Inflammation is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, is a protective response involving immune cells, blood vessels, molecular mediators. The function of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, initiate tissue repair; the five classical signs of inflammation are heat, redness and loss of function. Inflammation is a generic response, therefore it is considered as a mechanism of innate immunity, as compared to adaptive immunity, specific for each pathogen. Too little inflammation could lead to progressive tissue destruction by the harmful stimulus and compromise the survival of the organism. In contrast, chronic inflammation may lead to a host of diseases, such as hay fever, atherosclerosis, rheumatoid arthritis, cancer. Inflammation is therefore closely regulated by the body. Inflammation can be classified as either chronic.
Acute inflammation is the initial response of the body to harmful stimuli and is achieved by the increased movement of plasma and leukocytes from the blood into the injured tissues. A series of biochemical events propagates and matures the inflammatory response, involving the local vascular system, the immune system, various cells within the injured tissue. Prolonged inflammation, known as chronic inflammation, leads to a progressive shift in the type of cells present at the site of inflammation, such as mononuclear cells, is characterized by simultaneous destruction and healing of the tissue from the inflammatory process. Inflammation is not a synonym for infection. Infection describes the interaction between the action of microbial invasion and the reaction of the body's inflammatory response—the two components are considered together when discussing an infection, the word is used to imply a microbial invasive cause for the observed inflammatory reaction. Inflammation on the other hand describes purely the body's immunovascular response, whatever the cause may be.
But because of how the two are correlated, words ending in the suffix -itis are sometimes informally described as referring to infection. For example, the word urethritis means only "urethral inflammation", but clinical health care providers discuss urethritis as a urethral infection because urethral microbial invasion is the most common cause of urethritis, it is useful to differentiate inflammation and infection because there are typical situations in pathology and medical diagnosis where inflammation is not driven by microbial invasion – for example, trauma and autoimmune diseases including type III hypersensitivity. Conversely, there is pathology where microbial invasion does not cause the classic inflammatory response – for example, parasitosis or eosinophilia. Acute inflammation is a short-term process appearing within a few minutes or hours and begins to cease upon the removal of the injurious stimulus, it involves a coordinated and systemic mobilization response locally of various immune and neurological mediators of acute inflammation.
In a normal healthy response, it becomes activated, clears the pathogen and begins a repair process and ceases. It is characterized by five cardinal signs:An acronym that may be used to remember the key symptoms is "PRISH", for pain, immobility and heat; the traditional names for signs of inflammation come from Latin: Dolor Calor Rubor Tumor Functio laesa The first four were described by Celsus, while loss of function was added by Galen. However, the addition of this fifth sign has been ascribed to Thomas Sydenham and Virchow. Redness and heat are due to increased blood flow at body core temperature to the inflamed site. Loss of function has multiple causes. Acute inflammation of the lung does not cause pain unless the inflammation involves the parietal pleura, which does have pain-sensitive nerve endings; the process of acute inflammation is initiated by resident immune cells present in the involved tissue resident macrophages, dendritic cells, Kupffer cells and mast cells. These cells possess surface receptors known as pattern recognition receptors, which recognize two subclasses of molecules: pathogen-associated molecular patterns and damage-associated molecular patterns.
PAMPs are compounds that are associated with various pathogens, but which are distinguishable from host molecules. DAMPs are compounds that are associated with host-related cell damage. At the onset of an infection, burn, or other injuries, these cells undergo activation and release inflammatory mediators responsible for the clinical signs of inflammation. Vasodilation and its resulting increased blood flow causes increased heat. Increased permeability of the blood vessels results in an exudation of plasma proteins and fluid into the tissue, which manifests itself as swelling; some of the released mediators such as bradykinin increase the sensitivity to pain. The mediator molecules alter the blood vessels to
In medicine, sampling is gathering of matter from the body to aid in the process of a medical diagnosis and/or evaluation of an indication for treatment, further medical tests or other procedures. In this sense, the sample is the gathered matter, the sampling tool or sampler is the person or material to collect the sample. Sampling is a prerequisite for many medical tests, but not for medical history, physical examination and radiologic tests. Obtaining excretions or materials that leave the body anyway, such as urine, sputum, or vomitus, by direct collection as they exit. A sample of saliva can be collected from the mouth. Excision, a common method for the removal of solid or soft tissue samples. Puncture followed by aspiration is the main method used for sampling of many types of tissues and body fluids. Examples are thoracocentesis to sample pleural fluid, amniocentesis to sample amniotic fluid; the main method of centesis, in turn, is fine needle aspiration, but there are somewhat differently designed needles, such as for bone marrow aspiration.
Puncture without aspiration may suffice in, for capillary blood sampling. Scraping or swiping. In a Pap test, cells are scraped off a uterine cervix with a special spatula and brush or a special broom device, inserted through a vagina without having to puncture any tissue. Epithelial cells for DNA testing can be obtained by swiping the inside of a cheek in a mouth with a swab. In terms of sampling technique, a biopsy refers to a preparation where the normal tissue structure is preserved, availing for examination of both individual cells and their organization for the study of histology, while a sample for cytopathology is prepared for the examination of individual cells, not preserving the tissue structure. Examples of biopsy procedures are brain biopsy, skin biopsy and liver biopsy. Different types of matter that are sampled can be categorized by solidness versus fluidity, such as: Solid tissue, such as in bone marrow biopsy Soft tissue, such as in a muscle biopsy Body fluids Body fluid sampling include: Blood sampling for any blood test, including: Arterial blood sampling, such as by radial artery puncture.
This can be done for arterial blood gas analysis. Capillary blood sampling by using a blood lancet for puncture, followed by sampling by capillary action with a test strip or small pipe; this is common for routine diabetic monitoring for glucose. Venous blood sampling called venipuncture. Other than routine diabetic monitoring for glucose, the majority of blood tests are done on samples of venous blood taken by a phlebotomist or similar worker; such samples are collected in capped test tubes with a small amount of some sort of preservative. Cerebrospinal fluid sampling by lumbar puncture Pleural fluid sampling by thoracocentesis Amniotic fluid sampling by amniocentesis Peritoneal fluid sampling by peritoneocentesis, it can be used for cytology to detect spread of gynecologic cancers. The sampled matter can be analyzed for various components, for example: Electrolytes Proteins cells, such as white blood cells in blood sampling Microbiological agents, such as bacteria or fungi Microbiological sampling include: Blood sampling for blood cultures, performed as that for tests on the fluid itself above Throat swab for throat culture.
It is performed by applying a cotton swab to the surface of the throat. Sampling of sputum from the lungs for sputum culture, it can be performed by special techniques of coughing, or by a protected specimen brush, a brush that can be retracted into a plastic tube to prevent contamination of bacteria in the throat while inserting and removing the instrument
A fungus is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separate from the other eukaryotic life kingdoms of plants and animals. A characteristic that places fungi in a different kingdom from plants and some protists is chitin in their cell walls. Similar to animals, fungi are heterotrophs. Fungi do not photosynthesize. Growth is their means of mobility, except for spores, which may travel through the water. Fungi are the principal decomposers in ecological systems; these and other differences place fungi in a single group of related organisms, named the Eumycota, which share a common ancestor, an interpretation, strongly supported by molecular phylogenetics. This fungal group oomycetes; the discipline of biology devoted to the study of fungi is known as mycology. In the past, mycology was regarded as a branch of botany, although it is now known fungi are genetically more related to animals than to plants.
Abundant worldwide, most fungi are inconspicuous because of the small size of their structures, their cryptic lifestyles in soil or on dead matter. Fungi include symbionts of plants, animals, or other fungi and parasites, they may become noticeable when fruiting, either as molds. Fungi perform an essential role in the decomposition of organic matter and have fundamental roles in nutrient cycling and exchange in the environment, they have long been used in the form of mushrooms and truffles. Since the 1940s, fungi have been used for the production of antibiotics, more various enzymes produced by fungi are used industrially and in detergents. Fungi are used as biological pesticides to control weeds, plant diseases and insect pests. Many species produce bioactive compounds called mycotoxins, such as alkaloids and polyketides, that are toxic to animals including humans; the fruiting structures of a few species contain psychotropic compounds and are consumed recreationally or in traditional spiritual ceremonies.
Fungi can break down manufactured materials and buildings, become significant pathogens of humans and other animals. Losses of crops due to fungal diseases or food spoilage can have a large impact on human food supplies and local economies; the fungus kingdom encompasses an enormous diversity of taxa with varied ecologies, life cycle strategies, morphologies ranging from unicellular aquatic chytrids to large mushrooms. However, little is known of the true biodiversity of Kingdom Fungi, estimated at 2.2 million to 3.8 million species. Of these, only about 120,000 have been described, with over 8,000 species known to be detrimental to plants and at least 300 that can be pathogenic to humans. Since the pioneering 18th and 19th century taxonomical works of Carl Linnaeus, Christian Hendrik Persoon, Elias Magnus Fries, fungi have been classified according to their morphology or physiology. Advances in molecular genetics have opened the way for DNA analysis to be incorporated into taxonomy, which has sometimes challenged the historical groupings based on morphology and other traits.
Phylogenetic studies published in the last decade have helped reshape the classification within Kingdom Fungi, divided into one subkingdom, seven phyla, ten subphyla. The English word fungus is directly adopted from the Latin fungus, used in the writings of Horace and Pliny; this in turn is derived from the Greek word sphongos, which refers to the macroscopic structures and morphology of mushrooms and molds. The word mycology is derived from the Greek logos, it denotes the scientific study of fungi. The Latin adjectival form of "mycology" appeared as early as 1796 in a book on the subject by Christiaan Hendrik Persoon; the word appeared in English as early as 1824 in a book by Robert Kaye Greville. In 1836 the English naturalist Miles Joseph Berkeley's publication The English Flora of Sir James Edward Smith, Vol. 5. Refers to mycology as the study of fungi. A group of all the fungi present in a particular area or geographic region is known as mycobiota, e.g. "the mycobiota of Ireland". Before the introduction of molecular methods for phylogenetic analysis, taxonomists considered fungi to be members of the plant kingdom because of similarities in lifestyle: both fungi and plants are immobile, have similarities in general morphology and growth habitat.
Like plants, fungi grow in soil and, in the case of mushrooms, form conspicuous fruit bodies, which sometimes resemble plants such as mosses. The fungi are now considered a separate kingdom, distinct from both plants and animals, from which they appear to have diverged around one billion years ago; some morphological and genetic features are shared with other organisms, while others are unique to the fungi separating them from the other kingdoms: Shared features: With other euka
Medical diagnosis is the process of determining which disease or condition explains a person's symptoms and signs. It is most referred to as diagnosis with the medical context being implicit; the information required for diagnosis is collected from a history and physical examination of the person seeking medical care. One or more diagnostic procedures, such as diagnostic tests, are done during the process. Sometimes posthumous diagnosis is considered a kind of medical diagnosis. Diagnosis is challenging, because many signs and symptoms are nonspecific. For example, redness of the skin, by itself, is a sign of many disorders and thus does not tell the healthcare professional what is wrong, thus differential diagnosis, in which several possible explanations are compared and contrasted, must be performed. This involves the correlation of various pieces of information followed by the recognition and differentiation of patterns; the process is made easy by a sign or symptom, pathognomonic. Diagnosis is a major component of the procedure of a doctor's visit.
From the point of view of statistics, the diagnostic procedure involves classification tests. The first recorded examples of medical diagnosis are found in the writings of Imhotep in ancient Egypt. A Babylonian medical textbook, the Diagnostic Handbook written by Esagil-kin-apli, introduced the use of empiricism and rationality in the diagnosis of an illness or disease. Traditional Chinese Medicine, as described in the Yellow Emperor's Inner Canon or Huangdi Neijing, specified four diagnostic methods: inspection, auscultation-olfaction and palpation. Hippocrates was known to make diagnoses by smelling their sweat. A diagnosis, in the sense of diagnostic procedure, can be regarded as an attempt at classification of an individual's condition into separate and distinct categories that allow medical decisions about treatment and prognosis to be made. Subsequently, a diagnostic opinion is described in terms of a disease or other condition, but in the case of a wrong diagnosis, the individual's actual disease or condition is not the same as the individual's diagnosis.
A diagnostic procedure may be performed by various health care professionals such as a physician, physical therapist, healthcare scientist, dentist, nurse practitioner, or physician assistant. This article uses diagnostician as any of these person categories. A diagnostic procedure does not involve elucidation of the etiology of the diseases or conditions of interest, that is, what caused the disease or condition; such elucidation can be useful to optimize treatment, further specify the prognosis or prevent recurrence of the disease or condition in the future. The initial task is to detect a medical indication to perform a diagnostic procedure. Indications include: Detection of any deviation from what is known to be normal, such as can be described in terms of, for example, physiology, pathology and human homeostasis. Knowledge of what is normal and measuring of the patient's current condition against those norms can assist in determining the patient's particular departure from homeostasis and the degree of departure, which in turn can assist in quantifying the indication for further diagnostic processing.
A complaint expressed by a patient. The fact that a patient has sought a diagnostician can itself be an indication to perform a diagnostic procedure. For example, in a doctor's visit, the physician may start performing a diagnostic procedure by watching the gait of the patient from the waiting room to the doctor's office before she or he has started to present any complaints. During an ongoing diagnostic procedure, there can be an indication to perform another, diagnostic procedure for another concomitant, disease or condition; this may occur as a result of an incidental finding of a sign unrelated to the parameter of interest, such as can occur in comprehensive tests such as radiological studies like magnetic resonance imaging or blood test panels that include blood tests that are not relevant for the ongoing diagnosis. General components which are present in a diagnostic procedure in most of the various available methods include: Complementing the given information with further data gathering, which may include questions of the medical history, physical examination and various diagnostic tests.
A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of disease. Diagnostic tests can be used to provide prognostic information on people with established disease. Processing of the answers, findings or other results. Consultations with other providers and specialists in the field may be sought. There are a number of methods or techniques that can be used in a diagnostic procedure, including performing a differential diagnosis or following medical algorithms. In reality, a diagnostic procedure may involve components of multiple methods; the method of differential diagnosis is based on finding as many candidate diseases or conditions as possible that can cause the signs or symptoms, followed by a process of elimination or at least of rendering the entries more or less probable by further medical tests and other processing until, aiming to reach the point where only one candidate disease or condit
In vertebrate anatomy, the throat is the front part of the neck, positioned in front of the vertebra. It contains the larynx. An important section of it is the epiglottis, a flap separating the esophagus from the trachea preventing food and drink being inhaled into the lungs; the throat contains various blood vessels, pharyngeal muscles, the nasopharyngeal tonsil, the tonsils, the palatine uvula, the trachea, the esophagus, the vocal cords. Mammal throats consist of the hyoid bone and the clavicle; the "throat" is sometimes thought to be synonymous for the isthmus of the fauces. It works with the mouth and nose, as well as a number of other parts of the body, its pharynx is connected to the mouth, allowing speech to occur, food and liquid to pass down the throat. It is joined to the nose by the nasopharynx at the top of the throat, to ear by its Eustachian tube; the throat's trachea carries inhaled air to the bronchi of the lungs. The esophagus carries food through the throat to the stomach. Adenoids and tonsils are composed of lymph tissue.
The larynx contains vocal cords, the epiglottis, an area known as the subglottic larynx—the narrowest section of the upper part of the throat. In the larynx, the vocal cords consist of two membranes that act according to the pressure of the air; the Jugulum is a low part of the throat, located above the breast. The term Jugulum is reflected both by the internal and external jugular veins, which pass through the Jugulum. Strep throat Tracheotomy Tonsilloliths Throat singing
A hoarse voice known as dysphonia, is when the voice involuntarily sounds breathy, raspy, or strained, or is softer in volume or lower in pitch. A hoarse voice, can be associated with a feeling of unease or scratchiness in the throat. Hoarseness is a symptom of problems in the vocal folds of the larynx, it may be caused by laryngitis, which in turn may be caused by an upper respiratory infection, a cold, or allergies. Cheering at sporting events, speaking loudly in noisy situations, talking for too long without resting one's voice, singing loudly, or speaking with a voice that's too high or too low can cause temporary hoarseness. A number of other causes for losing one's voice exist, treatment is by resting the voice and treating the underlying cause. If the cause is misuse or overuse of the voice drinking plenty of water may alleviate the problems, it appears to occur more in females and the elderly. Furthermore, certain occupational groups, such as teachers and singers, are at increased risk.
Long-term hoarseness, or hoarseness that persists over three weeks when not associated with a cold or flu should be assessed by a medical doctor. It is recommended to see a doctor if hoarseness is associated with coughing up blood, difficulties swallowing, a lump in the neck, pain when speaking or swallowing, difficulty breathing, or complete loss of voice for more than a few days. For voice to be classified as "dysphonic", abnormalities must be present in one or more vocal parameters: pitch, quality, or variability. Perceptually, dysphonia can be characterised by hoarse, harsh, or rough vocal qualities, but some kind of phonation remains. Dysphonia can be categorized into two broad main types: functional; the type of dysphonia is dependent on the cause of the pathology. While the causes of dysphonia can be divided into five basic categories, all of them result in an interruption of the ability of the vocal folds to vibrate during exhalation, which affects the voice; the assessment and diagnosis of dysphonia is done by a multidisciplinary team, involves the use of a variety of subjective and objective measures, which look at both the quality of the voice as well as the physical state of the larynx.
Multiple treatments have been developed to address functional causes of dysphonia. Dysphonia can be targeted through direct therapy, indirect therapy, medical treatments, surgery. Functional dysphonias may be treated through direct and indirect voice therapies, whereas surgeries are recommended for chronic, organic dysphonias. Voice disorders can be divided into 2 broad categories: functional; the distinction between these broad classes stems from their cause, whereby organic dysphonia results from some sort of physiological change in one of the subsystems of speech. Conversely, functional dysphonia refers to hoarseness resulting from vocal use. Furthermore, according to ASHA, organic dysphonia can be subdivided into neurogenic. Notably, an additional subcategory of functional dysphonia recognized by professionals is psychogenic dysphonia, which can be defined as a type of voice disorder that has no known cause and can be presumed to be a product of some sort of psychological stressors in one’s environment.
It is important to note that these types are not much overlap occurs. For example, Muscle Tension Dysphonia has been found to be a result of many different causes including the following: MTD in the presence of an organic pathology, MTD stemming from vocal use, MTD as a result of personality and/or psychological factors; the most common causes of hoarseness is functional dysphonia. Hoarseness can be caused by laryngeal tumours. Causes that are overall less common include neurogenic conditions, psychogenic conditions, aging. A variety of different causes, which result in abnormal vibrations of the vocal folds, can cause dysphonia; these causes can range from vocal misuse to systemic diseases. Causes of dysphonia can be divided into five basic categories, although overlap may occur between categories.: It has been suggested that certain occupational groups may be at increased risk of developing dysphonia due to the excessive or intense vocal demands of their work. Research on this topic has focused on teachers and singers, although some studies have examined other groups of heavy voice users.
At present, it is known that teachers and singers are to report dysphonia. Moreover, physical education teachers, teachers in noisy environments, those who habitually use a loud speaking voice are at increased risk. However, the exact prevalence rates for occupational voice users are unclear, as individual studies have varied in the methodologies used to obtain data. Located in the anterior portion of the neck is the larynx, a structure made up of several supporting cartilages and ligaments, which houses the vocal folds. In normal voice production, exhaled air moves
Nonsteroidal anti-inflammatory drug
Nonsteroidal anti-inflammatory drugs are a drug class that reduce pain, decrease fever, prevent blood clots and, in higher doses, decrease inflammation. Side effects depend on the specific drug, but include an increased risk of gastrointestinal ulcers and bleeds, heart attack and kidney disease; the term nonsteroidal distinguishes these drugs from steroids, which while having a similar eicosanoid-depressing, anti-inflammatory action, have a broad range of other effects. First used in 1960, the term served to distance these medications from steroids, which where stigmatised at the time due to the connotations with anabolic steroid abuse. NSAIDs work by inhibiting the activity of cyclooxygenase enzymes. In cells, these enzymes are involved in the synthesis of key biological mediators, namely prostaglandins which are involved in inflammation, thromboxanes which are involved in blood clotting. There are two types of NSAID available: COX-2 selective. Most NSAIDs are non-selective, inhibit the activity of both COX-1 and COX-2.
These NSAIDs, while reducing inflammation inhibit platelet aggregation and increase the risk of gastrointestinal ulcers/bleeds. COX-2 selective inhibitors have less gastrointestinal side effects, but promote thrombosis and increase the risk of heart attack; as a result, COX-2 selective inhibitors are contraindicated due to the high risk of undiagnosed vascular disease. These differential effects are due to the different roles and tissue localisations of each COX isoenzyme. By inhibiting physiological COX activity, all NSAIDs increase the risk of kidney disease and, through a related mechanism, heart attack; the most prominent NSAIDs are aspirin and naproxen, all available over the counter in most countries. Paracetamol is not considered an NSAID because it has only minor anti-inflammatory activity, it treats pain by blocking COX-2 in the central nervous system, but not much in the rest of the body. NSAIDs are used for the treatment of acute or chronic conditions where pain and inflammation are present.
NSAIDs are used for the symptomatic relief of the following conditions: Aspirin, the only NSAID able to irreversibly inhibit COX-1, is indicated for antithrombosis through inhibition of platelet aggregation. This is useful for the management of arterial thrombosis and prevention of adverse cardiovascular events like heart attacks. Aspirin inhibits platelet aggregation by inhibiting the action of thromboxane A2. In a more specific application, the reduction in prostaglandins is used to close a patent ductus arteriosus in neonates if it has not done so physiologically after 24 hours. NSAIDs are useful in the management of post-operative dental pain following invasive dental procedures such as dental extraction; when not contra-indicated they are favoured over the use of paracetamol alone due to the anti-inflammatory effect they provide. When used in combination with paracetamol the analgesic effect has been proven to be improved. There is weak evidence suggesting that taking pre-operative analgesia can reduce the length of post operative pain associated with placing orthodontic spacers under local anaesthetic.
Combination of NSAIDs with pregabalin as preemptive analgesia has shown promising results for decreasing post operative pain intensity. The effectiveness of NSAID's for treating non-cancer chronic pain and cancer-related pain in children and adolescents is not clear. There have not been sufficient numbers of high-quality randomized controlled trials conducted. NSAIDs may be used with caution by people with the following conditions: Irritable bowel syndrome Persons who are over age 50, who have a family history of GI problems Persons who have had past GI problems from NSAID useNSAIDs should be avoided by people with the following conditions: The widespread use of NSAIDs has meant that the adverse effects of these drugs have become common. Use of NSAIDs increases risk of a range of gastrointestinal problems, kidney disease and adverse cardiovascular events; as used for post-operative pain, there is evidence of increased risk of kidney complications. Their use following gastrointestinal surgery remains controversial, given mixed evidence of increased risk of leakage from any bowel anastomosis created.
An estimated 10–20% of NSAID patients experience dyspepsia. In the 1990s high doses of prescription NSAIDs were associated with serious upper gastrointestinal adverse events, including bleeding. Over the past decade, deaths associated with gastric bleeding have declined. NSAIDs, like all drugs, may interact with other medications. For example, concurrent use of NSAIDs and quinolones may increase the risk of quinolones' adverse central nervous system effects, including seizure. There is an argument over the benefits and risks of NSAIDs for treating chronic musculoskeletal pain; each drug has a benefit-risk profile and balancing the risk of no treatment with the competing potential risks of various therapies is the clinician's responsibility. If a COX-2 inhibitor is taken, a traditional NSAID should not be taken at the same time. In addition, people on daily aspirin therapy must be careful if they use other NSAIDs, as these may inhibit the cardioprotective effects of aspirin. Rofecoxib was shown to produce fewer gastrointestinal adverse drug reactions compared with naproxen.
This study, the VIGOR trial, raised the issue of the cardiovascular safety of the coxibs. A statistically significant increase in the incidence of myocardial infarctions was observed in patients on rofecoxib. Further data, from the APPROVe trial, s