People who play soccer, football, tennis, basketball or volleyball, or who do gymnastics are more likely to twist their knees by mistake when they compete than, say, cross-country runners, who simply move forward at a steady pace. Your speed — combined with the way that you twist or turn your knee — makes it likely that you’ll stretch or tear your ACL.

ACL injuries are more common among women than men.

What Are the Symptoms?

Many people hear a popping noise in their knee when they get hurt. But it doesn’t happen to everyone. More common symptoms include:

Pain. If you have a minor injury, you may not feel pain. You may feel sore along your knee’s joint line. Some people have trouble standing or putting pressure on the hurt leg.

Swelling. This is most likely to happen during the first 24 hours. You can reduce swelling by putting ice on your knee and elevating (raising) your leg by propping it up on a pillow.

Trouble walking. If you’re able to put pressure on your hurt leg, you may notice that it’s harder than normal to walk. Some people find that the knee joint feels looser than it should.

Less range of motion. After you damage your ACL, it’s very likely that you won’t be able to bend and flex your knee like you normally would.

How Is It Diagnosed?

Your doctor will want to hear exactly how you injured your knee. He’ll look at both knees to see if the sore one looks different. He may also order any of the following:

Tests. Your doctor may ask you to lie on your back and bend your hips and/or your knees at certain angles. He’ll then place his hands on different parts of your leg and gently shift you around. If any of your bones move in a way that isn’t normal, that could be a sign that your ACL is damaged.X-ray. Soft tissues like the ACL don’t appear on X-rays, but your doctor may want to rule out broken bones.

MRI or ultrasound. These exams can show both soft tissue and bone. If you have a damaged ACL, it should appear on the images.

Arthroscopy. This literally means to “look within the joint.” During the exam, an orthopedic surgeon makes a small cut in your skin. He inserts a pencil-sized tool that contains a lighting system and lens (arthroscope) into the joint. The camera projects an image of the joint onto a TV screen. Your doctor can see what type of injury you have and repair or correct it, if needed.

What’s the Treatment?

It depends on how badly you’ve been hurt. Here are some of the options your doctor may give you:

First aid. If your injury is minor, you may only need to put ice on your knee, elevate your leg, and stay off your feet for a while. You can reduce swelling by wrapping an ace bandage around your knee. Crutches can help to keep weight off your knee.

Medications. Anti-inflammatory drugs can help to reduce swelling and pain. Your doctor may suggest over-the-counter medications or prescribe something stronger. For intense pain, your doctor may inject your knee with steroid medication.

Knee brace. Some people with a damaged ACL can get by with wearing a brace on their knee when they run or play sports. It provides extra support.

Physical therapy. You may need this a few days a week to get your knee back in working order. During your sessions, you’ll do exercises to strengthen the muscles around your knee and help you regain a full range of motion. You may be sent home with exercise to do on your own.

Surgery. Your doctor may tell you that you need this if your ACL is torn badly, if your knee gives way when you’re walking, or if you’re an athlete. A surgeon will remove the damaged ACL and replace it with tissue to help a new ligament grow in its place. With physical therapy, people who have surgery can often play sports again within 12 months.

Blastomycosis is an infection caused by a fungus called Blastomyces. The fungus lives in the environment, particularly in moist soil and in decomposing matter such as wood and leaves. People can get blastomycosis after breathing in the microscopic fungal spores from the air. Although most people who breathe in the spores don’t get sick, some of those who do may have flu-like symptoms, and the infection can sometimes become serious if it is not treated.

Reproductive Genetics

It is estimated that genetics contribute up to 10 percent of infertility issues or recurrent pregnancy losses in couples. The risk of finding chromosomal abnormalities grows as the age of the mother increases. Most embryos with an incorrect number of chromosomes fail to implant or miscarry during the first trimester of pregnancy. Genetic testing protocols have the potential to help many of those couples in their quest to have a family. Our comprehensive list of genetic testing services can greatly increase your chances of becoming a mother.

Pre-implantation Genetic Screening (PGS)

PGS is a last generation genetic test that allows us to screen for chromosomal abnormalities on embryos during an IVF cycle. The procedure requires to make a small biopsy on the embryos on which the analysis is performed. PGS analyse all 24 chromosome types using array Comparative Genomic Hybridisation (aCGH), in order to detect aneuploidies (alterations in the number of chromosomes) and select chromosomally normal embryos for transfer which are the most likely to develop to term and to be born as a healthy baby. The most common syndromes caused by chromosome aneuploidies are Down syndrome, Edwards syndrome and Patau syndrome.

Who is this for

Most of spontaneous miscarriages and some birth defects are caused by chromosomal abnormalities and the risks of having a child with a chromosome abnormality increases with maternal age. For this reason, PGS is especially recommended for:

i. Women over 35 years of age
ii. Couples who have experienced several spontaneous miscarriages of unknown cause
iii. Couples with several cycles of IVF that have not achieved pregnancy
iv. Men with low sperm concentration
v. Couples with a previous pregnancy with chromosomal abnormality

Pre-implantation Genetic Diagnosis (PGD)

The Concept

While PGD also analyzes a small piece of the embryos during an IVF cycle to detect genetic alterations, it is focussed on single gene diseases or mutations. Common examples of monogenic disorders are cystic fibrosis, fragile X syndrome, spinal muscular dystrophies (SMA), Duchenne muscular dystrophy (DMD), Huntington disease. PGD helps couples who have an increased risk for a genetic disease to conceive a healthy pregnancy.

Who is this for

• Fertile couples who have a known history of a genetic condition in their families.
• Any condition for which the couple’s offspring are at risk.

 

Endometrial Receptivity Array [ERA ]

The Concept

ERA is a personalized genetic test to diagnose the state of endometrial receptivity in the window of implantation. ERA determines the exact time period during which an embryo needs to be transferred into the woman’s uterus to achieve a successful pregnancy.

Who is this for

This test is advised

• for patients who have had implantation failure with embryos of good morphological quality (at least 3 failed embryo transfers for younger women or two in patients 37 years or more).
• for patients with apparently normal uterus and with normal endometrial thickness (≤6mm), in which no problems are apparent.

The food that we eat has a long journey through a convoluted tube that we refer to as the digestive tract. Each section of the digestive tract has specific functions. When one part is affected, it can have a perpetuating effect on other parts of the tract. The digestive tract like any part of the body is prone to a host of conditions. If any of these conditions impede movement of food through the tract then it can become backed up and give rise to unusual sensations like a stuck stomach.

What does stuck stomach mean?

We often explain symptoms that we do understand in lay terms that have little to no medical significance. One of these colloquial terms is a ‘stuck stomach’ or as if somethings feels like it is ‘stuck in the stomach’. The latter is often associated with a meal in that there is the sensation that the food is stuck in the stomach. These sensations may not be caused by any underlying medical condition. This does not mean that it is imaginary but rather than the perception of something being stuck in the stomach is incorrect.

However, there are times where food and fluid can become obstructed in the stomach or even the stomach itself can become strangulated. In the early stages there may only be some vague symptoms but with time it can become severe. The two most notable conditions in this regard is a hiatal hernia and gastroparesis leading to delayed gastric emptying. Understanding what causes these conditions will help in making sense of strange sensations like there is something stuck in the stomach.

Causes

The esophagus runs down from the throat, across the chest cavity and into the abdominal cavity where it joins the stomach. The diaphragm separates the chest and abdominal cavities and the esophagus passes through a small opening in the diaphragm known as the esophageal hiatus. Food is churned in the stomach where it is mechanically broken down and chemically digested by the strong gastric acid and stomach enzymes. Eventually a semi-liquid mixture known as gastric chyme is pumped out through the pylorus of the stomach into the duodenum of the small intestine. This ensures that food which enters the stomach is processed and expelled in an orderly manner to facilitate digestion.

Hiatal Hernia

A hiatal hernia is a condition where the upper portion of the stomach become stuck in the esophageal hiatus. Normally this hiatus in the diaphragm is small and tight to ensure that only the esophagus can pass through. However, in a hiatal hernia the opening allows for the upper portion of the stomach to push through. The affected portion of the stomach becomes stuck and squeezed in the hiatus for short periods of time until it releases and slips back down into the abdominal cavity.

Causes

• Enlarged esophageal hiatus from birth.
• Injury to the diaphragm.
• Repeated pressure with coughing, vomiting, when lifting heavy objects or straining during bowel movements.

Symptoms

• Difficulty swallowing
• Heartburn
• Belching
• Feeling full after small meals
• Vomiting (sometimes bloody vomit)
• Abdominal or chest pain

Gastroparesis

Gastroparesis is a condition where the stomach does not empty properly because the muscles that control movement through the stomach do not function as it should. Often the problem lies with the nerves that control these muscles. It is the vagus nerve that controls these muscles and it can malfunction for several reasons. Food may remain in the stomach for longer than normal. It can even become backed up and food can push up into the esophagus.

Causes

The cause of gastroparesis is not always known as is therefore referred to as idiopathic gastroparesis. Some of the known causes include:

• Damage during surgery
• Diabetes mellitus (diabetic neuropathy)
• Medication like narcotic painkillers and certain antidepressants
• Parkinson’s disease
• Rare conditions like scleroderma and amyloidosis

Symptoms

• Nausea and vomiting
• Feeling of fullness
• Changes in appetite
• Abdominal bloating
• Abdominal pain

Foreign Body

A foreign body in the stomach is any non-edible object in the stomach that was swallowed either intentionally or accidentally. It most often seen in young children. Sometimes the object can become lodged in the esophagus and not enter the stomach. However, it is possible that the object enters the stomach but cannot exit because it becomes lodged in the pylorus of the stomach. The symptoms are largely the same as gastroparesis. Another condition that is mainly seen in infants is pyloric stenosis which also presents in a similar way to gastroparesis.

Surgery:

Surgical procedures to treat a stomach hernia are reserved for severe cases that are unresponsive to lifestyle changes and medication. It is also indicated for cases where there are complications of the stomach hernia and in particular the acid reflux associated with it. These surgical procedures include Nissen fundoplication and laparoscopic paraesophageal hernia repair.

Nissen fundoplication where a portion of the upper stomach (fundus) is wrapped around the lower end of the esophagus. It is the procedure of choice in most stomach hernia cases and can be done as a laparoscopic procedure. This procedure is also used for gastroesophageal reflux disease (GERD).

Laparoscopic paraesophageal hernia repair is done by the means of a synthetic mesh to secure the area after removing the hernia sac from the thoracic cavity