The triangular fibrocartilage complex (TFCC) is found within the wrist joint at the little finger side. Oral thrush is caused by Candida albicans fungus and it affects the soft lining of the mouth or oral cavity. For mild forms of oral thrush the symptoms are very mild and sometimes you may not have any signs of infection at all.
In rare cases, the lesions will spread deep into the throat and even to your stomach and can cause difficulty in swallowing anything.
Candida infection or oral thrush is caused when the body’s immune system becomes weak due to certain diseases or while taking certain drugs like prednisone. People who have weakened immunity like HIV infected individuals, those suffering from cancer of any type, those undergoing treatment like chemotherapy or radiation therapy, those with diabetes and those with vaginal yeast infections. People who smoke, having cancer in any form, individuals wearing dentures, persons with weak immune system have increased chance for getting affected with oral thrush. Oral thrush can be easily diagnosed by your doctor by physically examining the oral cavity. You can prevent getting Candida fungal infections by practicing good oral hygiene and by monitoring what you eat. Continuando con nuestro monografico sobre los riesgos del embarazo multiple, hoy hablaremos de la preeclampsia, una complicacion del embarazo relativamente comun pero a la vez bastante peligrosa para la madre y los bebes, por lo que es fundamental recibir un seguimiento medico adecuado.
Aunque la preeclampsia puede aparecer tambien en un embarazo unico (en el caso de Espana se calcula que se manifiesta entre un 1% y un 2% de los embarazos), la incidencia en embarazos multiples  es significativamente mayor.
La preeclampsia, tambien conocida como toxemia del embarazo, se caracteriza por la aparicion de un cuadro de hipertension (subida de tension) junto con un aumento del nivel de proteinuria en la orina (existencia de proteinas en la orina en una cantidad elevada).
Asi, durante la preeclampsia el cuerpo de la madre inicia un proceso de rechazo a la presencia del feto y la placenta.
Hay que tener en cuenta que la aparicion de un cuadro de hipertension durante el embarazo no siempre significa que se trate de una preeclampsia. Generalmente la preeclampsia se manifiesta durante el embarazo, aunque tambien puede aparecer hasta seis semanas despues del parto (preeclampsia postparto). La conclusion es que la exposicion repetida al semen establece la tolerancia inmunologica necesaria para un embarazo sano con exito.
Dado que se ha comprobado existe una cierta predisposicion en mujeres con familiares con antecedentes de preeclampsia, algunas teorias apuntan a que el origen estaria en una susceptibilidad genetica. Dado que se han documentado casos de preeclampsia en pacientes con embarazos ectopicos o molares, otras teorias apuntan a que la clave estaria en la placenta, siendo la severidad de la preeclampsia proporcional a la masa placentaria (como en el caso de los embarazos multiples). Esta imagen muestra el estrechamiento de los vasos sanguineos de la placenta propia de la preeclampsia, lo que provoca una restriccion del flujo sanguineo que debe llegar hasta los fetos. Segun esta teoria el cuerpo de la madre produciria un agente que es toxico para las celulas endoteliales de la placenta debido a un desequilibrio en el sistema oxidativo. La preeclampsia, si no recibe el tratamiento adecuado, puede provocar en la madre fallos renales o hepaticos, problemas de coagulacion, problemas cardiovasculares o incluso danos cerebrales. Por lo que respecta al riesgo para los fetos, la preeclampsia aumenta el riesgo de desprendimiento prematuro de placenta.
Tambien produce oligoamnios (disminucion del liquido amniotico), lo que puede provocar alteraciones en el crecimiento fetal y aumenta las posibilidades de que se produzcan complicaciones con el cordon umbilical,  dificultando el parto. Por otro lado, el estrechamiento de los vasos sanguineos provoca que el riego sanguineo a ciertas areas de las placentas se vea restringido, por lo que los fetos reciben menos alimentos y oxigeno produciendose un retraso en el crecimiento intrauterino (CIR, RCIU). Ademas, debemos tener en cuenta los riesgos intrinsecos a la prematuridad y el nacimiento con bajo peso, ya que con frecuencia la aparicion de preeclampsia determina la terminacion anticipada del embarazo mediante cesarea. A pesar de lo anterior, si la gestante recibe un seguimiento medico adecuado y no desarrolla un cuadro de especial gravedad, el pronostico suele ser bueno.
Existencia de un embarazo multiple: La preeclampsia es de 3 a 5 veces mas frecuente en el caso de embarazos multiple. El riesgo es mas elevado si se trata del primer embarazo de la mujer (hasta el 85% de los casos), o bien si se trata del primer embarazo con esa misma pareja (de conformidad con la teoria del origen inmunologico, algunos estudios indican que la exposicion prolongada al semen de la pareja tiene un efecto protector contra la preeclampsia).
Antecedentes de diabetes, hipertension arterial o la existencia de una enfermedad renal previa. En la segunda parte del post veremos en detalle los distintos grados de severidad de la preeclampsia (preclampsia leve, preeclampsia grave, eclampsia y sindrome de HELLP), y hablaremos acerca de los sintomas que deben alertar a la mujer gestante, el tratamiento que suele recibir la preeclampsia y algunos factores de prevencion. In TED optic neuropathy, the optic nerve becomes compressed by the enlarged muscles at the narrow orbital apex where the nerve exits the orbit to enter the brain cavity.


The patient symptoms may include central visual blurring, loss of peripheral vision or colour desaturation. Objective measures of optic neuropathy include a loss in central visual acuity and colour vision, an afferent pupil defect, and infrequently congestion or pallor of the optic nerve. Ancillary testing includes coronal CT or MR Scans to confirm crowding of the orbital apex, standardized visual fields, and rarely VEP or optic nerve head photos. Because the disease is usually in the active or progressive phase when optic neuropathy develops, some clinicians may arrange additional radiotherapy subsequent to the decompression to prevent further enlargement of the muscles and recurrence of neuropathy.
Success of therapy for TED optic neuropathy from both a clinical or research standpoint is based on specific improved measurements for central vision, colour vision and visual fields. Symptoms of ocular and periocular soft tissue inflammation include orbital aching at rest or with movement, and eyelid or conjunctival swelling and redness. The Clinical Activity Score (CAS) described and validated by Mourits and the Amsterdam Orbitopathy group assigns one point for each of the following: orbital pain at rest, orbital pain with movement, chemosis, caruncular edema, eyelid edema, conjunctival injection and eyelid injection.
The VISA Inflammatory Score modifies the CAS slightly by widening the grade for chemosis and lid edema from 0-2. Lid edema is graded as 1 if it is present but not causing overhanging of the tissues, and as 2 if it causes a roll in the lid skin including festoons in the lower lid. The pain score is based on the patient’s report of deep orbit discomfort rather than ocular surface irritation (0 = no pain, 1 = pain with movement, 2 = pain at rest).
Treatment of active inflammation in TED depends on its inflammatory score and evidence of progression.
In general, if the inflammatory grade is 5 or more, or if there is subjective or objective evidence of progression in the inflammation, more aggressive therapy should be considered, including oral or intravenous corticosteroids, radiotherapy, and in refractory cases, immunosuppressive agents. Combination therapy is receiving increasing attention in severe, progressive cases [26, 27] and interest is also turning to new immunomodulatory agents, such as anti-tumor necrosis factor agents (etanercept, infliximab) or B-lymphocyte directed therapy (rituximab).
The symptoms for strabismus include a progression from no diplopia (double vision), diplopia with horizontal or vertical gaze, intermittent diplopia in straight gaze, and constant diplopia in straight gaze. Strabismus can be measured objectively by prism cover testing in different gaze directions. Ancillary testing includes using the Goldmann perimeter to quantify ocular ductions in four directions.  The patient keeps both eyes open and follows the V4e light target, tapping a coin when the image becomes double.
Figure 4b: Once the inflammation controlled and the strabismus measurements are stable, prisms may be offered or alignment surgery with adjustable sutures can be performed.
Symptoms in this category include appearance concerns such as bulging of the eyes, eyelid retraction and fat pockets, as well as exposure complaints of foreign body sensation, glare, dryness or secondary tearing.
Objective measures of appearance change include eyelid retraction (measured in millimeters), proptosis (measured with the Hertel exophthalmometer), and documentation of redundant skin and fat prolapse.  Measures of exposure include corneal staining or ulceration. Rarely a tarsorrhaphy (temporarily suturing the upper and lower lids) or emergency orbital decompression may be required for severe exposure or corneal ulceration. Once the inflammatory phase has settled, management for proptosis might include orbital decompression and for eyelid retraction may include upper lid lowering from an anterior or posterior approach or lower lid elevation.31  These surgical measures often relieve many of the exposure complaints. ITEDS is a non-profit society dedicated to educating the public and physicians about thyroid eye disease as well as conducting research to understand the disease and lead to prevention and cures.
This is usually made worse by loading the wrist through activities such as press ups or pushing up from a chair.  Swelling may also be present and this may come on rapidly in an acute injury situation or gradually over time through micro-damage to the cartilage in repetitive activities. In these cases recovery may be prolonged and good post-operative physiotherapy support is important to optimise your recovery. It produces white blisters or lesions on the tongue and inner part of mouth which can be painful and bleeding. For moderate infections it will cause lesions on the tongue, inner cheeks and on the upper part of oral cavity and back of your throat. When the natural balance of the body gets disturbed due to intake of prolonged antibiotics it can weaken the immunity. In rare cases, oral thrush can spread to other body parts like esophagus, digestive tract, and liver. In rare cases he would do a biopsy of the lesions to test it on the lab for confirming the diagnoses.
For infants the doctor would prescribe mild antifungal medicines for destroying the fungus. De igual modo, el hecho de que una mujer sufra una hipertension cronica no implica necesariamente que deba desarrollar una preeclampsia durante el embarazo, pero si debera estar mas controlada.


Segun la misma la causa de la preeclampsia residiria en una respuesta inmune anormal del cuerpo de la madre al feto y la placenta.
Incluso algunos expertos se han atrevido a sugerir la implicacion de un gen presente en los cromosomas 1, 3, 9, o 18. Asi, la causa podria estar relacionada con la presencia de unos vasos sanguineos en la placenta mas delgados de lo habitual, lo que generaria una reaccion inapropiada del utero a la presencia de la placenta.
En los casos mas graves la preeclampsia podra evolucionar en una eclampsia o en el sindrome de HELLP. Algunas investigaciones realizadas han puesto de manifiesto que entre el 20% y el 40% de las gestantes cuyas madres padecieron preeclampsia la desarrollaron tambien, asi como entre el 11% y el 37% de las gestantes cuyas hermanas sufrieron de preeclampsia durante el embarazo. This interferes with flow of information through the optic nerve connecting the eyes to the brain.
As a summary grade, VISA lists optic neuropathy as present or absent since most clinicians would attempt some treatment for this condition if present.
The common treatment for TED optic neuropathy initially is high dose corticosteroids either by intravenous route (1 gram Methyl-prednisolone over 30 minutes on alternate days for 3 treatments) or oral route (100 mg prednisone daily on a tapering dose) with an expectation that vision should improve within days of therapy. Radiotherapy is administered using a lateral port focused behind the globe to minimize the risk of retinal or lens exposure; it is divided into 10 fractions of 200 rads over two weeks [23] and is contraindicated in diabetics because of the risk of inciting or aggravating retinopathy. The worst scores from any of the four eyelids are recorded in the inflammatory score table on the far right section of the table. The additional grading scores for chemosis and lid edema allow for documentation of more subtle changes in inflammatory features between visits. If the score is less than 4 out of 10, and there is no deterioration based on history or sequential clinical examination, conservative management is offered with reassurance, cool compresses, nocturnal head elevation, and non-steroidal anti-inflammatories.
For some people it will spread to the roof of your oral cavity and your gums or even on your throat.
Thus there is every chance for the infection to spread on mother’s breasts causing redness on the nipples with itchiness.
The protective mechanism of the body will fail on such occasions and the immune system will not be able to differentiate between ‘good’ and ‘bad’ bacteria or fungus thus allowing the oral thrush to happen. For nursing mothers antifungal lotions or ointments are given for reducing the pain and inflammation on their breasts. By taking yogurt you are increasing the ‘good’ bacteria in the body which helps in killing the fungus.
For mild form of oral thrush you can prepare salt water and gargle it twice or thrice a day. Otros han considerado que la preeclampsia esta relacionada con variante anormal de la molecula de angiotensinogeno.
Esto explicaria que la preeclampsia tenga una mayor incidencia en madres primerizas debido a un menor desarrollo de la vasculatura uterina. The severity of the neuropathy is reflected in the individual measurements of central and colour vision. In most cases, this treatment will cause incomplete or only temporary visual improvement so that surgical decompression of the medial wall is required (through a Lynch, transcaruncular or endoscopic transethmoidal approach) or through a lateral approach (thinning the outer boney wall of the orbit near the apex) in order to relieve pressure more permanently on the optic nerve at the crowded orbital apex.
An additional point is assigned for diurnal variation of symptoms, to reflect the variability in congestion typically seen during the active phase. Oral thrush can develop on anyone but it largely occurs in babies and adults who use corticosteroid medicines or who are wearing fixtures on their teeth or those with weakened immunity. Your doctor will prescribe antifungal drugs like amphotericin B or give lozenges or liquids for clearing throat infection. You can use it as an effective antibiotic rinse liquid for clearing the bacterial infection from your mouth.
The area around the nipple will become dark and shiny causing intense pain thus making the mother unable to feed.



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