Tag: HPV

Human Papilloma Virus

Definition:
Human papilloma viruses or HPVs are a group of more than 80 different types of virus, including those causing genital warts. They can be transmitted through sexual intercourse and have been linked to cervical cancer. It is estimated that up to 15% of women aged 20 to 30 women and up to 6% of women over 40 carry the virus. The majority do not go on to develop cancer.

Human papillomavirus (HPV) is one of the most common causes of sexually transmitted infection (STI) in the world. Health experts estimate there are more cases of genital HPV infection than any other STI in the United States. According to the Centers for Disease Control and Prevention (CDC), approximately 6.2 million new cases of sexually transmitted HPV infections are reported every year. At least 20 million people in this country are already infected.

Genital warts
Genital warts (sometimes called condylomata acuminata or venereal warts) are the most easily recognized sign of genital HPV infection. Many people, however, have a genital HPV infection without genital warts.

Genital warts are soft, moist, or flesh colored and appear in the genital area within weeks or months after infection. They sometimes appear in clusters that resemble cauliflower-like bumps, and are either raised or flat, small or large. Genital warts can show up in women on the vulva and cervix, and inside and surrounding the vagina and anus. In men, genital warts can appear on the scrotum or penis. There are cases where genital warts have been found on the thigh and groin.

The name papillomavirus relates to warts or papillomas which many of the 80 types of the virus cause.These are non-cancerous tumours. Warts on different parts of the body relate to different types of papillomavirus.Thirty types are linked to infections in the genital tract. In women, warts or flat, abnormal growths may form on the skin around the external genitalia, the skin round the anus, the vagina and the cervix.

In men, warts may appear on and under the foreskin, on the penis and around the anus.People with visible warts are thought to be most at risk of spreading the virus through sexual intercourse.
They are likely to carry the virus for life.Doctors believe people are most infectious when they first contract the virus, but even people with no visible warts, but a past history of having them could be infectious.They say that there may be a time lag between contracting the virus and developing warts, sometimes lasting several years.People with a lowered immune system are more likely to develop warts than others. The body’s immune system can normally fight off the virus within three to six months.

Click to see pictures of different diseases caused by HPV

Cause
More than 100 different types of HPV exist, most of which are harmless. About 30 types are spread through sexual contact and are classified as either low risk or high risk.Some types of HPV cause genital warts–single or multiple bumps that appear in the genital areas of men and women including the vagina, cervix, vulva (area outside of the vagina), penis, and rectum. These are considered low-risk types.
High-risk types of HPV may cause abnormal Pap smear results. They could lead to cancers of the cervix, vulva, vagina, anus, or penis.

Transmission
Genital warts are very contagious. You can get them during oral, vaginal, or anal sex with an infected partner. You can also get them by skin-to-skin contact during vaginal, anal, or (rarely) oral sex with someone who is infected. About two-thirds of people who have sexual contact with a partner with genital warts will develop warts, usually within 3 months of contact.If you are infected but have no symptoms, you can still spread HPV to your sexual partner and/or develop complications from the virus.

Symptoms
In women, genital warts occur on the outside and inside of the vagina, on the opening to the uterus (cervix), or around the anus.In men, genital warts are less common. If present, they usually are seen on the tip of the penis. They also may be found on the shaft of the penis, on the scrotum, or around the anus.Rarely, genital warts also can develop in your mouth or throat if you have oral sex with an infected person.Like many STIs, genital HPV infections often do not have signs and symptoms that you can see or feel. One study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) reported that almost half of women infected with HPV had no obvious symptoms.If you are infected but have no symptoms, you can still spread HPV to your sexual partner and/or develop complications from the virus.

Diagnosis
Genital warts are assumed to be caused by HPV, but other tests can be done to identify whether a person is carrying the virus, including biopsy.However, none has been totally reliable. Scientists say some people may have been told they have the virus when they do not because HPV-type changes may be similar to normal anatomical variations.

Your health care provider usually diagnoses genital warts by seeing them.If you are a woman with genital warts, you also should be examined for possible HPV infection of the cervix. Your health care provider can diagnose HPV infection based on results from an abnormal Pap smear, a primary cancer-screening tool for cervical cancer or pre-cancerous changes of the cervix. In some cases, a health care provider will take a small piece of tissue from the cervix and examine it under the microscope.Another test to diagnose HPV infection detects HPV DNA, which may indicate possible infection.Your provider may be able to identify some otherwise invisible warts in your genital tissue by applying vinegar (acetic acid) to areas of your body that might be infected. This solution causes infected areas to whiten, which makes them more visible.

Treatment
There are treatments for genital warts, though the warts often disappear even without treatment. There is no way to predict whether the warts will grow or disappear. Therefore, if you suspect you have genital warts, you should be examined and treated, if necessary.

Depending on factors such as the size and location of your genital warts, your health care provider will offer you one of several ways to treat them.

* Imiquimod cream
* 20 percent podophyllin antimitotic solution
* 0.5 percent podofilox solution
* 5 percent 5-fluorouracil cream
* Trichloroacetic acid (TCA)

If you are pregnant, you should not use podophyllin or podofilox because they are absorbed by your skin and may cause birth defects in your baby. In addition, you should not use 5-fluorouracil cream if you are pregnant.

If you have small warts, your health care provider can remove them by one of three methods.

* Freezing (cryosurgery)
* Burning (electrocautery)
* Laser treatment

If you have large warts that have not responded to other treatment, you may have to have surgery to remove them.

Some health care providers inject the antiviral drug alpha interferon directly into warts that have returned after removal by traditional means. The drug is expensive, however, and does not reduce the rate that the genital warts return.

Although treatments can get rid of the warts, none get rid of the virus. Because the virus is still present in your body, warts often come back after treatment.

Complecations:
HPV and cancer
The presence of some forms of sexually-transmitted HPVs in both men and women have been linked with cancer.Cancer-associated forms of HPV usually have a thin, flat shape and are almost invisible, compared with other forms of genital warts.The major form of cancer linked to HPV is cervical cancer.Women who have been infected with sexually-transmitted HPV are thought to be at greater risk of developing cervical dysplasia, a pre-cancerous condition which can be detected on a Pap or smear test.This is treatable, but should be followed up by regular yearly smears.Doctors say the presence of HPVs should not affect a woman’s ability to give birth or her likelihood of needing a hysterectomy.HPVs can be detected in Pap tests. These divide the lesions caused by the virus into two main types: low-grade and high grade, both of which cause the growth of abnormal cells.High-grade lesions are thin, flat cells found in the vagina and the outer cervix.Low-risk lesions are fairly common and most return to normal after a few months or years. However, they can sometimes develop into cancer-associated lesions.Women who start having sex at an early age or have several sexual partners carry an increased chance of having HPV, but most infections disappear without treatment.Even those who develop cancer-associated HPVs rarely go on to develop cervical cancer.Researchers say this is because other factors may be involved in whether HPV may cause cancer, including smoking and a lowered immune system.

Cancer:
Some types of HPV can cause cervical cancer. Other types are associated with vulvar cancer, anal cancer, oral cancer, and cancer of the penis (a rare cancer).

Most HPV infections do not progress to cervical cancer. If you are a woman with abnormal cervical cells, a Pap smear will detect them. If you have abnormal cervical cells, it is particularly important for you to have regular pelvic exams and Pap smears so you can be treated early, if necessary.
Pregnancy and Childbirth

Genital warts may cause a number of problems during pregnancy. Because genital warts can multiply and become brittle, your health care provider will discuss options for their removal, if necessary.

Genital warts also may be removed to ensure a safe and healthy delivery of the newborn. Sometimes they get larger during pregnancy, making it difficult to urinate if the warts are in the urinary tract. If the warts are in the vagina, they can make the vagina less elastic and cause obstruction during delivery.

Rarely, infants born to women with genital warts develop warts in their throats (respiratory papillomatosis). Although uncommon, it is a potentially life-threatening condition for the child, requiring frequent laser surgery to prevent blocking of the breathing passages. Research on the use of interferon therapy with laser surgery indicates that this drug may show promise in slowing the course of the disease.

Prevention:
The best way to prevent getting an HPV infection is to avoid direct contact with the virus, which is transmitted by skin-to-skin contact. If you or your sexual partner has warts that can be seen in the genital area, you should avoid any skin-to-skin and sexual contact until the warts are treated.

Recently, the Food and and Drug Administration (FDA) approved a vaccine called Gardasil. Gardasil is highly effective in preventing persistent infection with HPV types 16 and 18, two “high-risk” HPVs that cause most (70 percent) of cervical cancers, and types 6 and 11, which cause virtually all (90 percent) of genital warts.

Gardasil has not been proven to provide complete protection against persistent infection with other HPV types, some of which also can cause cervical canter. Therefore, about 30 percent of cervical cancers and 10 percent of genital warts will not be prevented by the current vaccine. In addition, Gardasil does not prevent other STIs, nor does it treat HPV infection or cervical cancer.

The CDC Advisory Committee on Immunization Practices (ACIP) has federal HPV vaccine recommendations. In addition, the National Cancer Institute and CDC have more information on the HPV vaccine.

Historically, research studies have not confirmed that male latex condoms prevent transmission of HPV. Recent studies, however, demonstrate that consistent condom use by male partners suggests strong protection against low- and high-risk types of HPV infection in women.

Unfortunately, many people who don’t have symptoms don’t know that they can spread the virus to an uninfected partner.

Research
In June 2006, FDA approved Gardasil, the first vaccine developed to prevent cervical cancer, precancerous lesions, and genital warts due to HPV types 6,11,16, and 18. FDA licensed the vaccine for use in girls and women aged 9 to 26 years.

Researchers continue to work on another vaccine for HPV to help protect against HPV types 16 and 18.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://news.bbc.co.uk/2/hi/health/medical_notes/429762.stm
http://www3.niaid.nih.gov/healthscience/healthtopics/human_papillomavirus/

Tags Centers for Disease Control and Prevention, Genital wart, Health, HPV, Human papillomavirus, Infectious disease, Sexually transmitted disease, United States

Ailmemts & Remedies

Wart

Post author By Mukul
Post date March 23, 2008
5 Comments on Wart

Alternative Names :
Plane juvenile warts; Periungual warts; Subungual warts; Plantar warts; Verruca; Verrucae planae juveniles; Filiform warts; Verruca vulgaris

Definition:
Warts are small, usually painless growths on the skin caused by a virus. They are generally harmless. However, warts can be disfiguring and embarrassing, and occasionally they itch or hurt (particularly on the feet).

It is generally a small, rough tumor, typically on hands and feet, that can resemble a cauliflower or a solid blister. Warts are common, and are caused by a viral infection, specifically by the human papillomavirus (HPV) and are contagious when in contact with the skin of another. It is also possible to get warts from using towels or other objects. They typically disappear after a few months but can last for years and can recur. A few papilloma viruses are known to cause cervical cancer.

Types of Wort:

A range of different types of wart has been identified, varying in shape and site affected, as well as the type of human papillomavirus involved.

These include:

(YOU MAY CLICK TO SEE THE PICTURES)

*Common wart (Verruca vulgaris): a raised wart with roughened surface, most common on hands and knees.

Common wart> CLICK & SEE
*Flat wart (Verruca plana): a small, smooth flattened wart, tan or flesh coloured, which can occur in large numbers; most common on the face, neck, hands, wrists and knees

.Flat wart>...CLICK & SEE

*Genital wart (venereal wart, Condyloma acuminatum, Verruca acuminata):They are usually found on the genitals, in the pubic area, and the area between the thighs, but can appear inside the vagina and anal canal.

Genital.wart>...CLICK & SEE

*Plantar warts (verruca, Verruca pedis): a hard sometimes painful lump, often with multiple black specks in the center; usually only found on pressure points on the soles of the feet.

Plantar wart>CLICK & SEE

*Subungual and periungual warts appear under and around the fingernails or toenails .

Subungual wart >CLICK & SEE

*Filiform or digitate wart: a thread- or finger-like wart, most common on the face, especially near the eyelids and lips.

A filiform wart on the eyelid.>..CLICK & SEE

*Mosaic wart: a group of tightly clustered plantar-type warts, commonly on the hands or soles of the feet…..CLICK & SEE

Causes:
The typical wart is a raised round or oval growth on the skin with a rough surface. Compared with the surrounding normal skin, warts may appear light, dark, or black (rare). Most adults are familiar with the look of a typical wart and have little trouble recognizing them. Unusual warts with smooth surfaces or flat warts in children may be more difficult for parents to recognize.

Common warts tend to cause no discomfort unless they are in areas of repeated friction or pressure. Plantar warts, for example, can become extremely painful. Large numbers of plantar warts on the foot may cause difficulty running and even walking.

Warts around and under your nails are much more difficult to cure than warts elsewhere.

Some warts will disappear without treatment, although it can sometimes take a couple years. Treated or not, warts that go away often reappear. Genital warts are quite contagious, while common, flat, and plantar warts are much less likely to spread from person to person. All warts can spread from one part of your own body to another.

Because people generally consider warts unsightly and there is often a social stigma, treatment is often sought.
Symptoms :

*Small, hard, flat or raised skin lesion or lump

*Abnormally dark or light skin surrounding the lesion

*Numerous small, smooth, flat (pinhead sized) lesions on forehead, cheeks, arms, or legs

*Rough, round, or oval lesions on soles of feet — flat to slightly raised — painful to pressure

*Rough growths around or under fingernails or toenails

Diagnosis:
Exams and Tests
Warts can generally be diagnosed simply by their location and appearance. Your doctor may want to cut into a wart (called a biopsy) to confirm that it is not a corn, callus, or other similar-appearing growth.

Treatment:
Prescription
Treatments that may be prescribed by a medical professional include:

*Keratolysis, removal of dead surface skin cells usually using salicylic acid, blistering agents, immune system modifiers (“immunomodulators”), or formaldehyde.

*Cryosurgery, which involves freezing the wart (generally with liquid nitrogen), creating a blister between the wart and epidermal layer,after which the wart and surrounding dead skin falls off by itself.

*Surgical curettage of the wart.

*Laser treatment.

*Imiquimod, a topical cream that helps the body’s immune system fight the wart virus by encouraging interferon production.

*Candida injections at the site of the wart, which also stimulate the body’s immune system.

*Cantharidin, a chemical found naturally in many members of the beetle family Meloidae which causes dermal blistering…...CLICK & SEE
Two viral warts on a middle finger, being treated with a mixture of acids (like salicylic acid) to remove them. A white precipitation forms on the area where the product was applied.

The wart often regrows after the skin has healed.One review of 52 clinical trials of various cutaneous wart treatments concluded that topical treatments containing salicylic acid were the best supported, with an average cure rate of 75% observed with salicylic acid compared with 48% for placebo in six placebo-controlled trials including a total of 376 participants. The reviewers also concluded that there was little evidence of a significant benefit of Cryotherapy over placebo or no treatment.

Over-the-counter
There are several over-the-counter options. The most common ones involve salicylic acid. These products are readily available at drugstores and supermarkets. There are typically two types of products: adhesive pads treated with salicylic acid or a bottle of concentrated salicylic acid solution. Removing a wart with salicylic acid requires a strict regimen of cleaning the area, applying the acid, and removing the dead skin with a pumice stone or emery board. It may take up to 12 weeks to remove a wart.

Another over-the-counter product that can aid in wart removal is silver nitrate in the form of a caustic pencil, which is also available at drug stores. This method generally takes three to six daily treatments to be effective. The instructions must be followed to minimize staining of skin and clothing.

Over-the-counter cryosurgery kits are also available, however they can often cost three times as much as the previously named products.Like prescription treatments, over-the-counter treatments usually require multiple applications and are only necessary if the warts are problematic. Additionally, these treatments are capable of destroying healthy skin as well as warts, so caution must be exercised by those attempting them without medical supervision.

Household remedies
Duct tape occlusion therapy involves placing a piece of duct tape (or medical tape) over the affected area for a week at a time. The procedure is otherwise identical to that of using salicylic acid adhesive pads. One study by Focht et al. found that the duct tape method was 85% effective, compared to a 60% success rate in the study’s cryotherapy group. Another study by Wenner and coworkers, however, found no statistically significant effect in a double-blind, randomized and controlled clinical trial in 90 adults when duct tape was compared to moleskin.There was no statistically significant difference for resolution of the target wart between patients treated with moleskin versus patients treated with duct tape. Eight of 39 patients [21%] in the treatment group vs 9 of 41 patients in the control group [22%] had complete resolution of the target wart. Fewer of the patients achieving resolution of their wart in the moleskin group had recurrence of their wart. Of the patients who had complete resolution, 6 (75%) in the treatment group and 3 (33%) in the control group had recurrence of the target wart by the sixth month. “Whether or not the standard type of duct tape is effective is up in the air,” said co-author

Dr. Rachel Wenner of the University of Minnesota, who started the new study as a medical student. “Theoretically, the rubber adhesive could somehow stimulate the immune system or irritate the skin in a different manner.”Other household remedies include the application of common household items. These include various fruits and vegetables such
as a bruised garlic, banana skin, unskinned potatoes, potato or cauliflower or tomato juice, or other food products like green tea, vinegar, salt, or vegemite. Other common household products used include rubbing alcohol, hot water and washing liquid, aerosol sprays or compressed air, and tempera paint. Oils and saps from milkweed, dandelion, and poison ivy, tea tree, Thuja occidentalis, and fig trees have also been used. Accounts vary in regards to how long these remedies must be applied with each session and how long they take to work.

As there have been no controlled studies for most household remedies, it is impossible to know if warts that disappear after such treatments do so because the treatment was effective, or because warts often disappear due to the individual’s own immune system regardless of treatment. The evidence that hypnosis may effectively treat warts suggests that the condition may be amenable to the placebo effect, that is, that belief in a remedy rather than any property of the remedy itself is what’s effective.

Some household remedies are potentially dangerous. These include attempts to cut or burn away the warts. Incense is sometimes used in Asian countries to burn warts. These methods are very painful, and can lead to infection and/or permanent scarring.

Prognosis:
Warts are generally harmless growths that often go away on their own within two years. They can be contagious, but transmission from person to person is uncommon. Warts may be unsightly or cause discomfort, especially on the feet.

Possible Complications:
*Spread of warts
*Return of warts that disappeared
*Minor scar formation if the wart is removed
*Formation of keloids after removal

Call for an appointment with your doctor if:
*There are signs of infection (red streaking, pus, discharge, or fever) or bleeding. Warts can bleed a little, but if bleeding is significant or not easily stopped by light pressure, see a doctor.

*The wart does not respond to self-care and you want it removed.

*You have pain associated with the wart.

*You have anal or genital warts.

*You have diabetes or a weakened immune system (for example, HIV) and have developed warts.

*There is any change in the color or appearance of the wart.

Prevention:
Avoid direct skin contact with a wart on someone else.
After filing your wart, wash the file carefully since you can spread the virus to other parts of your body.
After touching any of your warts, wash your hands carefully.

Resources:
http://en.wikipedia.org/wiki/Wart
http://www.nlm.nih.gov/medlineplus/ency/article/000885.htm

Tags Access to knowledge movement, Adverse event, Aerosmith, Allergy, Centers for Disease Control and Prevention, Cervical cancer, Conditions and Diseases, Genital wart, Health, HPV, HPV vaccine, Human papillomavirus, plantarwart, United States, Verruca plana, Wart

Ailmemts & Remedies

Cervical Dysplasia

Alternative Names: Cervical intraepithelial neoplasia (CIN); Precancerous changes of the cervix
Definition:Cervical dysplasia is the abnormal growth of cells on the surface of the cervix. Although this is not cancer, this is considered a pre-cancerous condition. Depending on the extent of changes, the condition is further categorized as:

CIN I — mild dysplasia (a few cells are abnormal)
CIN II — moderate to marked dysplasia
CIN III — severe dysplasia to carcinoma-in-situ (cancer confined to the surface layer of the cervix)

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In some women, the cells of the cervix gradually change from normal to a cancerous state. The condition between these two extremes, when the cells are abnormal with the potential to become cancerous, is known as cervical dysplasia. There are three grades of dysplasia: mild, moderate, and severe. mild dysplasia may return to a normal state, but severe dysplasia may progress to cancer of the cervix if not treated.

Many developed countries, including the US, have established screening programs to check for cervical dysplasia using the pap test. Regular testing, which helps ensure that cervical dysplasia is diagnosed and treated at an early stage before the abnormal cells become cancerous, has led to a dramatic fall in the total number of cases of cancer of the cervix.

Causes: The exact cause of cervical dysplasia is not known, but a number of different risk factors have been identified. for

example, the risk of developing cervical dysplasia appears to be slightly higher after exposure to those types of human

papilloma virus that cause genital warts. other risk factors for the development of cervical dysplasia include unprotected

sex at an early age, and becoming pregnant before age 20. however, exactly how these risk factors are connected to cervical

dysplasia is unknown. smoking also increases the risk of developing cervical dysplasia.

Less than 5% of all Pap smear test results find cervical dysplasia. While the cause is unknown, a number of risk factors have

been identified. Most cases occur in women aged 25 to 35.

Other risk factors include:

Multiple sexual partners
Starting sexual activity before age 18
Having children before age 16
DES exposure
Having had sexually transmitted diseases, especially HPV (genital warts) or HIV infection .

Symptoms: There are usually no symptoms.

Diagnosis: Cervical dysplasia does not produce symptoms. the condition is only normally diagnosed after a pap test, during which a sample of cells is taken from the cervix and sent for examination under a microscope. If you are found to have abnormal cells, your doctor may arrange for you to have a colposcopy, so that the cervix can be seen through an instrument and examined for abnormal-looking areas. A small sample of tissue may also be removed from the cervix and examined under the microscope for abnormalities.

Exams and Tests:

A pelvic examination is usually normal.

The following tests may indicate cervical dysplasia:

Pap smear showing mild, moderate, marked, or severe dyspepsias.
Colposcopy revealing “white epithelium.” These are mosaic-like patterns on the surface of the cervix, caused by changes in the surface blood vessels.
Colposcopy-directed biopsy to confirm dyspepsias and the extent of cervical involvement.
Endocervical curettage to rule out involvement of the cervical canal.
Cone biopsy may be necessary to rule out invasive cancer.

Treatment:If you are diagnosed with cervical dysplasia, the treatment depends on the degree of abnormality cells revert to normal in up to 4 in 10 cases. however, the disorder will be monitored by pap tests every 6 months. If cervical dysplasia persists or worsens, treatment to destroy or remove the abnormal cells will be needed. after treatment you may have a bloodstained discharge for a few weeks.

The treatment depends on the degree of dysplasia. Mild dysplasia, which may go away on its own, usually involves careful observation with repeat Pap smears every 3 to 6 months. Other forms may require methods to destroy the abnormal tissue, including electrocauterization, cryosurgery, laser vaporization, or surgical removal.

Consistent follow-up, every 3 to 6 months or as prescribed, is essential.

Ayurvedic Recommended Therapy: Basti

Click to learn about Alternative Cervical Dysplasia Treatment…(1)….(2).………(3)

Click to learn about homeopathic medication for Cervical Dysplasia…….(1).…..(2)…..(3)

Prognosis: In many cases of cervical dysplasia, the cells of the cervix will return to normal after treatment. However, your condition will be monitored for the next few years to ensure that no further abnormalities develop. about 3 months after treatment, you will have a pap test and colposcopy, followed by regular pap tests every 6 months. The risk of developing cancer of the cervix is higher in cases of severe cervical dysplasia.
Nearly all cervical dysplasia can be cured with early identification, proper evaluation and treatment, and careful, consistent follow-up.

Without treatment, 30-50% cases of cervical dysplasia may progress to invasive cancer. The risk of cancer is higher for severe dysplasia (CIN III) that is not treated.

When to Contact your Medical Professional :
Call for an appointment with your health care provider if you are a woman who is sexually active or aged 20 or older, and you have never had a pelvic examination and Pap smear.

Call for an appointment with your health care provider if you have not had regular Pap smears at these intervals:

Every year initially
For women up to age 35 or 40: every 2-3 years after having three negative, consecutive annual Pap smear tests and a single sexual partner or no sexual partner
*Every year for women over age 35 or 40
*Every year for women who have had multiple sexual partners
*Every year for women who are taking oral contraceptives (birth control pills)
*Every 6 months for women who have a history of HPV (genital warts)
*Every year for DES daughters (women whose mothers took DES during the pregnancy)
The frequency recommended by your health care provider after an abnormal Pap smear or prior dysplasia

Prevention :
To reduce the chance of developing cervical dysplasia:

Wait until you are 18 or older before becoming sexually active
Practice monogamy and use condoms during intercourse

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/001491.htm
http://www.charak.com/DiseasePage.asp?thx=1&id=200