Spina Bifida

Spina bifida is a group of congenital defects of the spine developed during fetal stage. During the first month after conception, the embryonic structure called neural tube is formed which eventually develops into the baby's brain, spinal cord and the surrounding bony structure. In case of spina bifida, the lower part of the neural tube does not develop or fuse fully leading to abnormalities in brain or spinal cord. When the spinal column does not close properly around the baby's spinal cord the nerves start to protrude through the opening causing spina bifida.

Spina bifida is a broader term used for various conditions of the spine. The defect may range from very mild form which may not present itself with any symptoms to a severe one causing disability and disrupting the patient's normal life. There are broadly three types of spina bifida which are discussed below.

Spina bifida occulta

It is a very mild and most common form of spina bifida in which one or two vertebrae are left unfused. The portion of the spinal cord that is not enclosed by vertebrae is covered by skin. Occulta means 'hidden' and since the opening is hidden under the skin, the condition is referred as spina bifida occulta. However, in such cases, nerve roots and the spinal cord are not affected and hence, the person remains asymptotic.

Meningocele

In meningocele, the meninges (membranes that surround and protect the spinal cord) protrude through the spinal opening without affecting the spinal cord. Sometimes a layer of skin is formed over the opening. In few cases of meningocele, when the membranes push through the opening, they get filled with the spinal fluid forming a cyst. With this type of spina bifida, one may experience only mild symptoms or in few cases the damage may be very severe.

Myelomeningocele

Myelomeningocele is the most severe form of spina bifida. Myelomeningocele, almost certainly leads to mental and physical disabilities. The severity of the damage depends upon the site of the opening on the spine as the portion that is below the opening becomes dysfunctional. The higher the location of the opening, the greater will be the impact on the functioning of the body.

Symptoms

The symptoms vary depending upon the type of the spina bifida. In case of spina bifida occulta, the child remains largely asymptotic and there may be a birthmark, a patch, a dimple or hair growth on the skin under which the vertebrae is not joined properly. This condition is usually diagnosed during an ultrasound performed for some other purpose.

Meningocele may or may not show any symptoms. Partial paralysis with urinary and bowel problems are usually associated with meningocele. This condition is diagnosed before birth through fetal ultrasound and other tests. This condition is diagnosed when a test called maternal serum alpha-fetoprotein is performed on pregnant woman.

Treatment

Spina bifida occulta doesn't require any treatment; however other two conditions are always treated surgically. In case of meningocele, surgery involves pushing back the membranes into the place and closing the vertebrates. Babies born with Myelomeningocele are operated within 24 to 48 hours of their birth. The surgery is mainly performed to prevent infection and further damage to the spinal cord. If the baby develops too much cerebrospinal fluid which is known as hydrocephalus, a shunt will be placed as part of the treatment. In recent times spina bifida is also treated through fetal surgery, wherein the uterus is surgically opened to correct the spine defect and immediately closed back. Spina bifida, particularly Myelomeningocele type, requires lifelong medical support as children with such a condition continue to suffer from neurological, orthopaedic and bladder and bowel related problems.

Angular Cheilitis

Angular Cheilitis is a condition in which one or both corners of the mouth develop cracks and sensitive sores and eventually get infected. The ends of the lips become dry, scaly and painful. The infection is caused by continuous exposure to the bacteria present in the saliva. The bacteria get accumulated in the cracks of the lips giving rise to infection. The infection may be caused by various microbes like bacteria, virus or fungi leading to Oral Thrush or candidiasis.

Causes

• Vitamin deficiency, particularly of B12
  
• Exposure to irritants
  
• Drooling of saliva in children
  
• Poorly fitted dentures
  
• Weakened immune system
  
• Systemic disorders
  
• Dry weather
  
• Continuous licking of lips
  
• Loss of teeth in elders

Signs and Symptoms

Initially, angular cheilitis will show up with mild symptoms, and if left untreated, turns chronic and causes severe discomfort. At the initial stage, Angular Cheilitis presents itself with the following symptoms:

• Tight feeling near the angles of the mouth
  
• Dry and scaly lips
  
• Mild discomfort in opening the mouth.

As the condition worsens one may suffer from the following symptoms:

• Redness with pain
  
• Sores and bleeding fissures
  
• Pain and oozing
  
• Difficulty while talking and eating.

Angular Cheilitis causes

A single definitive cause is yet to be ascertained. Contributory factors are identified. Poor nutrition and infection score high as compared to other factors. One or combination of these factors is enough for bacteria or fungus in the mouth region to suddenly multiply and cause localized soreness.

• Nutritional deficiency of mineral and vitamin (folate, iron, B-vitamin deficiency)
  
  
• Deficient immune system
  
  
• Poor hygiene
  
  
• Diabetes, cancer, anemia, Celiac disease, HIV/AIDS, infection
  
  
• Ill fitting dentures , dry mouth, tobacco smoking, make-up, lip balm, high fever, cold weather, allergic reactions, overdose of vitamin A
  
  
• Facial disorders where the lips are enlarged, Down syndrome, Crohn's disease
  
  
• Medications to treat specific health issues such as lithium (for mania), ionized (TB), D-penicillamine (Wilson's disease), retinoids for acne, chemotherapy agents, phenothiazine (for headache, mental disorders).

Angular Cheilitis signs and symptoms

• Slight tightness in one or both corners of the mouth causing discomfort in opening mouth.
  
  
• Formation of small flaky skin in the corners of the mouth.
  
  
• Redness and swelling that tempt frequent licking of the mouth which aggravate the condition.
  
  
• Split corners at the edges of the mouth.
  
  
• Difficulty in eating and talking.

Treatment

Treatment for angular cheilitis involves applying topical anti bacterial and anti fungi creams or ointments along with oral medication. Ointment with emollient properties is usually prescribed and depending upon the microbial infection antibiotics, antifungal, anti-viral and topical steroids are prescribed.

Angular cheilitis can also be treated at home with the help of easily available natural products. Aloe Vera, honey or fresh neem leaves have anti bacterial and anti fungi properties. They can be gently rubbed on the wounded area at frequent intervals. Applying salt water on affected region works well as the saline water inhibits the growth of bacteria and kills the existing microbes.

Appearance of Angular Cheilitis is often misconstrued to be an outcome of cold sore throat. It is actually a form of dermatitis, a type of skin infection. Typically, one or both the corners of the mouth have lesions making opening of the mouth highly painful. If left untreated, the lips can chap and the areas around the lips may start to peel off thereby worsening the condition.

A culture test to establish the bacteria, fungus or virus is required. A swab from the affected corner is taken and tested. Nutritional supplements containing Vitamin B12, folate and iron are suggested. Maintain good oral hygiene and avoid lip makeup till the condition improves.

Abdominal hernia

Abdominal hernia refers to a tear in the abdominal wall that allows the abdominal organs or fatty tissues to protrude through the cavity holding the organ. The tear occurs due to the weakness of the muscles surrounding the wall and causes a bulge in the affected area. The bulge tends to enlarge with cough or any other activity that puts pressure on the abdominal muscles and the size of the hernia reduces when the patient is rested or made to lie down. Hernias normally occur in males; however infants and women are also prone to this condition.

Abdominal hernia can be classified into reducible hernia and non reducible hernia. In case of reducible hernia, bulge can be pushed back into the sack with mild pressure and surface can be flattened in the affected area. But in few acute cases, hernia cannot be pushed back into the cavity and this condition is known as non reducible hernia. This is a medical emergency as it poses the risk of strangulation. In case of strangulation, blood supply to the herniated tissue will be cut off leading to the death of the tissue. If the intestines get strangulated and eventually lose blood supply, patient may develop gangrene (dead bowel) and this may prove fatal if medical attention is not given immediately.

Different types of abdominal hernia

Inguinal hernia or groin hernia develops in the groin region due to the natural anatomical weakness present in that area. Hernia that develops in the internal ring within the groin area is called indirect inguinal hernia whereas hernia that develops near the groin area is called direct inguinal hernia. It is the most common type of abdominal-wall hernia that occurs mostly in men.

Femoral hernias appear in upper thigh region and these hernias are most common in women than men. Cause is usually the result of pregnancy and childbirth. Incidence rate is highest in middle-aged and elderly women, especially women who have had one or more pregnancies.

Umbilical hernia develops near the naval area. Most common in infants but can affect adults also. Medical attention is mandatory when hernia turns tender, discolored, swollen and/or when the infant seems to be suffering from abdominal pain.

Epigastric hernia occurs at upper abdominal area lying between the chest and naval. Develops in the middle of the upper abdomen between the breastbone and the umbilicus.

Spigelian hernia happens at the side of abdominal wall.

Incisional hernia develops at the place of incision that has occurred during earlier surgery. The place is a weak area usually an incompletely healed surgical wound. Symptoms are bulge or knot beneath the skin near the scar, sharp pains in the abdomen and/or constipation.

Causes of abdominal hernia

Abdominal hernia may be congenital (present at birth) or acquired later in life due to the weakening of abdominal muscles. Some other factors can also contribute to developing an abdominal hernia.

• Obesity
  
• Severe cough
  
• Continuous sneezing
  
• Heavy lifting
  
• Pregnancy
  
• Straining while urination or bowel movements
  
• Lung disease
  

Symptoms and warning signs of abdominal hernia

Mild to intense pain and bulge on the abdomen or groin area are the significant indications of hernia. However, in few cases, patient may not experience any pain or may have only occasional pain and the swelling also may not appear. Almost all hernias swell up and enlarge with cough, continuous sneezing or any other condition that puts pressure on the abdomen. If the hernia involves intestines, patient will suffer from bowel obstruction and may have fever, nausea and vomiting.

Abdominal hernia treatment

Hernia is usually palpable and a surgeon can easily diagnose the condition during the clinical examination. Hernias are normally corrected through surgery as there is always a risk of strangulation associated with hernia. Reducible hernias are not a medical emergency; hence surgery appointments can be fixed according to the convenience of the patient and doctor. Irreducible hernias with painful lumps require immediate medical attention and surgery is performed as an emergency. During surgery the protruded organs are pushed back into the sack and if the intestines are strangulated, they will be removed. Sometimes, a synthetic mesh is placed behind the weakened abdominal muscle which will eventually merge with adjoining tissues and act as a protective wall against future recurrences.

Preventing Abdominal hernia

Some types of abdominal hernia cannot be prevented. Steps can be taken to avoid further complications and to prevent recurrence.

• Maintaining healthy weight
  
• Avoiding heavy weights
  
• Consuming fiber rich food
  
• Treating severe cough and other allergies promptly