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?

Iron deficiency anemia is a type of anemia, which occurs due to deficiency of iron. Iron is the main component of hemoglobin. So, a decrease in the hemoglobin level results in iron deficiency anemia.
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What are the Signs and Symptoms of Iron Deficiency Anemia?

Signs and symptoms appear when anemia is moderate to severe. In the mild stage, iron deficiency anemia often goes unnoticed. The signs and symptoms of iron deficiency anemia are:

Extreme fatigue (weakness)
Pale skin and brittle nails
Reduced  appetite
Headache, dizziness, or lightheadedness
Cold hands and feet with tingling numbness
Chest pain, palpitations, or shortness of breath
Inflammation or soreness of the tongue
Unusual cravings for indigestible substances, such as ice, dirt, or starch. 
What are the Causes of Iron Deficiency Anemia? 

Inadequate iron intake: Your body gets iron from the food you eat. If you consume too little iron, then your body may become iron deficient. Hence, resulting in anemia.
Inability to absorb iron: Iron is absorbed into your bloodstream from the food in your small intestine. In conditions like an intestinal disorder, this absorption of iron is hampered which results in iron deficiency anemia. Also, when your small intestine is bypassed or removed surgically, absorption of iron is hampered.
Blood loss: Red blood cells in your blood contain iron, and if the blood loss is severe, you can end up having iron deficiency. Conditions, such as bleeding hemorrhoids, colorectal cancer, and heavy menstruation can result in iron deficiency anemia.
Pregnancy and lactation: During pregnancy and lactation period, the iron requirement of the mother is more, and when it is unfulfilled, she may end up having iron deficiency anemia. 
Which Group is at Risk? 

Vegetarians
Women
Infants and children 
Frequent blood donors
How is it Diagnosed?

Diagnosis is made with the help of: 

Patient s history  
Blood tests, such as CBC and serum ferritin
Some additional tests, such as colonoscopy, endoscopy, and sonography to diagnose the underlying cause
Treatment

Treating the underlying cause is the primary step. 

Severe cases: When the iron level is too low, blood transfusion and even intravenous iron is given
Mild to Moderate Cases: Iron and vitamin C supplements are given in mild and moderate cases of iron deficiency anemia.
Can you Prevent Iron Deficiency Anemia?

Yes. You can prevent iron deficiency anemia by including iron-rich foods in your diet, such as:

Dark green leafy vegetables, such as spinach, peas, and beans
Dry fruits, such as raisins and apricots
Red meat, pork and poultry, and seafoodIron-fortified cereals, bread, and pasta
Include vitamin C-rich foods in your diet to enhance iron absorption. Vitamin C is found in Grapefruit, oranges, strawberries, lemons, and melonsLeafy greens, broccoli, peppers, and tomatoes

Iron Deficiency - What Are The Possible Signs And Symptoms?

Scabies is a type of a skin condition that is characterized by itching and rashes. This dermatological condition is caused by sarcoptes scabiei, a type of microscopic mite. A contagious condition, scabies spreads through physical contact. It usually transmits through clothes, towels, sexual contact and other such ways. An estimate shows that scabies infect over 300 million humans worldwide per year.
This eight-legged microscopic mite creates a tunnel in the human skin and lays eggs in it. These larvae move under the surface of the skin and spread across the whole body, once hatched. Dogs, cats and mice can also be affected by the disease. It usually takes 2-6 weeks for the symptoms to develop. Signs and symptoms of scabies involve itching, rashes, sores and thick crusts on the surface of the skin.

Some of the risk factors of scabies are:
1. Scabies spreads through direct, prolonged skin-to-skin contact with a person who has mites.

2. An infected person can easily pass scabies to his/her household or sexual partners. Scabies in adults is usually sexually acquired.

3. The likelihood of scabies increases easily under crowded conditions which involves close body and skin contact. Nursing homes, prisons, and several types of care facilities are sites of scabies outbreaks.

4. Immunocompromised, elderly and disabled people also suffer from an increased likelihood of contracting such.

Complications of scabies include:
1. Persistent and vigorous scratching can break the surface of your skin which can lead to secondary bacterial infections. Impetigo, a superficial infection is quite a common occurrence in case of such.

2. Crusted scabies is the most severe form of scabies which is common among certain groups. People suffering from diseases such as HIV or leukemia and severely ill people who have weakened immune systems are at a higher risk of contracting this condition. This condition, also known as Norwegian scabies is very contagious and also hard to cure.

Depending on the symptoms and severity of the condition, appropriate medications and creams are prescribed by medical professionals.

All About Scabies

Most people would panic on seeing slightly red urine being passed. A common urologic condition, this happens because blood cells are leaking into the urine. There are multiple reasons which can cause it, and not all of them are major causes for concern.

Read on to know more about some common causes, and how to manage this.

Urinary tract infections: There could be an infection of the entire urinary tract including the kidneys, the ureters, the bladder, and the urethra. In addition to blood in the urine, there could also be an urge to urinate, pain with urination, fever, and flank pain.
Enlarged or infected prostate: The prostate naturally enlarges with age and can obstruct the urethra, causing pain and blood in the urine. There is a constant urge to urinate and difficulty initiating the stream. Infection of the prostate also produces similar symptoms along with fever and pain.
Kidney diseases: In addition to infections, other kidney diseases including glomerulonephritis, which can also lead to hematuria. Kidney stones, which are quite common, are also another reason, and this will be characterised by the sudden sharp pain around the flank which is very diagnostic of kidney stones. Injury to the kidneys from trauma or sports is another reason for hematuria.
Cancers/tumours: Cancers in the kidney, bladder, or prostate can cause blood to appear in the urine, but this would happen once cancer has reached some advanced stage, not very early in the process.
Listed below are some risk factors for hematuria.

Age: Men older than 50 are more prone to hematuria
Sex: While men are more likely to have stones or prostate infections, UTIs are quite common in women below 50s.
Family history: though not hereditary, if kidney stones or cancers or infections are in the family, chances of developing hematuria also goes up.
Medications: Aspirin, blood thinners, NSAIDs, and some antibiotics increase the chances of hematuria.
Exercise: Long distance runners are shown to be more prone to developing hematuria.
Diagnosis: In addition to a physical exam, blood tests, imaging (CT scans and/or MRI) and cystoscopy might be required to confirm the diagnosis. Identifying the cause is extremely important as treatment would depend completely on the causative agent. Though hematuria is just one of the symptom, the underlying cause could have severe adverse effects on the whole body system.

Treatment: Whether it is an infection or enlarged prostate or kidney stone or tumour, once the cause is identified treatment is customised accordingly. Antibiotics for the infections, laser treatment for the stones, etc. are recommended.

If you see your urine turning slightly pink in colour, talk to your doctor immediately. Identifying the underlying cause and treating it will help solve the problem of hematuria.

In case you have a concern or query you can always consult an expert & get answers to your questions!


Blood In Urine - Is It Actually Serious?

Post-Transplant Lymphoprolipherative Disorder (PTLD) is a condition or a reaction that happens post your liver transplantation or any kind of organ transplantation. There is a rapid increase in the immune cells or more precisely, the lymphoid cells in the body. These cells start increasing without any control. The seriousness of this growth can be harmless but sometimes, it can develop into lymph node cancer as well.

The major reason behind PTLD is the anti-rejection medicines that are taken by the patient to avoid rejection and attack by the immune system.

Types of Post-Transplant Lymphoprolipherative Disorder (PTLD)

Early lesions: This will go away by itself, if the dose of anti-rejection medicine is reduced.
Polymorphic PTLD: This is a mixture of different kinds of lymphoid cells.
Monomorphic PTLD: This is the most common type of PTLD found in many people who have undergone a liver transplantation. This has just one type of lymphoid cell.
Hodgkin Lymphoma: This is a very rare kind of PTLD.
Diagnosis of Post-Transplant Lymphoprolipherative Disorder (PTLD)

Small and painless lump under the armpit, groin, or neck area
Night sweats
High fever
Excessive weight loss
Low appetite
Unwell feeling
Usually, it is not at all easy to diagnose PTLD. The lump may grow so deep inside the body that it can be hard to see or feel it from outside. Apart from the lump, others are general symptoms and they can be a reason for any kind of infection in the body post transplantation. It can be a reaction to any new medicine taken by you or a reaction to rejection. Early diagnosis can help you in increasing the chances of a successful treatment. A biopsy is also a good way to detect PTLD, where a small piece of the liver is taken and tested under a microscope to detect PTLD.

Management of Post-Transplant Lymphoprolipherative Disorder (PTLD)
Your liver transplant surgeon is going to work closely with the lymphoma doctor in order to provide the best treatment for you. For early lesions or Polymorphic PTLD, reduction of the anti-rejection dose can give you better results. Your immune system will restore back and will destroy all the abnormal cells in the body. But it has to be done slowly so that it does not cause organ rejection again. If reduction of anti-rejection medicine is not possible or if reduction causes any kind of harm, then other treatment methods like antibody medicine such as Rituximab, or chemotherapy regimen or radiotherapy may be used.

Post-Transplant Lymphoproliferative Disorder (PTLD) - How To Diagnose It Correctly?

The menopause can take three very different routes for women. There are those who sail through it with very few symptoms or problems and don't even notice that their ovaries have stopped producing the hormone. Then there are those for whom it is a matter of a few hot flushes and a couple of night sweats, doesn't last long and not really a bother. This usually marks a relief from the periods. But for some it is abject misery accompanied with crippling fatigue, absolute exhaustion, hot flushes, vaginal drying, mood swings along with low desire or lack of sexual feelings. These symptoms might persist for more than 7 years.
Hormone Replacement Therapy (HRT) is considered to be an effective treatment for menopausal symptoms. The other problems linked with menopause can also be influenced by HRT in a positive manner.

HRT is indicated in:
1. Treatment of symptoms of menopause and the risk benefit ratio is apt for the women and they have been informed about the same
2. For women who are around 51 years and are reaching menopause even though they are asymptomatic
3. In women who are at the risk of osteoporotic fractures and are under 60 years and the non-estrogen treatments cannot be given
4. HRT is not recommended in women who are above 60 years

Benefits of HRT:
The benefits of HRT usually are more than the risk if done in a woman who is under 60 years of age. 
These include:
1. Improvement in quality of life by relieving muscle pains and improving sleep
2. The mood swings are controlled and low moods are usually alleviated by HRT. Low moods usually arise due to menopause.
3. It reduces the vasomotor symptoms, usually within four months of the treatment with maximum benefit in three months
4. HRT improves the urogenital symptoms by lowering the vaginal dryness, vaginal atrophy, urinary frequency and symptoms. 
5. HRT reduces the risk of osteoporosis. HRT is believed to preserve the bone mass density of the skeletal sites thus reducing the chances of vertebral and nonvertebral fractures.
6. HRT also reduces the risk of colorectal cancer and cardiovascular diseases

Risks of HRT
The main risks of HRT are stroke, endometrial and breast cancer, thromboembolic disease, pulmonary embolism and gallbladder disease. Though other risks are:
1. It increases the risk of ischemic stroke
2. There is a small risk associated with breast cancer and the risk increases more, if the woman is underweight or overweight, alcohol user, smoker and stops HRT suddenly
3. Estrogen only HRTs can increase the risk of endometrial cancer. If cyclical progestogen is used for 10 days for 28 cycles then the risk is eliminated.

The Efficacy of Hormone Therapy in Early Menopause

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