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TEST ON VAGINA DISCHARGE  The normal vaginal discharge is white, nonhomogeneous, and viscous. It contains vaginal squamous epithelial cells in a serous transudate, as well as material from sebaceous, sweat, and Bartholin's glands, and secretions from the cervix. A small number of polymorphonuclear leukocytes may be seen, probably coming from the cervix. The pH is below 4.5, usually between 3.8 and 4.2. The predominant organisms are lactobacilli, large gram-positive rods. The quantity of normal discharge varies from woman to woman and increases during ovulation, premenstrually, and during pregnancy. A normal discharge does not have an offensive odor and is not associated with vaginal irritation, itching, or burning. Technique A variety of tests and cultures can be done on secretions obtained at the time of pelvic examination. None is more important than the microscopic examination. Using a Q-tip, obtain some secretions from the posterior fournix. To prepare a  wet

                                Sandfly   The group is the  Phlebotominae , a subfamily of flies. Parasitic diseases spread by the flies include leishmaniasis, bartonellosis and pappataci fever. In the New World leishmaniasis is spread by sand flies in the genus  Lutzomyia .  Lutzomyia  often live in caves, where their main hosts are bats. In the Old World sand flies in the genus  Phlebotomus  spread leishmaniasis. Phlebotomine females, and only females, suck blood from various mammals, reptiles and birds. Some species are selective, whereas others bite any suitable host they find. As far as is known all species need a blood meal for every following clutch of eggs after the first. Proteins and other nutrients in the blood enable the female to produce eggs. The flies use their mouthparts to start the host bleeding. They then suck up the exposed blood. Like practically all blood-feeding parasites, they inject biochemicals that inhibit blood clotting, plus some that stimul

Vaginal Yeast Infections (Candidiasis) According to the Centers for Disease Control (CDC), about 75% of women get at least one yeast infection during their lifetime and 40-45% will have two or more. Some women have many yeast infections. Women of all ages can get yeast infections. What causes yeast infections? Yeast infections are usually caused by an overgrowth of a type of fungus called Candida, also known as  yeast . Small amounts of yeast and other organisms are normally found in your vagina, as well as in your mouth and digestive tract. Yeast infections occur when the balance of organisms in your vagina is upset, and the amount of yeast grows too much, causing an infection. Yeast infections are most likely to be noticeable just before or just after your menstrual period. Some types of “yeast” infections are harder to treat and are caused by other species. Ask your health care provider (HCP) if you should be checked for the other types if your symptoms do n

Definition Paroxysmal nocturnal hemoglobinuria or PNH is a rare and chronic disease that results in an abnormal breakdown of red blood cells. PNH is due to a spontaneous genetic mutation that causes red blood cells to be deficient in a protein, leaving them fragile. Because the kidneys help to filter out waste products from red cell breakdown, when urine is concentrated overnight as a person with PNH sleep, the morning urine may be reddish to a darker, cola color. Paroxysmal nocturnal hemoglobinuria This led to term the problem as “nocturnal.” One of the red blood cell products that the kidneys metabolize into the urine is hemoglobin. Because urine discoloration occurs irregularly due to physiological changes, the disease was thought to occur irregularly and so was termed “paroxysmal”. History The syndrome of PNH was first recognized in the second half of the nineteenth century. Paul Strübing differentiated PNH from both paroxysmal cold hemoglobinuria and march hemoglobin

Small intestinal bacterial overgrowth  Definition Small intestinal bacterial overgrowth (SIBO) is defined as the presence of excessive bacteria in the small intestine. SIBO is frequently implicated as the cause of chronic diarrhea and malabsorption. Patients with SIBO may also suffer from unintentional weight loss, nutritional deficiencies, and osteoporosis. A common misconception is that SIBO affects only a limited number of patients, such as those with an anatomic abnormality of the upper gastrointestinal (GI) tract or those with a motility disorder. Prevalence The prevalence of SIBO in the general population is unknown but estimated to be 0–35% in healthy individuals. Anywhere from 30% to 85% of adult patients with IBS are estimated to have SIBO, with the most current data reporting 67% as determined by duodenal aspiration and culture. Two meta-analyses have shown 3.5–9.6 fold increased odds of SIBO in patients with IBS. In the United States and Europe, one in fiv

Definition A hydrocele is a sac filled with fluid that forms around a testicle. This occurs when the fluid collects in the thin sheath surrounding a testicle. Hydroceles are most common in babies and usually disappears without treatment by age 1. Older boys and adult men can develop a hydrocele due to inflammation or injury within the scrotum. Hydroceles vary greatly in size. Very large hydroceles are sometimes seen in elderly men who have never shown their swelling to a doctor. It might have been getting larger over a number of years. In most cases, hydroceles are not harmful and tend to go away on their own, without treatment, but scrotal swelling should always be evaluated by a health care provider to rule out other causes. Pathophysiology The normal testis is surrounded by a smooth protective tissue sac. You cannot normally feel this. It makes a small amount of ‘lubricating’ fluid to allow the testis to move freely. Excess fluid normally drains away into the veins in yo

Definition Hydrocephalus is a usually congenital condition in which an abnormal accumulation of cerebrospinal fluid in the cerebral ventricles causes enlargement of the skull and compression of an injury to brain tissue. If hydrocephalus becomes progressive, a shunt is surgically placed to reduce pressure by conducting fluid away from the brain, usually to the peritoneum. Hydrocephalus is sometimes called “water on the brain.” The word “hydrocephalus” in Greek literally means “watery head.” Hydrocephalus Pathophysiology The obstruction of the cerebrospinal fluid in the subarachnoid space is believed to have been caused by a precious hemorrhage or infective conditions, such as meningitis. Because of this obstruction, the arachnoid starts to thicken and the return-flow channels are blocked as well. It is possible that the spaces filled with cerebrospinal fluid are enlarged, with the intracranial pressure being increased. This is the normal-pressure communicating hydrocephal

Definition Degenerative disc disease is not actually a disease but a term used to describe the normal changes in your spinal discs as you age. Spinal discs are soft, compressible discs that separate the interlocking bones also known as vertebrae that make up the spine. The discs act as shock absorbers for the spine, allowing it to flex, bend, and twist. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back lumbar region and the neck cervical region. The changes in the discs can result in back or neck pain and/or: Osteoarthritis, the breakdown of the tissue cartilage that protects and cushions joints. Herniated disc, an abnormal bulge or a breaking open of a spinal disc. Spinal stenosis, the narrowing of the spinal canal, the open space in the spine that holds the spinal cord. These conditions may put pressure on the spinal cord and nerves, leading to pain and possibly affecting nerve function. Epidemiolo