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Ulcer - Symptom, Treatment And Causes

What is Ulcer ?

Although ulcer in the small intestine and stomach are common in our modern society, but there are no clear evidence to suggest that just fast food and stress are the main reasons for this disease. About one out of every ten citizens globally will suffer from the gnawing and burning sensation of abdominal pain because of ulcer at some point in life.

Peptic ulcers are breaks or holes in the protective lining of the stomach or the duodenum. Areas that come in contact with enzymes and acids that are secreted by the stomach. It has been noticed, that duodenal ulcers are more common than stomach ulcers. Comparatively rare, esophageal ulcers, which forms in the esophagus (swallowing tube) are often the result of alcohol abuse or exposure to medications like certain anti-inflammatory drugs and antibiotics.

While secretion of excess stomach acids indeed plays a role in development of this disease, in a recent research on ulcers, it has also been found that bacterial infection is the main cause of peptic ulcers. Nevertheless, since mid-1980s there were medical evidences that Helicobacter pylori (H. pylori) bacteria is present in more than 80% of stomach ulcers and in 90% of duodenal ulcers.

Treatment of Ulcer :

Peptic ulcers can be treated using various medications and in some cases with surgical correction. Antibiotics may be used to eradicate H.pylori, anti-ulcer medications are used to inhibit the acid secretions and to heal the ulcers, and some medications help protect the mucosal layer. In cases of bleeding ulcers, Esophagogastroduodenoscopy may be performed and surgery is recommended when Esophagogastroduodenoscopy fails to stop the bleeding or in cases of perforated ulcers. Your physician may advise to quit smoking, avoid or limit the alcohol consumption and avoid overuse of NSAID's to prevent the development of peptic ulcers.

What does Experts Says :

It has also been noticed by experts that people with blood group A, are more affected with stomach ulcers, which at times can also get cancerous. While it has also been seen that duodenal ulcers often happens with people with blood type O. As people who are born with this blood group do not produce the substance on their blood, which helps in protecting the lining of their duodenum.

More About :

However, the good thing about this illness is that peptic ulcers are easier to treat, and in many cases can be cured with antacids and antibiotics. There are also several drugs that even reduce the amount of acids produced by the stomach.

So if you are suffering from ulcers, its best to consult your physician, as left untreated all ulcers can lead to serious illnesses like anemia and stomach carcinoma.

Treatable by medical professional Usually self diagnosable Lab test sometimes required Short-term: resolves within days to weeks Non communicable
Symptoms
Belching Pain in chest or upper abdomen. Heartburn, indigestion and nausea,

Popular Health Tips

Non-Healing Ulcer And Wound Management!

MBBS, DNB - Peripheral Vascular Surgery, DNB - General Surgery, MNAMS
Vascular Surgeon, Nashik
Non-Healing Ulcer And Wound Management!

A non-healing wound can be any wound that does not show improvement after roughly a month and is not on the way to healing in about 2 months. There are several types of non-healing wounds, and ulcers are a major type. The other types include:

Surgery wounds that don’t seem to heal.
• Pressure related ulcers.
• Wounds that start healing but go back to square one several times.
• Wounds and ulcers caused due to disorders of body metabolism.

Symptoms: how do you understand a wound is of the non-healing variety?

Following are The Symptoms to Look Out For:

• Pain in the wound, either one that starts out after some time or one that was present from the very beginning but keeps increasing in magnitude.
• A foul smell surrounding the wound.
• An oozing sensation from the wound, or a feeling of liquid oozing from it.
• The wound becomes tender, and can turns red and hot.

Non-healing wounds are dangerous because the surface is exposed to the environment for a very long time, making it open passage for numerous bacterial germs in the atmosphere. This can lead to serious infection. The infection can get so bad that a limb might even have to be amputated.

How to manage and cure these wounds?

There are Several Ways to Keep the Damage Under Control, and These are The Most Effective Methods:

The most important part of treatment is to investigate to know the cause for ulcer. Here are the investivative measures taken:

  1. Arterial: Evaulation of circulation to leg if reduce corrective measures like angioplasty/stenting/bypass and wound care.
  2. Venous: Correction of venous insufficiency with laser or vein surgery amd wound care.
  3. Neuropathic and treatemnt accordingly: Offloading shows and corrective measures.
  4. Skin Grafting

• Trans-cutaneous oximetry: this is a method that uses electrodes to achieve its objective. The electrode is attached to the skin and heats it up. The blood vessels just beneath the skin are also heated up, and they dilate. It also improves oxygen circulation in the area and provides a reading of the oxygen pressure. This apparatus also maintains a specific temperature at the site so as to not cause thermal trauma.

• Skin grafting: in this procedure, skin is removed from one part of the body and transplanted onto another. The skin is surgically removed from a part that is generally not exposed through clothes, like the thighs or buttocks. The procedure can involve removal of either the top layers or all the layers of a portion of the skin.

Non-healing wounds and ulcers are dangerous and infectious, and proper care must be taken to diagnose and heal them. If you spot one on your body, the best bet is to go for methods like skin grafting or transcutaneous oximetry, for complete cure.

2923 people found this helpful

Blocked Bile Duct & Gallbladder - How Surgery Can Be Of Help?

M.Ch - Paediatric Surgery, MBBS, MS - General Surgery
Pediatric Surgeon, Hyderabad
Blocked Bile Duct & Gallbladder - How Surgery Can Be Of Help?

The Kasai procedure involves removal of the bile duct and gallbladder that are blocked and get them replaced with a segment of a child’s own small intestine. The segment of intestine gets sewed into the liver and hence functions as a new extrahepatic bile duct system.

A paediatric surgeon, who has specialized training in the management of surgically corrected problems in children, performs the operation. The surgeon carries out the operation through a laparoscope by making small incisions instead of a large one. He or she would determine the safest method of performing the operation and would discuss with the parents of a child before going ahead to conduct the surgery.

What are the possible outcomes after a kasai procedure?
Children, after having undergone the Kasai Procedure can come across the following outcomes, which include:

  • Bile flow gets restored back to normal and recovery of liver function takes place in almost one third of children after Kasai Procedure.
  • In the long-term, antibiotic therapy helps to reduce the risk of infection that enters the liver through the intestine.
  • Though this procedure is not a permanent cure to get rid of biliary atresia, still in most of the cases, it allows patients to grow and stay healthy for a number of years.
  • The children might not need liver transplantation.
  • The remaining two thirds of children who have undergone this procedure won’t have sufficient bile flow as well as liver function, hence eventually requiring a liver transplantation.
  • Out of this group of two-third children, half of them would soon require liver transplantation, whereas the other half would need it at a later date.
  • When the surgery is done at an early stage, and the child is younger than 3 months old, close to 80 percent of the patients have some sort of bile flow.
  • In almost 30 percent of those infants, sufficient bile gets drained out from the liver, which allows the bilirubin level to go back to normal.

Recovery process after the pperation
The recovery process for a child, who has undergone Kasai Procedure would include:

  • A child would be cared for in the recovery area, so that one of the parents could be with him or her when they wake up.
  • Then, from the recovery room, the child would be transferred to the paediatric floor and hence stay in the hospital for a few days.
  • Then, once the child is able to eat properly, does not have any fever and feels comfortable to receive pain medication by mouth, he or she gets discharged and can get back home.
  • Doctors give medications in order to prevent build-up of ascites or excess fluid.

 

5 Things You Can Do To Protect Yourself From Peptic Ulcer!

MD - General Medicine, DM - Gastroenterology
Gastroenterologist, Jaipur
5 Things You Can Do To Protect Yourself From Peptic Ulcer!

Peptic ulcers are wounds that develop in the stomach lining, less esophagus or small intestine. They are usually due to inflammation caused by bacterial H. pylori, in addition to corrosions from stomach acids. An ulcer is generally rooted in the stomach or inner layer of the small intestine. A stomach ulcer is the most visible sign of peptic an ulcer disease.

People with an ulcer may have a really hard time dealing with it. It is an open wound on the outer or internal surface of the body, which causes excessive pain. It is due to a breakdown in the mucous membrane or skin which fails to recover.

Causes of peptic ulcer:
Several reasons can cause stomach, esophagus, and small intestine to break. Contains:

  1. Helicobacter pylori (H. pylori), a type of bacteria that can cause stomach infections and swelling
  2. Continuous use of Aspirin (Bayer), Ibuprofen (Advil), and other anti-inflammatory drugs (the risks linked with this behavior among women and people over 60 years of age)
  3. Smoking
  4. Alcohol drinking
  5. radiation therapy
  6. stomach cancer

Symptoms of peptic ulcer:
The most common symptom of peptic ulcer is burning abdominal pain, which spread from navel to chest, which can range from light to severe. In few circumstances, the pain can get you up at night. Small peptic ulcers cannot develop any symptoms in initial stages.

  1. A burning, grinding pain in the upper middle part of the stomach and is comforted just by eating or taking antacids.
  2. Change in taste
  3. Sickness
  4. Bloody or dark stool
  5. Ambiguous weight loss
  6. Indigestion
  7. Vomit
  8. Pain in chest

Below are the ways to you from Peptic ulcers?
Stomach ulcer pain is not a joke: it can leave you weak. Fortunately, following these steps are ways to reduce your risk of getting ulcer.

  1. Avoid some foods such as spicy, lemon, fatty, etc., because they can be burdens your stomach. Specifically, if you have seen that particular types of food disturb your stomach, keep away from it.
  2. Improve the quality of your life by including exercise, stress-free activities, yoga etc. in your daily routine.
  3. The heavy consumption of alcohol can cause ulcers. They have been contributing to the development of ulcers, so it is good to reduce the consumption of alcohol.
  4. Taking no steroid anti-inflammatory medicines can reduce the risk of disturbing your stomach lining and thus avoiding the growth of ulcers.
  5. Management of anxiety level avoids the expansion of ulcers. Do yoga and other comforting arts that help prevent the ulcer.

Some lifestyle choices and habits can reduce your risk of developing the peptic ulcer. In case you have a concern or query you can always consult an expert & get answers to your questions!

2887 people found this helpful

Ulcerative Surgery - What Should You Know?

MBBS, MS - General Surgery
General Surgeon, Pune
Ulcerative Surgery - What Should You Know?

What Is Ulcerative Colitis?
Ulcerative colitis is a chronic, inflammatory condition of the colon and the rectum. It affects the mucosal lining of the large intestine (colon) and the rectum. The rectum is present just above the anus.
In this condition, patients have ulcers and abscesses in their colon and rectum.

Symptoms are seen periodically. The symptoms are severe pain in the abdomen, blood in stools and diarrhea. Anemia is seen due to decreased healthy red blood cells as a consequence of bleeding in stools.

When is surgery required?

  • The colon has ruptured
  • There is extensive bleeding
  • The treatment results in severe side effects affecting the patient's health
  • Drug therapy fails to provide results
  • When it progresses to colon cancer
  • Surgery for Ulcerative colitis

There are 2 types of surgeries:

  1. Colectomy: Surgery performed to remove the entire colon
  2. Proctocolectomy: Surgery is conducted to remove both the colon and rectum. It is considered as the standard treatment for ulcerative colitis.

Procedures for the surgery

  1. Ileostomy: The entire colon and rectum are removed and the surgeon creates an opening or stoma in the abdominal wall particularly below the waist. Stoma allows waste from the intestines to exit the body. The tip of the lower small intestine is brought through the stoma. An external bag, or pouch, is attached to the stoma. This is called a permanent ileostomy. Stools pass through this opening and collect in the pouch. The pouch must be worn at all times. Before an ileostomy, the surgeon will perform a proctocolectomy. They will perform the ileostomy in the hospital, and the patient receives a general anesthesia.
  2. Ileal Pouch Anal Anastomosis (IPAA): This is also called a J-pouch. This is a procedure that does not require a permanent stoma. The patient is still able to eliminate stool through the anus. A pouch is constructed at the end of the ileum and attached to the anus. This is called a J- pouch. As with the ileostomy, the patient will need a proctocolectomy before an IPAA. An IPAA is done in a hospital, and the patient will receive a general anesthesia.

Side-effects
Some people experience incontinence after the surgery. Medications may help control the function of the pouch.
Some women may become infertile after the procedure.

Recovery after Surgery
Both sets of the procedure will require a four-to-six-week recovery period.

  1. Keep your diet healthy: A healthy diet is essential because good nutrition can help the body heal faster and help avoid post-operation health issues. Absorption of nutrients can be an issue after these surgeries, so eating well will help in maintaining the proper level of nutrients.
  2. Keep yourself hydrated: Hydration is important for overall health, especially for the digestive health. Drinking six to eight glasses of water per day is recommended.
  3. Manage your stress: Anxiety or emotional stress can cause stomach issues, which can aggravate the complaint.

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

2892 people found this helpful

Peptic Ulcers - Strange Things About It!

DM - Gastroenterology, MD - General Medicine, DNB (Medical), MBBS
Gastroenterologist, Delhi
Peptic Ulcers - Strange Things About It!

Peptic ulcer, often referred to as stomach ulcer, is usually a misunderstood disease. Most people are unaware of the reasons why the ulcer is caused and are also unaware of the early symptoms of the disorder. Here is a look at some of the strange facts about peptic ulcers that you may not know.

  1. Stress does not cause ulcers: The myth that stress causes ulcers is just that- a myth. Ulcers are not caused by stress and tension. However, if you are already affected by an ulcer, stress can alleviate the symptoms and make matter worse. Non-steroidal anti-inflammatory drugs can result in ulcers. So, if you have already been diagnosed with peptide ulcer, try not to stress too much.
  2. Ulcer pain is not caused due to food: Contrary to popular belief, ulcer pain is not alleviated when you eat something. In fact, pain increases if your stomach remains empty for a long period of time. So, if you are an ulcer patient, make a point of eating at regular intervals. In fact, the American College of Gastroenterology claims that people with ulcers do not need to follow a bland diet in order to recover from the condition.
  3. Heartburn medication is effective against ulcer: Stomach acid is the common link between heartburn and ulcer, as both of these disorders are caused as a result of excess acid formation in the stomach. This is why physicians often prescribe antacids to ulcer patients.
  4. Untreated ulcers can be problematic: Ulcers are easy to cure and can be completely treated with proper medication and adherence to restrictions. However, you should seek treatment for ulcers as soon as it is diagnosed. If left untreated, this ulcer may go on to cause severe issues for the patient. For instance, untreated ulcers may lead to internal bleeding and scar tissue. The same also impedes the digestive process. So, do not leave ulcers untreated and think that they will be repaired automatically over time.
  5. Endoscopy is the best way to diagnose ulcers: Even though X-rays may often reveal ulcers, a normal X-ray cannot detect certain smaller ulcers. Endoscopy is the best way to detect the disorder. In this process, a small tube, containing a light and a camera, is inserted inside the patient’s esophagus. The camera reveals any abnormal growth or infection inside the stomach. If you suspect an ulcer, book an appointment with the doctor as soon as possible.

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

2451 people found this helpful

Popular Questions & Answers

For last 3 and half months I am suffering from duodenal ulcers and mild gastritis .now I am taking razo 20 and nervijen p tablet, how many months can I take these tablets what happens if I take these tablets another one month. Is eating garlic, hot turmeric water, onion,ginger, honey,yogurt, carrot, cabbage juice heals duodenal ulcers and mild gastritis fast please tell me.

MBBS, MD - General Medicine, DNB- Gastroenterology
Gastroenterologist, Ahmedabad
Within 8-12 weeks usually the ulcers heal. I am not aware of any diet which has property of ulcer healing. But you can consume whatever you like and feel is healthy.
3 people found this helpful

I have ulcer. The symptoms are serious pain at the back with stomach ache, sometimes I vomit and also purge. I do take flagyl, omeprazole and cimetidine and gascol. Want to know if the treatment is in order. Also went for blood text and was diagnosed of ulcer caused by h.pylori.

MBBS, FCPS - Surgery, DNB ( General Surgery ), Fellowship in Minimal Access Surgery, Fellowship of Indian association of gastroendoscopic surgeons, Fellowship of association of colo rectal surgeons of India
General Surgeon, Delhi
Hi, Get An upper GI endoscopy done, You can continue to take omeprazole or start on H pylori kit which contains PPI.Please share your endoscopy report and Kindly make a personal consultation to me regarding the specific medication and surgical opinion. Thank you

I am suffering from venus ulcer wound on. My left leg since 8 months .now I am on steroid treatment. But is there much pain won't get sleep .daily I am on dressing .My question is why it is not healing fastDoes steroid treatment helpfulWhat is the remedy for wound pain.

MS(gen.surg), M.B.B.S.
General Surgeon, Kota
If it venous ulcer than possiblits tha you r suffering from varicose veins 1st get colour Doppler of limb, if it found than treat it first so ulcer can heal.

I have a cronical duodenal ulcer .I take medicine in last 18 days. But I feel not good. In my mind I think it has been go to cancer .Can it be possible? How many day cronical duodenal ulcer heal?

MCh(Minimally Invasive & Robotic Surgery), MS - Surgical, MBBS
General Surgeon, Guwahati
You need to take medicines for at least a month before getting the desired result. Helico bacter pylori test is another one you need to do. If positive then to add the medicines accordingly. Upper GI endoscopy is also to be repeated on follow up .also spices, smoke and spirit need to be avoided strictly.
5 people found this helpful

Table of Content

What is Ulcer ?

Treatment of Ulcer :

What does Experts Says :

More About :

Play video
Diabetic Foot Ulcer
Diabetic foot ulcer is a major complication of diabetes and is one of the major component of diabetic foot. It is caused by neuropathic (nerve) and vascular (blood vessel) Hello friends!

I am Dr. Anubhav Gupta. I am a consultant plastic surgeon at Sir Ganga Ram Hospital. Today I am going to talk with you about a very neglected problem faced by a lot of patient of ours and that is the diabetic foot. Now what happens usually is people who have diabetes are always prone to have some problem in their feet. It is because of microangiopathy and because of the high level of glucose which is constantly there so there is a culture medium in the blood which can cause a lot of injuries. So it is very important for them to take very good care of their feet.

I always recommend my patients from diabetes that they should look at their feet just like they look at their face everyday in the morning. So every day you have to see even if there is a small issue then you should not neglect it. You should approach a plastic surgeon or an aesthetic surgeon or any other surgeon who is taking care of the feet. Usually, these kinds of the patient require a multimodality approach. A plastic surgeon, a vascular surgeon and sometimes a paediatrics.

So it's a combined therapy. Multiple sessions are required but what is more important is to attack the problem at the very beginning, because if we don't attack the problem in the very beginning it can lead to catastrophic consequences. It may start with a small blackening of the toe and it can actually extend up to right above the knee also. So when we treat these patients aggressively and at an early stage we usually limit the damage caused by the diabetic neuropathy and as well as other infective focus. The point or the take the home message over here is that we should treat these patients aggressively and early and the patient should be made aware that these kinds of problem are not to be taken lightly. For more details, you can contact me on lybrate.

Thank you!omplications of diabetes.
Play video
Diabetic Neuropathic Foot Ulcers
Mai Dr Suhas Shah,

Ashwini Accident Hospital Mumbai se bol raha hoon. Main Orthopaedic surgeon hoon. I am Russian surgery specialist, my speciality is cosmetic limb lengthening but recently I have started a new surgery for diabetic foot and diabetic neuropathy, the name of the surgery is Ilizarov angioplasty with that we can save the leg from amputation in patients of diabetic foot and a gangrene and non healing also. The results of this surgery are miraculous and within 6 hours, in diabetic neuropathic patients recover their sensation back. With this surgery the 300 blood cent, blood supply of the leg increases. We solve the problem of diabetic foot, non healing ulcer and diabetic foot with gangrene it awards amputation and many patients of mine who was advocated amputation of the diabetic foot required this surgery and they save their leg and this is the miraculous surgery for diabetic foot and diabetic neuropathy. I am expert in cosmetic limb lengthening , I get international patients to increase their height by 3 and a half inches to 7 inches and any person can increase his height by 3 and a half inches to 7 inches with the cosmetics lengthening surgery. It is a Russian surgery, Ilizarov method surgery and you can increase the height of any normal individual at any age by 3 and a half inch.

Any patient who is suffering from diabetic foot should contact me through lybrate.com and take appointment through lybrate.com.
Play video
Endoscopy
Hello everybody,

I am Doctor Dr. Gurwant Singh Lamba, Gastroenterologist. I look after diseases of the liver and the digestive system. So today we are going to talk about investigation which is very commonly used investigation these days but about which lot of patients have got lot of queries and questions and they appear in their minds and they are generally apprehensive of getting that investigation done and investigation I am talking about is Endoscopy.

You all must have heard of this term Endoscopy which is generally done to diagnose many of the digestive disease problems and it is often prescribed by doctors. So what I have seen is that there are lot of myth and misunderstandings about this procedure in the patient s mind and they are reluctant to get this, they have heard things from people around without any substantive evidence or anything and they are generally not very willing to get this investigation done. So what I am going to enlighten you today is about Endoscopy.

Now, believe me, it s a very very simple investigation, the upper GI endoscopy as we call, is to see the about the problems which may be there in the upper digestive track. With Endoscopy we can see the food pipe, we can see the stomach and we can see the upper part of the intestine. So any disease in this area which can be seen directly, we can put endoscope and we can see these regions directly and then accordingly we can do the treatment. So it s a very very useful tool, it s a very simple investigation. It doesn t require any admission. It can be done on openly basis. It can be done without any anesthesia or without any sedation but suppose somebody is very apprehensive, so in those patients we can always give a short sedation for few minutes and do the Endoscopy procedure. In every Endoscopy procedure, diagnostic don t take more than 2 minutes to finish. So it s a very brief simple procedure and one can go to one s work or one can go to whatever he has to do after the Endoscopy.

You don t have to take any leave, you don t have to miss any appointments because of it. So it is a very simple thing and it is done with the help of a flexible you can say flexible long camera. It s a very sophisticated instrument made from very sophisticated rubber material with some light fibers. It s a very smooth flexible instrument which causes no trauma to the body, which causes no injury to the body in any way and it s a costly instrument and the Endoscopy is done through that and the patient is generally in lying done position, we put him the endoscope in his mouth and then within 2 minutes we examine his whole upper digestive track through it and lot of things and lot of diseases which can be diagnosed through it specially ulcers in the stomach, ulcers in the food pipe, severe acidity, tumors of the food pipe, tumors of the stomach, diurnal ulcers.

There are so many different diseases. It s very useful tool in liver disease patients where we can pick up some veins which get dilated and their food pipe and the stomach. So all these disease can be seen with the help of this endoscope. Endoscopy is not only a diagnostic tool, it s a very important therapeutic tool also. There are lots of diseases which we can treat with Endoscopy also. For example a patient comes with the bit blood in vomiting. It s a very common situation we get such patients every day. They vomited and there was blood in it. So our aim is to do the Endoscopy quickly in that patiently, see from where the bleeding is occurring and suppose there is a tear in his mucosa, suppose there is a ulcer there which is bleeding, we can inject medicines there, we can spray medicines over there, we can do laser therapy over it, we can put some clips over it to stop the bleeding if there is a vessel which has punctured and bleeding.

So there are lots of therapeutic applications also where a treatment can be done through Endoscopy and many of these treatments may be for example in case of bleeding, may be life-saving treatments and instead of the patient going in for an extensive long surgery which will which will require time, lot of rehabilitation time after the surgery, simple endoscopic procedure which can be finished in few minutes can take care of the problem. There are patients who have tumors which are bleeding, we have modalities which can control tumor bleed also. Then for diagnostic purposes we can also take samples from inside and get them tested. So all these things can be done with the help of Endoscope.

Another very interesting thing which we do with Endoscope is removal of foreign bodies. You may have seen there are many small children who swallow coins or pens or even some older patients also accidentally swallow something and it goes inside the stomach and obviously it may a needle, it may be a pen, it may be a clip anything. So all these things now don t require any surgery. We can with the help of endoscope in a few minutes almost every kind of foreign body which has gone inside and which is still there in the upper GI can be removed with the help of Endoscope.

Then we can do many pediatric procedure through Endoscope for example somebody who would have tumor of the food pipe, he cannot eat. So we can insert a stent or an artificial food pipe and make him eat. If there is a blockage in the stomach and the food is not going ahead, we can again we can put in a pipe to open that blockage where the patient can then start eating. So these are the various things which can be done by Endoscope. It s a very useful and simple tool and I think it has helped us in saving many lives. It has helped us in reducing morbidity in many patients. It has helped us in diagnosing so many diseases.

So I think there should be no fear in getting endoscopy. It s a very simple harmless procedure. There are hardly any side effects of the procedure that matters in complication of the Endoscopy. So if an Endoscopy is prescribed by the specialist, don t hesitate to get it done and because it is very good tool to diagnose so many diseases and timely diagnosis will help us in treating the disease faster and in a much better way.

Thank you.
Having issues? Consult a doctor for medical advice