Have you ever come across a person with usual toes, toes that are mysteriously curled or bend upwards, downwards or inwards? As strange and intriguing as it may appear, the condition can be quite painful and is known as toe deformity. In toe deformity, the foot bone is unusually and abnormally positioned, resulting in pain and discomfort.

Toe deformity in a person can be of different types. It can be:

Hammer toe: This is one of the most commonly observed toe deformity. A hammer toe is characterized by the curling or bending down of the second toe at the proximal interphalangeal joint (the middle toe joint). The toe may further bend up at the distal interphalangeal joint (joint adjacent to the toe tip) or the metatarsophalangeal joint (meeting point of the foot and the toe) as well. In hammer toe, the awkward alignment results in a slight elevation in the joint of the middle toe. A hammer toe is often seen accompanied by a bunion (a bony bump or a deformity formed at the joint that links the foot with the big toe).
Mallet toe: Mallet toe mostly affects the second toe (other toes may be affected). The deformity results in bending down of the toe at the distal interphalangeal joint (appears like a mallet).
Claw toe: The deformity affects all the toes, with the big toe being an exception. Here, the toes bend up at the metatarsophalangeal joint and bend down at the distal interphalangeal joint. The deformity results in the toes curling down towards the floor (appears claw-like).
What causes Toe Deformity?
There can be many factors responsible for toe deformities.

Toe deformity in a person may be congenital (present from birth).
It can also be an outcome of medical conditions such as arthritis (osteoarthritis, rheumatoid arthritis), stroke, heart attack, diabetes, an injury, an accident, or wearing wrong footwear.
Toe deformity can also be hereditary.
Signs and symptoms:
The symptoms for Toe Deformity (hammer toe, claw toe, and mallet toe) include

There is redness, pain, and swelling in the affected part of the toe. In claw toe, however, there may or may not be pain associated with the condition.
A person faces difficulties in straightening the toe.
In hammer toe, corns, and calluses appear on the middle joint (top) of the affected toe.
In mallet toe, ulcers may occur on the toe (in diabetic patients).
Treatment:
Initially, toe deformity appears flexible, where movement around the affected joint is possible. However, if left unattended, the condition can become severe and rigid, thereby restricting the movement (in the affected area). Treatment for toe deformity depends on how severe the condition is.

In most cases, the treatment involves wearing custom-made shoes, fitted with supports (cushions or pads) and wider toe box.
Using of tapes and splints may be helpful in correcting and repositioning the deformed toe.
Patients with excruciating pain benefit immensely from cortisone injections.
Corn pads can be used to deal with corns and calluses better.
Toe stretching exercises are highly effective.
If severe cases or extreme rigidity, doctors may opt for surgical treatments like arthrodesis, tendon transfer, arthroplasty, to name a few.

Toe Deformity- What Causes It And What Are Its Treatment Options?

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

Two kidneys are present on either side of the spine, above the waist. The kidneys perform important functions of cleansing the blood, controlling blood pressure and maintaining salt and mineral balances. Kidney related issues are to be treated as soon as they occur as failing to do so might lead to kidney failure, which is a serious condition.

Ayurvedic approach for treating kidney related problems
Each type of medical treatment has their distinctive approaches towards such treatment and so does Ayurvedic care. The weak body is toned up in a natural way in the first stage. The second stage is the prevention of diseases using natural remedies and the final stage is treatment through ayurvedic care.

Causes for kidney related issues and Ayurvedic care for such issues
The causes for kidney related issues are toxins, anatomical abnormalities, abiotic stress, mental imbalance, the easy entrance of microvita, and side effects of various allopathic medicines. One major reason for kidney related problems is the side effects of modern medicines or over dosage of allopathic medication. On the contrary, the medication system of Ayurveda effectively treats all the issues in a natural way without imposing ill-effects to the human body.

When to seek Ayurvedic care?
A few symptoms, the occurrence of which indicates that you should consult a doctor for checking of kidney related issues are nausea, weakness, ankle swelling, vomiting and shortness of breath. A few other symptoms are high blood pressure or urea and decreased hemoglobin. If these symptoms are due to kidney related problems, Ayurveda cure for kidney related issues is one of the best options for recovery.

Prevention of kidney failure- Ayurveda treatment to avoid dialysis
"Prevention is better than cure." If kidney problems arise, it is best to take preventive measures to avoid kidney failure. A few things that help in preventing kidney failure are controlling blood pressure, controlling blood sugar and improving breathing pattern. Diet plays a major role in preventing kidney failure. Ayurveda approach insists the change of acidic diet to an alkaline one. Diabetes and blood sugar can also lead to kidney failure. According to Ayurveda, natural remedies are available to treat chronic kidney failure patients. Dialysis can be avoided and the kidney functions can be restored with the help of a few herbal remedies in the Ayurveda approach. The level of creatinine and urea are controlled effectively by Ayurveda treatment

Recovery using Ayurveda care for kidney failure patients
Kidney damage for a period of 3 months or more is known as chronic kidney failure. The treatment of underlying cause, treatment of damaged kidneys and treatment of dhatus (body tissues) which makes up the kidneys are done in the case of Ayurvedic care. The kidneys are made up of "Rakta" and "Meda" and treating these two will lead to recovery. The benefits of using Ayurvedic medications for kidney related issues are plenty. The kidney damage is recovered, the risk of death can be reduced to a significant extent and frequency of dialysis can be minimized effectively.

Kidney Issues - How Ayurveda Can Help You?

Stone diseases are a part of health issues related to the urological system in our body. Depending on their position, they may be classified into kidney stones and ureteral stones. Stone diseases are extremely common in nature and if treated timely it does not cause much damage to the body.

Types of Stones in the Human Body:

There are four types of kidney stones and ureteral stones in the human body namely   calcium, uric acid, struvite and cystine. The main difference between kidney stones and ureteral stones is that of the location. Kidney stones are transformed into ureteral stones when they pass from the kidney into the ureter.

Warning Signs to detect Kidney and Ureteral Stones

Kidney stones may be present in your body but they do not cause any obstructions unless they move into the ureter. Symptoms to detect the presence of stones in your body include  

  Intense and shifting pain in the lower abdomen and groin
  Frequent and painful urination
  Presence of blood in urine
  Nausea and vomiting
  Frequent fever accompanied by chills

Modes of Diagnosis:

The following methods are used to diagnose kidney stones/ureteral stones in the body-

  Imaging Tests   X-rays and CT scans are used to detect the presence of bigger and smaller stones respectively.
  Urine Tests   They help to detect the presence of stone forming particles in urine thus helping to diagnose stones in the kidney.
  Blood Tests   They help display levels of calcium and uric acid in the blood and monitor the general health of kidneys.

Treatment of kidney/ureteral stones:

Treatment of stones depends on their size and severity. For smaller stones, doctors recommend drinking 2-3 litres of water per day that help in flushing out the stone through urine. Doctors also prescribe medicines which helps break down the stone and reduce pain.

If the stones are large in size and exhibit severe complications, then the urologist will resort to the following treatment procedures-

  Shock Wave Lithotripsy (SWL)   In this process, a machine called lithotripter is used which passes ultrasonic waves through the skin to break up the stone into smaller components. The shattered pieces then pass out of the body through the urinary tract.

  Percutaneous Nephrolithotomy (PNL)   This is an endoscopic method used to remove large stones, which are not possible to eliminate through SWL. This is an invasive procedure and general anaesthesia is done prior to surgery.

  Ureteroscopy   In this process, a ureteroscope is inserted into the urethra to locate the stone and a tool is used to break it into smaller pieces or is taken out as a whole.

Prevention of Kidney and Ureteral Stones

Certain lifestyle changes can go a long way in preventing stones in the body. Some of them include drinking lots of healthy fluids, reducing consumption of oxalate-rich foods and animal protein, reducing sodium intake and controlling one s body weight.

Maintaining a healthy lifestyle and taking prompt medical action in case of detection of stone lessens the harmful effect of kidney and ureteral stones in the body.

Stone Disease - All You Should Know About It!

Hunner's ulcers, simply put are painful ulcers in your urinary bladder. These ulcers are inextricably linked to another disorder called the painful bladder syndrome or intestinal cystitis. They occur in 10 to 15 percent of people with interstitia cystitis. These, in fact, are red patches or lesions on the bladder wall which can stiffen tissue and cause reduced bladder capacity. Hunner s ulcers bleed, ooze pus and can be of different sizes. The ulcers in the bladder can be extremely painful and uncomfortable.

These are called Hunner s ulcers because they were first described by Dr. Guy LeRoy Hunner, a Johns Hopkins gynecologist, in 1915. Since Hunner s ulcers are seen only in people with intestinal cystitis, it s important to know more about this painful life-altering bladder disorder before we can even understand how to deal with them.

Interstitial cystitis (IC)
IC is also called painful bladder syndrome. Another important thing to know about IC is that it strikes more women than men. IC is a chronic disorder and there s no cure for it. It causes recurring bouts of pain and pressure in the urinary bladder and the pelvic area. This is often accompanied by an urgent and frequent need to urinate. Sufferers may have to rush to the  loo  as much as 40, 50, or 60 times a day.

Diagnosis
Hunner's ulcers can only be accurately diagnosed by doing a cytoscopy which involves inserting a fibre-optic tube through the urethra to look at the bladder wall closely. During this procedure, a tissue sample from the bladder wall is usually also taken to rule out bladder cancer. Cytoscopy is usually done with hydrodistention under local anesthesia. This involves filling the bladder with a liquid for stretching it to provide a closer view of the bladder wall. Usually, a urologist performs this surgery along with a gynaecologist. IC and also Hunner s ulcers are both a diagnosis of exclusion. This means that they re diagnosed only after a number of other conditions have been ruled out.

Hence, the urologist will first take your thorough medical history, followed by a physical exam and a pelvic exam for women patients and perform tests for ruling out infection, and other disorders like bladder stones and cancer, kidney disease, multiple sclerosis, endometriosis, sexually transmitted diseases amongst others. Only after these tests are inconclusive or uncertain and if there is blood in urine, will the urologist go for cystoscopy.

Treatment
There's no cure for IC, but Hunner s ulcers can be cured by burning them off the bladder wall. Called fulguration, the process uses electricity or laser to burn the ulcers on the bladder wall. Resection is also used in which skin from around the Hunner s ulcer is cut for removing both the ulcer and the inflamed tissue around it. The problem is that ulcers may recur in the same location.
So, managing IC becomes critical. Your doctor can try to treat the patient with one treatment or with a combination of treatment depending on the condition of the patient.

Pain medicines are the first line of treatment to manage Hunner s ulcers and IC both, and many patients do go in for this. Patients also find relief by modifying their diet to remove foods and drinks like caffeinated beverages- tea, coffee, colas etc. Sodas, artificial sugars and fruit juices, especially Cranberry juice can trigger intense pain and discomfort, so these are usually contraindicated. Another important aspect is patient education about normal bladder function and tips on self-care and behavioural modifications like stress control to manage Hunner s ulcers.

Hunner's Ulcer In Urinary Bladder - How They Can Be Treated?

HIV is a systemic disease which affects all parts of the body. The oral cavity also has some tell-tale symptoms which indicate HIV / AIDS. A careful examination and detailed history of symptoms is essential. In some cases, the oral manifestations could be the area where HIV is suspected. This can help in reducing morbidity and improves prognosis. The oral lesions that occur in HIV patients can vary and differ significantly in children and adults. While there are a variety of oral lesions in HIV-infected individuals, listed below are some common infections seen in HIV patients. These are a combination of fungal, viral and bacterial infections.

Candidiasis: Candida is an opportunistic fungus that is normally present in the oral cavity and with reduced immunity of HIV, recurrent bouts of the infection begins to show up. It can be in the form of regular thrush which is whitish and cannot be scraped off (pseudomembranous candidiasis), hyperplastic candidiasis (white patches which can be scraped off) or erythematous (reddish patches). Candida can involve any part of the oral mucosa including the pharynx and the palate.
Herpes Simplex: This is the most common viral infection seen in patients with HIV/AIDS. There could be primary or secondary infection of herpes virus, especially inside the mouth and the vermillion border of the lips.
Herpes zoster: This virus, when already present in the body, can be reactivated with HIV/AIDS and with oral herpes. The distinction with herpes simplex is from their distribution. These are unilateral, along the distribution of the maxillary or mandibular nerve. The lesions appear both on the facial skin and the oral mucosa. While the facial ones break open and form crusts, the mucosal ones coalesce to form larger lesions.
Hairy Leukoplakia: This is present in about 20% of asymptomatic HIV patients. Onset of hairy leukoplakia is an indication of rapid progression of HIV with increased CD4 counts. The typical lesion is a non-movable, hairy lesion along the side of the tongue and can spread to the top and the undersurface of the tongue. There are large amounts of Epstein-Barr virus (EBV) identified from biopsies of hairy leukoplakia.
Cytomegalovirus: If the ulcers have a necrotic base with a halo surrounding it, it is CMV infection, usually seen on any oral mucosal surface.
Periodontal disease: This is one of the bacterial infections that manifests itself in HIV patients. It can take two forms such as Linear Gingival Erythema (LGE) which can subsequently lead to Necrotizing Ulcerative Periodontitis (NUP). The oral hygiene is generally good with minimal plaque and there is rapid bone loss and soft tissue reddening and swelling. The, mouth, therefore is certainly a window to one s health.
Diagnosing HIV with Western Blot Test-

It is a series of blood screenings are performed to test for HIV. The enzyme-linked immunosorbent assay (ELISA), also known as an enzyme immunoassay (EIA), is the first test that your healthcare provider will order to screen for HIV. ELISA, like the Western blot test, detects HIV antibodies in your blood. Antibodies are proteins your immune system produces in response to the presence of foreign substances, such as viruses. If you test positive for HIV on the ELISA test, your provider will order the Western blot test to confirm HIV infection. 

Can HIV Be Diagnosed Through Oral Manifestation?

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