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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Hormonal vaginitis includes atrophic vaginitis usually found in postmenopausal or postpartum women. Sometimes it can occur in young girls before puberty. In these situations the estrogen support of the vagina is poor.
Vaginitis is the disruption of the healthy vaginal microbiota. The vaginal microbiota consists of those organisms which generally do not cause symptoms, infections, and results in good pregnancy outcomes, and is dominated mainly by Lactobacillus species. The disruption of the normal microbiota can cause a vaginal yeast infection. Vaginal yeast infection can affect women of all ages and is very common. The yeast "Candida albicans" is the most common cause of vaginitis. Specific forms of vaginal inflammation include the following types:
Infectious vaginitis accounts for 90% of all cases in reproductive age women:
- Candidiasis: vaginitis caused by proliferation of "Candida albicans", "Candida tropicalis", "Candida krusei"
- Bacterial vaginosis: vaginitis caused by increased growth of "Gardnerella" (a bacterium).
- Aerobic vaginitis
Other less common infections are caused by gonorrhea, chlamydia, "Mycoplasma", herpes, "Campylobacter", improper hygiene, and some parasites, notably "Trichomonas vaginalis". Women who have diabetes develop infectious vaginitis more often than women who do not.
Vaginal infections often have multiple causes (varies between countries between 20 and 40% of vaginal infections), which present challenging cases for treatment. Indeed, when only one cause is treated, the other pathogens can become resistant to treatment and induce relapses and recurrences. Therefore, the key factor is to get a precise diagnosis and treat with broad spectrum anti-infective agents (often also inducing adverse effects).
Further, either a change in pH balance or introduction of foreign bacteria in the vagina can lead to infectious vaginitis. Physical factors that have been claimed to contribute to the development of infections include the following: constantly wet vulva due to tight clothing, chemicals coming in contact with the vagina via scented tampons, antibiotics, birth control pills, or a diet favoring refined sugar and yeast.
Sexually transmitted disease that affect the vagina include:
- Herpes genitalis. The herpes simplex virus (HSV) can infect the vulva, vagina, and cervix, and this may result in small, painful, recurring blisters and ulcers. It is also common for there to be an absence of any noticeable symptoms.
- Gonorrhea
- Chlamydia
- Trichomoniasis
- Human papillomavirus (HPV), which may cause genital warts.
HIV/AIDS can be contracted through the vagina during vaginal intercourse, but it is not associated with any local vaginal or vulval disease.
Because of STIs, health authorities and other health outlets recommend safe sex practices when engaging in sexual activity.
About 5 to 10% of women are affected by aerobic vaginitis. Reports in pregnant women point to a prevalence of 8.3–10.8%.
When considering symptomatic women, the prevalence of AV can be as high as 23%.
Vaginitis an inflammation of the vagina, such as caused by infection, hormone disturbance and irritation/allergy.
Aerobic vaginitis has been associated with several gynecological and obstetrical complications, including:
- Premature rupture of membranes
- Preterm labour
- Ascending chorioamnionitis.
- Increased risk to acquire sexually transmitted infections (including HIV)
- Abnormal Pap test results
Leukorrhea is also caused by trichomonads, a group of parasitic protozoan, specifically "Trichomonas vaginalis". Common symptoms of this disease are burning sensation, itching and discharge of frothy substance, thick, white or yellow mucous.
It is not a major issue but is to be resolved as soon as possible. It can be a natural defense mechanism that the vagina uses to maintain its chemical balance, as well as to preserve the flexibility of the vaginal tissue. The term "physiologic leukorrhea" is used to refer to leukorrhea due to estrogen stimulation.
Leukorrhea may occur normally during pregnancy. This is caused by increased bloodflow to the vagina due to increased estrogen. Female infants may have leukorrhea for a short time after birth due to their in-uterine exposure to estrogen.
Vulvitis, inflammation of the vulva, can have a variety of etiologies in children and adolescents, including allergic dermatitis, contact dermatitis, lichen sclerosus, and infections with bacteria, fungi, and parasites. Dermatitis in infants is commonly caused by a soiled diaper being left on for an extended period of time. Increasing the frequency of diaper changes and topical application of emollients are sufficient to resolve most cases. Dermatitis of the vulva in older children is usually caused by exposure to an irritant (e.g. scented products that come into contact with the vulva, laundry detergent, soaps, etc.) and is treated with preventing exposure and encouraging sitz baths with baking soda as the vulvar skin heals. Other treatment options for vulvar dermatitis include oral hydroxyzine hydrochloride or topical hydrocortisone.
Lichen sclerosus is another common cause of vulvitis in children, and it often affects an hourglass or figure eight-shaped area of skin around the anus and vulva. Symptoms of a mild case include skin fissures, loss of skin pigment (hypopigmentation), skin atrophy, a parchment-like texture to the skin, dysuria, itching, discomfort, and excoriation. In more severe cases, the vulva may become discolored, developing dark purple bruising (ecchymosis), bleeding, scarring, attenuation of the labia minora, and fissures and bleeding affecting the posterior fourchette. Its cause is unknown, but likely genetic or autoimmune, and it is unconnected to malignancy in children. If the skin changes are not obvious on visual inspection, a biopsy of the skin may be performed to acquire an exact diagnosis. Treatment for vulvar lichen sclerosus may consist of topical hydrocortisone in mild cases, or stronger topical steroids (e.g. clobetasol propionate). Preliminary studies show that 75% of cases do not resolve with puberty.
Organisms responsible for vulvitis in children include pinworms ("Enterobius vermicularis"), "Candida" yeast, and group A hemolytic "Streptococcus". Though pinworms mainly affect the perianal area, they can cause itching and irritation to the vulva as well. Pinworms are treated with albendazole. Vulvar "Candida" infections are uncommon in children, and generally occur in infants after antibiotic therapy, and in children with diabetes or immunodeficiency. "Candida" infections cause a red raised vulvar rash with satellite lesions and clear borders, and are diagnosed by microscopically examining a sample treated with potassium hydroxide for hyphae. They are treated with topical butoconazole, clotrimazole, or miconazole. "Streptococcus" infections are characterized by a dark red discoloration of the vulva and introitus, and cause pain, itching, bleeding, and dysuria. They are treated with antibiotics.
Vulvitis is inflammation of the vulva, the external female mammalian genitalia that include the labia majora, labia minora, clitoris, and introitus (the entrance to the vagina). It may co-occur with vaginitis, inflammation of the vagina, and may have infectious or non-infectious causes.
Females that have received estradiol as a mismating shot (abortifacient) in diestrus are at risk for more severe disease because estrogen increases the number of progesterone receptors in the endometrium. 25 percent of females receiving estradiol in diestrus develop pyometra. Pyometra is less common in female cats because progesterone is only released by the ovaries after mating. Also in cats, the risk of developing the disease differ depending on breed.
Many postmenopausal women (who are not using topical estrogen) have at least some degree of vaginal atrophy; however, many women do not actively ask that medical attention be paid to this, possibly because it is naturally caused, or because of the taboo that still exists surrounding aging and sexuality.
The cause of vaginal atrophy is usually the normal decrease in estrogen as a result of menopause. Other causes of decreased estrogen levels are decreased ovarian functioning due to radiation therapy or chemotherapy, immune disorder, removal of the ovaries, entering the post-partum period, and lactation. Various medications can also cause or contribute to vaginal atrophy, including tamoxifen (Nolvadex), danazol (Danocrine), medroxyprogesterone acetate (Depo-Provera), leuprolide (Lupron), and nafarelin acetate (Synarel). Vaginal atrophy can also be idiopathic.
The risk of developing pyometra differs between dog breeds. Pyometra is a result of hormonal and structural changes in the uterus lining. This can happen at "any" age, whether she has bred or not, and whether it is her 1st or 10th heat (although it becomes more common as the dog gets older). The main risk period for a female is for eight weeks after her peak standing heat (or estrous cycle) has ended. Normally during this period, the cervix, which was open during her heat, begins to close, and the inner lining begins to adapt back to normal. However, cystic hyperplasia of the endometrium (inner lining of the uterus) – known as cystic endometrial hyperplasia (CEH) – may occur at this time for some animals, as an inappropriate response to progesterone.
Under these circumstances, bacteria (especially "E. coli") that have migrated from the vagina into the uterus find the environment favorable to growth, especially since progesterone also causes mucus secretion, closes the cervix (preventing uterine drainage), and decreases uterine contractility. The condition of the cervix is a major factor in the severity of the condition.
Proper treatment will usually relieve the symptoms, at least to some extent.
One of the most common areas of the body associated with irritation is the vagina. Many women complain of an itch, dryness, or discharge in the perineum at some point in their lives. There are several causes of vaginal irritation including fungal vaginitis (like candida) or trichomoniasis. Often, herpes simplex infection of the mouth or genitalia can be recurrent and prove to be extremely irritating.
Sometimes, the irritation can be of the chronic type and it can be so intense that it also causes painful intercourse. Aside from infections, chronic irritation of the vagina may be related to the use of contraceptives and condoms made from latex. The majority of contraceptives are made of synthetic chemicals which can induce allergies, rash and itching. Sometimes the lubricant used for intercourse may cause irritation.
Another cause of irritation in women is post menopausal vaginitis. The decline in the female sex hormones leads to development of dryness and itching in the vagina. This is often accompanied by painful sexual intercourse. Cracks and tears often develop on outer aspects of the labia which becomes red from chronic scratching. Post menopausal vaginitis can be treated with short term use of vaginal estrogen pessary and use of a moisturizer.
Individuals who smoke or are exposed to smog or other airborne pollutants can develop a condition known as COPD. In this disorder, there is constant irritation of the breathing tubes (trachea) and the small airways. The constant irritation results in excess production of mucus which makes breathing difficult. Frequently, these individuals wake up in the morning with copious amounts of foul smelling mucus and a cough which lasts all day. Wheeze and heavy phlegm are common findings. COPD is a lifelong disorder and there is no cure. Eventually most people develop recurrent pneumonia, lack any type of endurance, and are unable to work productively. One of the ways to avoid chronic bronchitis is to stop or not smoke.
The cause of juvenile cellulitis is unknown. Cytologic examination of aspirates of affected lymph nodes, pustules, abscesses, and joint fluid rarely reveal bacteria, and culture results of intact lesion are always negative for bacterial growth, suggesting a nonbacterial etiology. As signs resolve following treatment with glucocorticoids, the cause is likely to be an immune disorder.
Atopy is a hereditary and chronic (lifelong) allergic skin disease. Signs usually begin between 6 months and 3 years of age, with some breeds of dog, such as the Golden Retriever showing signs at an earlier age. Dogs with atopic dermatitis are itchy, especially around the eyes, muzzle, ears and feet. In severe cases the irritation is generalised. If the allergens are seasonal, the signs of irritation are similarly seasonal. Many dogs with house dust mite allergy have perennial disease. Some of the allergens associated with atopy in dogs include pollens of trees, grasses and weeds, as well as molds and House dust mite. Ear and skin infections with the bacteria "Staphylococcus pseudintermedius" and the yeast "Malassezia pachydermatis" are common secondary to atopic dermatitis.
Food allergy can be associated with identical signs and some authorities consider food allergy to be a type of atopic dermatitis.
Diagnosis of atopic dermatitis is by elimination of other causes of irritation including fleas, scabies and other parasites such as Cheyletiella and lice. Food allergy can be identified through the use of elimination diet trials in which a novel or hydrolysed protein diet is used for a minimum of 6 weeks and allergies to aeroallergens can be identified using intradermal allergy testing and/or blood testing (allergen-specific IgE ELISA).
Treatment includes avoidance of the offending allergens if possible, but for most dogs this is not practical or effective. Other treatments modulate the adverse immune response to allergens and include antihistamines, steroids, ciclosporin and immunotherapy (a process in which allergens are injected to try to induce tolerance). In many cases shampoos, medicated wipes and ear cleaners are needed to try to prevent the return of infections.
New research into T-cell receptor peptides and their effects on dogs with severe, advanced atopic dermatitis are being investigated.
Large doses of glucocorticoids are the treatment of choice, and are administered until the signs have resolved. In uncomplicated cases, this can take up to a month. If dogs are not treated promptly and with high doses of steroids, severe scarring may occur. If there is evidence of secondary bacterial infection, treatment with antibiotics is required.
Skin disease may result from deficiency or overactivity of immune responses. In cases where there is insufficient immune responses the disease is usually described by the secondary disease that results. Examples include increased susceptibility to demodectic mange and recurrent skin infections, such as Malassezia infection or bacterial infections. Increased, but harmful immune responses, can be divided into hypersensitivity disorders such as atopic dermatitis, and autoimmune disorders (autoimmunity), such as pemphigus and discoid lupus erythematosus.
The definitive hosts for these "Taenia" species are canids. The adult tapeworms live in the intestines of animals like dogs, foxes, and coyotes. Intermediate hosts such as rabbits, goats, sheep, horses, cattle and sometimes humans get the disease by inadvertently ingesting tapeworm eggs (gravid proglottids) that have been passed in the feces of an infected canid. This can happen from ingesting food, water or soil that has been contaminated by dog feces. The disease cannot be transmitted from one intermediate host to another, but it is still not a good idea to eat meat that presents with cystic nodules from coenurosis.
Coenurosis is a parasitic infection that results when humans ingest the eggs of dog tapeworm species "Taenia multiceps", "T. serialis, T. brauni," or "T. glomerata."
It is important to distinguish that there is a very significant difference between intestinal human tapeworm infection and human coenurosis. Humans are the definitive hosts for some tapeworm species, the most common being "T. saginata" and "T. solium" (beef and pork tapeworms). This means that these species can develop into full grown, reproductively capable adult worms within the human body. People infected with these species have a tapeworm infection. In contrast, the four species that cause human coenurosis can only grow into mature, reproductively capable worms inside their definitive hosts, canids such as dogs, wolves, foxes and coyotes. Humans who ingest eggs from any of these four species of "Taenia" become intermediate hosts, or places where the eggs can mature into larvae but not into adult worms. When humans ingest these eggs, the eggs develop into tapeworm larvae that group within cysts known as coenuri, which can be seen in the central nervous system, muscles, and subcutaneous tissues of infected humans. People with coenurosis do not develop a tapeworm infection because the larvae of coenurosis-causing parasites cannot develop into worms inside of humans.
In the United States, research examining the Foxhound and Neapolitan Mastiff is scheduled to continue into 2011 at the University of Iowa. The goals of this project are to screen for the presence of the "Leishmania" parasite DNA and to be a stepping stone to future research of T-cell function with the hopes of understanding canine leishmaniasis as a model for better understanding human leishmaniasis.
- Foxhound submissions forms
- Neapolitan Mastiff submission forms
Also in the United States, the CDC is monitoring Italian Spinones, with no end date indicated on sample submissions.
Puppy pregnancy syndrome is a psychosomatic illness in humans brought on by mass hysteria.
The syndrome is thought to be localized to villages in several states of India, including West Bengal, Assam, Bihar, Jharkhand, Orissa, and Chhattisgarh, and has been reported by tens of thousands of individuals. It is far more prevalent in areas with little access to education.
People suffering from this condition believe that shortly after being bitten by a dog, puppies are conceived within their abdomen. This is said to be especially likely if the dog is sexually excited at the time of the attack. Victims are said to bark like dogs, and have reported being able to see the puppies inside them when looking at water, or hear them growling in their abdomen. It is believed that the victims will eventually die – especially men, who will give birth to their puppies through the penis.
Witch doctors offer oral cures, which they claim will dissolve the puppies, allowing them to pass through the digestive system and be excreted "without the knowledge of the patient".
Doctors in India have tried to educate the public about the dangers of believing in this condition. Most sufferers are referred to psychiatric services, but in rare instances patients fail to take anti-rabies medication in time, thinking that they have puppy pregnancy syndrome and thus the witch doctor's medicine will cure them. This is further compounded by witch doctors stating that their medicine will fail if sufferers seek conventional treatment.
Some psychiatrists believe that the syndrome meets the criteria for a culture-bound disorder.
Traditionally, canine transmission is directly from sandfly to dog. Cases in the United States have proven "L. infantum" transmission from dog to dog by direct contamination with blood and secretions, as well as transplacentally from an infected bitch to her pups. This mode of transmission seems to be unique to the "L. infantum" Mon1 strain found in the United States. Although "in utero" transmission is likely the predominant method of disease spread amount the "L. infantum" Mon1 strain, it is still a viable parasite (has not lost virulence factors associated with sandfly-uptake) which can be transmitted via sandfly bite. A Brazilian study of 63 puppies from 18 "L. donovani"-infected parents found no evidence of congential or transplacental infection.