Tag Archives: Toxic shock syndrome

Toxic Shock Syndrome

Definition:-
Toxic shock syndrome (TSS) is a very rare but potentially fatal illness caused by a bacterial toxin. Different bacterial toxins may cause toxic shock syndrome, depending on the situation. The causative bacteria include Staphylococcus aureus and Streptococcus pyogenes. Streptococcal TSS is sometimes referred to as toxic shock-like syndrome (TSLS) or Streptococcal Toxic Shock Syndrome (STSS).

TSS, is a serious condition which mainly affects menstruating women using tampons. The patient develops a high fever, diarrhea, vomiting and muscle ache. This is followed by hypotension (low blood pressure), which may eventually lead to shock and death. In some cases there may be a sunburn-like rash with skin peeling.

Experts are not sure why such a significant proportion of toxic shock syndrome patients are women who are menstruating and using a tampon – especially “super absorbent” tampons.

Toxic shock syndrome may also occur as a result of an injury, burn or as a complication of localized infections, such as a boil, as well as with the use of contraceptive sponges.

According to the National Health Service (NHS), UK, approximately 20 patients develop toxic shock syndrome each year in the United Kingdom, of which about 3 die. According to the Centers for Disease Control and Prevention (CDC), USA, toxic shock syndrome affects approximately 1 to 2 in every 100,000 women aged 15-44 years in the USA every year.

CLICK & SEE THE PICTURES

You may click to see the pictures of Toxic Shock Syndrome

Main Routes of infection:-
TSS can occur via the skin (e.g., cuts, surgery, burns), vagina (prolonged tampon exposure), or pharynx. However, most of the large number of individuals who are exposed to or colonized with toxin-producing strains of S. aureus or S. pyogenes do not develop toxic shock syndrome. One reason is that a large percentage of the population have protective antibodies against the toxins that cause TSS. It is not clear why the antibodies are present in people who have never had the disease, but likely that given these bacteria’s pervasiveness and presence in normal flora, minor cuts and such allow natural immunization on a large scale.

It is believed that approximately half the cases of staphylococcal TSS reported today are associated with tampon use during menstruation. However, TSS can also occur in children, men, and non-menstruating women.

Although scientists have recognized an association between TSS and tampon use, no firm causal link has been established. Research conducted by the CDC suggested that use of some high-absorbency tampons increased the risk of TSS in menstruating women. A few specific tampon designs and high-absorbency tampon materials were found to have some association with increased risk of TSS. These products and materials are no longer used in tampons sold in the U.S. (The materials include polyester, carboxymethylcellulose and polyacrylate). Tampons made with rayon do not appear to have a higher risk of TSS than cotton tampons of similar absorbency.

Toxin production by S. aureus requires a protein-rich environment, which is provided by the flow of menstrual blood, a neutral vaginal pH, which occurs during menstruation, and elevated oxygen levels, which are provided by the tampon that is inserted into the normally anaerobic vaginal environment. Although ulcerations have been reported in women using super-absorbent tampons, the link to menstrual TSS, if any, is unclear. The toxin implicated in menstrual TSS is capable of entering the bloodstream by crossing the vaginal wall in the absence of ulcerations. Women can avoid the risk of contracting TSS by choosing a tampon with the minimum absorbency needed to manage their menstrual flow and using tampons only during active menstruation. Alternately, a woman may choose to use a different kind of menstrual product that may eliminate or reduce the risk of TSS, such as a menstrual cup or sanitary napkin.

History:-
Initial description of toxic shock syndrome
The term toxic shock syndrome was first used in 1978 by a Denver pediatrician, Dr. James K. Todd, to describe the staphylococcal illness in three boys and four girls aged 8–17 years. Even though S. aureus was isolated from mucosal sites in the patients, bacteria could not be isolated from the blood, cerebrospinal fluid, or urine, raising suspicion that a toxin was involved. The authors of the study noted that reports of similar staphylococcal illnesses had appeared occasionally as far back as 1927. But the authors at the time failed to consider the possibility of a connection between toxic shock syndrome and tampon use, as three of the girls who were menstruating when the illness developed were using tampons. Many cases of TSS occurred after tampons were left in the woman using them.

Rely tampons:-
Following a controversial period of test marketing in Rochester, New York and Fort Wayne, Indiana, in August 1978 Procter and Gamble introduced superabsorbent Rely tampons to the United States market in response to women’s demands for tampons that could contain an entire menstrual flow without leaking or replacement. Rely used carboxymethylcellulose (CMC) and compressed beads of polyester for absorption. This tampon design could absorb nearly 20 times its own weight in fluid. Further, the tampon would “blossom” into a cup shape in the vagina in order to hold menstrual fluids without leakage.

Package of Rely Tampons

In January 1980, epidemiologists in Wisconsin and Minnesota reported the appearance of TSS, mostly in menstruating women, to the CDC. S. aureus was successfully cultured from most of the women. A CDC task force investigated the epidemic as the number of reported cases rose throughout the summer of 1980, accompanied by widespread publicity. In September 1980, the CDC reported that users of Rely were at increased risk for developing TSS.

On September 22, 1980, Procter and Gamble recalled Rely following release of the CDC report. As part of the voluntary recall, Procter and Gamble entered into a consent agreement with the FDA “providing for a program for notification to consumers and retrieval of the product from the market.” However, it was clear to other investigators that Rely was not the only culprit. Other regions of the United States saw increases in menstrual TSS before Rely was introduced. It was shown later that higher absorbency of tampons was associated with an increased risk for TSS, regardless of the chemical composition or the brand of the tampon. The sole exception was Rely, for which the risk for TSS was still higher when corrected for its absorbency. The ability of carboxymethylcellulose to filter the S. aureus toxin that causes TSS may account for the increased risk associated with Rely.

By the end of 1980, the number of TSS cases reported to the CDC began to decline. The reduced incidence was attributed not only to the removal of Rely from the market, but also to reduced use of all tampon brands. According to the Boston Women’s Health Book Collective, 942 women were diagnosed with tampon-related TSS in the USA from March 1980 to March 1981, 40 of whom died.

Symptoms:-
Symptoms of toxic shock syndrome vary depending on the underlying cause. TSS resulting from infection with the bacteria Staphylococcus aureus typically manifests in otherwise healthy individuals with high fever, accompanied by low blood pressure, malaise and confusion, which can rapidly progress to stupor, coma, and multi-organ failure. The characteristic rash, often seen early in the course of illness, resembles a sunburn, and can involve any region of the body, including the lips, mouth, eyes, palms and soles. In patients who survive the initial onslaught of the infection, the rash desquamates, or peels off, after 10–14 days.

Signs and symptoms of TSS (toxic shock syndrome) develop suddenly:
Sudden high fever (first symptom) The following signs and symptoms normally appear within a few hours:

*Vomiting
*Diarrhea
*Sunburn-like skin rash, particularly in the palms and soles
*Redness of eyes, mouth and throat
*Fainting
*Feeling faint
*Muscle aches
*Dizziness
*Confusion
*Hypotension (low blood pressure)
*Seizures
*Headaches

Causes of toxic shock syndrome :-
Scientists have been investigating the causes of TSS for over two decades and are still baffled. 20% to 30% of all humans carry the TSS causing bacterium, Staphylococcus aureus on their skin and nose; usually without any complications. Most of us have antibodies which protect us. Scientists believe that some of us do not develop the necessary antibodies.

Some experts suggest that the super-absorbent tampons – the ones that stay inside the body the longest – become breeding grounds for bacteria, while others believe the tampon fibers may scratch the vagina, making it possible for bacteria to get through and into the bloodstream. However, both are just theories without any compelling evidence to back them up.

We do know that the bacteria get into the body via wounds, localized infections, the vagina, the throat or burns. When the toxins (produced by the bacteria) enter the bloodstream they mess up the blood pressure regulating process, resulting in a hypotension (low blood pressure). Hypotension can cause dizziness and confusion (shock). The toxins also attack tissues, including organs and muscles. Kidney failure is a common TSS complication.

TSS does not only develop in young menstruating women. Older women, men and children may also be affected. Women who have been using a diaphragm or a contraceptive sponge have a slightly higher risk of developing TSS. In fact, anyone with a staph or strep infection has the potential to develop TSS (even though it is extremely rare).

Diagnosis:-
In contrast, TSS caused by the bacteria Streptococcus pyogenes, or TSLS, typically presents in people with pre-existing skin infections with the bacteria. These individuals often experience severe pain at the site of the skin infection, followed by rapid progression of symptoms as described above for TSS. In contrast to TSS caused by Staphylococcus, Streptococcal TSS less often involves a sunburn rash.

In either case, diagnosis is based strictly upon CDC criteria modified in 1981 after the initial surge in tampon-associated infections.:

1.Body temperature > 38.9 °C (102.02 °F)
2.Systolic blood pressure < 90 mmHg
3.Diffuse rash, intense erythroderma, blanching (“boiled lobster”) with subsequent desquamation, especially of the palms and soles
4.Involvement of three or more organ systems:

*Gastrointestinal (vomiting, diarrhea)
*Mucous membrane hyperemia (vaginal, oral, conjunctival)
*Renal failure (serum creatinine > 2x normal)
*Hepatic inflammation (AST, ALT > 2x normal)
*Thrombocytopenia (platelet count < 100,000 / mm³)
*CNS involvement (confusion without any focal neurological findings)

To date, there is no specific TSS test. The doctor needs to identify the most common symptoms, as well as checking for signs of organ failure.

*Blood and urine tests – these help determine organ function (or organ failure).

According to the National Health Service (NHS), UK, a confident TSS diagnosis can generally be made when:

*The patient’s temperature is above 38.9C (102.02F)
*The patient’s systolic blood pressure is below 90 mmHG
*The patient has a skin rash
*There is evidence that at least three organs have been affected by the infection

Pathogenesis:-
In both TSS (caused by Staph. aureus) and TSLS (caused by Strep. pyogenes), disease progression stems from a superantigen toxin that allows the non-specific binding of MHC II with T cell receptors, resulting in polyclonal T cell activation. In typical T cell recognition, an antigen is taken up by an antigen-presenting cell, processed, expressed on the cell surface in complex with class II major histocompatibility complex (MHC) in a groove formed by the alpha and beta chains of class II MHC, and recognized by an antigen-specific T cell receptor. By contrast, superantigens do not require processing by antigen-presenting cells but instead interact directly with the invariant region of the class II MHC molecule. In patients with TSS, up to 20% of the body’s T cells can be activated at one time. This polyclonal T-cell population causes a cytokine storm, followed by a multisystem disease. The toxin in S. aureus infections is Toxic Shock Syndrome Toxin-1, or TSST-1.

Treatment:-
The medical team’s aim is to fight the infection as well as supporting any body functions that the infection may have affected. The patient will be hospitalized and may be placed in an intensive care unit.

*Oxygen – the patient will usually be given oxygen to support breathing.

*Fluids – fluids will be administered to prevent dehydration and to bring blood pressure back up to normal.

*Kidneys – a dialysis machine will be used if there is kidney failure. The machine filters toxins and waste out of the bloodstream.

*Other damage – damage to skin, fingers or toes will need to be treated. This often involves draining and cleaning. In severe cases a body extremity or parts of skin may need to be surgically removed.

*Antibiotics – a combination of antibiotics is administered intravenously (directly into the bloodstream).

*Immunoglobulin – these are samples of donated human blood with high levels of antibodies which can fight the toxin. In some cases the medical team may administer immunoglobulin as well as antibiotics.
In the majority of cases the patient responds to treatment within a couple of days. However, he/she may have to stay in hospital for several weeks.

Click to see :->Streptococcal Toxic-Shock Syndrome: Spectrum of Disease, Pathogenesis, and New Concepts in Treatment

Prognosis :-
With proper treatment, patients usually recover in two to three weeks. The condition can, however, be fatal within hours.

Prevention:
Before going through about possible preventive measures, it is important to remember that the risk of developing TSS is very low. A significant number of experts point to a probably link between tampon absorbency and TSS risk, and advise women to:

*Thoroughly wash their hands before inserting a tampon
*Use the lowest absorbency tampons for their period flow
*Switch from tampons to sanitary towels (or panty liners) during their period
*Change tampons at least as regularly as directed on the pack
*Insert only one tampon at a time (never more than one)
*Insert a fresh tampon when going to bed and replace it immediately in the morning
*Remove the tampon as soon as the period has ended

The Mayo Clinic, USA, advises women to avoid using tampons completely when their flow is very light (use minipads instead).

The National Health Service (NHS), UK, advises that people who have had TSS should avoid using tampons.

Women who use a diaphragm, cap or contraceptive sponge should follow the manufacturer’s instructions carefully (regarding how long to leave the device inside the vagina). The NHS advises women who have had TSS to use an alternative method of contraception.

You may click & see also->

*Necrotizing fasciitis  :
*Septic shock    :
*Toxic headache :

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://en.wikipedia.org/wiki/Toxic_shock_syndrome
http://www.medicalnewstoday.com/articles/175736.php

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Some Health Quaries & Answers


Q: My baby is six months old and sleeps for eight hours in the night. I do not know if I am supposed to wake her up and feed her. She is breast fed

A: Consider yourself lucky if your baby has adjusted so quickly to night and day. Breast-feeding should be on demand (by the baby). If she sleeps all night, let her do so. However, if she stops feeding even during the day, and is inactive or lethargic, you need to show her to a paediatrician.

Hygiene products
Q: Are sanitary pads dangerous? Do tampons cause cance


A: Cycles are very individual, and can occur once in 24-60 days and you can still be normal. Keep a diary and track your periods. Check if they occur “regularly” at some odd interval like 33 or 52 days. They may seem irregular when in fact they are not. In that case, you need not worry. Ovulation occurs 14 days before the next period, so it is the first part of your cycle that is prolonged. You may be functioning normally but with a longer cycle. After maintaining records for six months, if you find that you still have irregular periods, consult a gynecologist. An ultrasound scan and a few blood tests to evaluate hormone levels are usually all that is necessary. If any abnormality is found, it can be usually be corrected with medication while you are still young.

Broken bones
Q: My son has osteogenesis imperfecta and his bones break frequently. He has had several surgeries, and his legs are now deformed. He has also not gained enough height. I have decided that natural therapy is best as it does not involve intervention, and have put him on calcium supplements alone. Will this work?


A:
Osteogenesis imperfecta is due to a genetic defect as a result of which bone collagen — or the building blocks of which bones are made — are ill formed and inadequate. The condition is not due to a deficiency of calcium. To manage it well, the individual deformities should be minimised and functional ability maximised at home and in the community.

Physiotherapy and functional aids like braces are useful to maintain mobility. Fractures and deformities, unfortunately, will occur and require surgical correction. Medications called biphosphates and calcitonin can be used to strengthen the bones. You need to follow the advice of your orthopaedic surgeon.

Adolescent exercise
Q: I am 15 and my height is 5 feet 4 inches. I exercise regularly in the gym and have developed arm muscles and a six-pack abdomen. But I am afraid I will remain short.


A
: Your lifestyle is commendable, considering the epidemic of adolescent obesity. Even 10 years ago, children and teenagers were not encouraged to do weight training. That’s because the ends of their growing bones are not yet fused, and any injury might prove costly. And gyms were not geared for teenagers. Supervision or training by qualified personnel was rare and there were no light weights. Now, however, the scenario is changing. Teenagers are advised to combine running, jogging, swimming and other forms of aerobic exercise with mild, supervised strength training. They should, however, avoid competitive weight lifting, power lifting, body building and maximal lifts until they reach physical and skeletal maturity (that is, at around 21 years). They can follow a general strengthening programme which should address all major muscle groups and exercise through the complete range of motion.

Source: The Telegraph (Kolkata, India)

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Rapid Strep Test (RADT)

For a rapid strep test, the throat and tonsils are swabbed to collect bacteria from the infected area for testing. The bacteria are analyzed to see whether strep (streptococcal) bacteria are causing the sore throat.

.This scanning electron micrograph shows disease-causing Streptococcus bacteria, commonly found in the human mouth, throat, respiratory tract, bloodstream, and wounds. Often airborne in hospitals, schools, and other public places, Streptococcus bacteria are responsible for infections such as strep throat, scarlet fever, and some types of pneumonia.

A throat infection with streptococcus bacteria (called strep throat) needs to be treated with an antibiotic. A test is commonly used to find out whether streptococcus bacteria are present on your throat surface. The traditional test for a strep throat has been a throat culture, which takes two to three days to produce results. Several different types of rapid strep tests, however, can produce results within minutes to hours. A rapid strep test can only detect the presence of Group A strep, the one most likely to cause serious throat infections; it does not detect other kinds of strep or other bacteria.

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A good sample of throat secretions is needed to make sure the test is accurate. A person must remain very still during the procedure so that the doctor is able to collect enough secretions for an accurate test.

The Rapid Strep Test works by detecting the presence of a carbohydrate antigen unique to Group A Streptococcus. This may account for some of the problems with the Rapid Strep Test sensitivity. Gargling, eating or other infusion of liquids into the mouth prior to the test may affect the results. If the test is performed before sufficient organisms are present in the throat, or late in the infection when most of the strep germs have been cleared by the immune system, or if it is performed after someone has been partially treated with antibiotics that kill the organism, then the Rapid Strep Test is less likely to detect the organism.

If the Rapid Strep Test detects strep, the infection should be treated with appropriate antibiotics to prevent long-term damage and sequelae. Should the Rapid Strep Test fail to detect strep throat, the clinician might still treat the throat infection based on his or her own judgment.

How do you prepare for the test?
No preparation is necessary.

When it is required to do?

A rapid strep test may be done in the following cases:

*A person has symptoms of strep throat infection.

*A person has been exposed to strep during an epidemic of rheumatic fever.

The person has a personal or family history of rheumatic fever or other serious infections (such as toxic shock syndrome) and has been exposed to strep. In these cases, if there are no symptoms, a culture may be done first because it is more accurate than a rapid strep test.

In general, it is not necessary to test people who have been exposed to strep throat but do not have any symptoms.

What happens when the test is performed?
A cotton swab is rubbed against the back of your throat to gather a sample of mucus. This takes only a second or two and makes some people feel a brief gagging or choking sensation. The mucus sample is then tested for a protein that comes from the strep bacteria.


Risk factor.
:-
There are no risks.

Anything to be done after the test?
Nothing

How long is it before the result of the test is known?
Results may be available in minutes to a few hours. Often the doctor will ask you to wait in the office until the result is back.

Results:-
Findings of a rapid strep test may include the following:

Normal
A normal or negative test means that strep bacteria may not be present.

Sometimes, negative results are wrong. This means that you may have a negative rapid strep test result and still have strep throat.
A throat culture may be done if the rapid strep test result is negative.

Abnormal

An abnormal or positive strep test means that strep bacteria are present.

Antibiotic treatment can be started.
A positive test result does not distinguish those people with an active strep infection from those who are carriers of strep bacteria but actually have a viral infection (rather than a bacterial one).
What To Think About:
The rapid strep test costs less than a throat culture and may diagnose strep throat quickly

Resources:
https://www.health.harvard.edu/diagnostic-tests/rapid-strep-test.htm
http://www.webmd.com/a-to-z-guides/rapid-strep-test-for-strep-throat
http://en.wikipedia.org/wiki/RADT

http://encarta.msn.com/media_461520073_761574409_-1_1/streptococcus_bacteria.html

 

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Pharyngitis

Definition:
Pharyngitis: (far-in-jÄ«’ tis) is a painful inflammation of the pharynx, and is colloquially referred to as a sore throat. Infection of the tonsils, tonsillitis may occur simultaneously.
Inflammation of the pharynx (the hollow tube in the back of the throat about 5 inches long that starts behind the nose and ends at the top of the trachea). Pharyngitis is popularly known as a sore throat…CLICK & SEE
Causes, incidence, and risk factors:
The major cause is infection, of which 90% are viral, the remainder caused by bacterial infection and rarely oral thrush (fungal candidiasis e.g. in babies). Some cases of pharyngitis are caused by irritation from agents such as pollutants or chemical substances.

Pharyngitis is caused by a variety of microorganisms. Most cases are caused by a virus, including the virus causing the common cold, flu (influenza virus), adenovirus, mononucleosis, HIV, and various others.

Bacterial causes include Group A streptococcus, which causes strep throat, in addition to corynebacterium, arcanobacterium, Neisseria gonorrhoeae, Chlamydia pneumoniae, and others. In up to 30% of cases, no organism is identified.

Most cases of pharyngitis occur during the colder months — during respiratory disease season. It often spreads among family members.

Strep throat is a serious cause of pharyngitis. The complications of strep throat can include acute rheumatic fever, kidney dysfunction, and severe diseases such as bacteremia and streptococcal toxic shock syndrome.

Symptoms
Sore throat
Strep throat may be accompanied by fever, headache, and swollen lymph nodes in the neck
Viral pharyngitis may be associated with runny nose and postnasal drip
Severe cases may be accompanied by difficulty swallowing and, rarely, difficulty breathing
Additional symptoms are dependent on the underlying microorganisms

Signs and tests
The health care provider will perform an examination of the pharynx to look for drainage or coating. The skin, eyes, and neck lymph nodes may be examined.
A rapid antigen test may be done for strep. If the rapid test is positive, the patient is treated with an antibiotic. If the rapid test is negative, a throat culture may be done.
If there is suspicion for strep throat a streptococcal screen and/or throat swab culture may be performed. Additional throat cultures or blood tests may be done depending on the suspected organism (e.g., mononucleosis, gonorrheae).

Modern Treatment:
The treatment depends on the underlying cause. Viral infections are managed with warm salt water gargles, pain relievers, and fluids. Antibiotics are needed if strep throat is diagnosed.But most sore throats are viral and will not respond to antibiotics. Bacterial causes include Group A streptococcus. The cephalosporin antibiotics such as cephalexin (Keflex, Keftabs, Biocef) and cefadroxil (Duricef) have been found to be much less likely to fail in eradicating the strep than penicillin.

Symptomatic Treatment:
Twenty-two non-antibiotic managements for sore throat have been studied in controlled trials.Analgesics are among the most effective, but there are many simple measures that can also be used.

Avoid foods and liquids highly acidic in nature, as they will provoke temporary periods of intense pain
Analgesics such as NSAIDs can help reduce the pain associated with a sore throat.

Throat lozenges (cough medicine) are often used for short-term pain relief.

Gargling with warm salty water is a popular household remedy, although there is only anecdotal evidence this gives anything other than temporary relief and likewise for the use of aspirin gargles. Gargling with salty water can help clear up mucus.

Honey has long been used for treating sore throats due to its antiseptic properties.

Warm tea (true or herbal) or soup can help temporarily alleviate the pain of a sore throat.

Cold beverages and popsicles numb the nerves of the throat somewhat, alleviating the pain for a brief time.

Mouthwash (when gargled) reduces the pain but only for a brief time.

There have been some studies that show ingesting a solution high in protein can have a profound relieving effect on sore throats, particularly if they are allergy related.

Drinking heavy amounts of liquid reduces the pain for a short time.

Peppermint candy might help with some cases as well as other hard candies. It will reduce the pain for a short time.
Raw juice of papaya leaves may help to recover sore throat.

Yogurt has been shown to help alleviate the pain temporarily by coating the affected area. Milk also has the same effect.

Raw juice of lemon or lime may help destroy bacteria in bacteria-related throat infections but the high acid content may irritate the affected throat tissues more.

Alcohol has a mild analgesic and antiseptic effect, but may also weaken the immune system.

Powdered liquorice root is very effective.

Malt vinegar when gargled is very effective for treating sore throats.

Pharyngitis Remedies Natural Cure And Ayurvedic Herbal Pharyngitis Treatment
Home Remedy Of Sore Throat
Homeopathic Treatment Of Pharyngitis

Expectations (prognosis)
Most cases of pharyngitis go away on their own, without complications.

Complications
The possible complications of strep throat include rheumatic fever, kidney inflammation, chorea, bacteremia (bloodstream infection) and, rarely, streptococcal shock syndrome
In some severe forms of pharyngitis (e.g., severe mononucleosis-pharyngitis) the airway may become blocked.
Peritonsillar abscess or retropharyngeal abscess are possible.

When to call your health care provider
Notify your provider if you develop a persistent sore throat that does not resolve in several days or if you have high fevers, swollen lymph nodes in the neck or rash. If you have a sore throat and develop difficulty breathing, you must seek medical care immediately.

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.

Help taken from :healthline.com and en.wikipedia.org