Diseases Caused by Epstein Barr Virus

Epstein barr virus is a DNA virus of family Human Herpes Virus. It is also known as HHV-4 or Human HerpesVirus 4. It is ubiquitously present and infects around 90% of world population generally resulting in mild to asymptomatic flu like symptoms.

Infections

It causes infectious mononucleosis or glandular fever in the adolescents.  It is transmitted by saliva and infects the epithelium of nasopharynx and oropharynx and subsequently enters B cell to infect it. It manifests as pharyngitis, cervical lymphadenopathy, fatigue and fever.It is transmitted with kissing and hence is known as Kissing disease.

Cancers

First known virus to cause cancers to human was EBV affecting epithelial cells, mesenchymal cells and lymphocytes. It affects all immunocompromised and immunocompetent hosts or those with acquired iatrogenic immunosuppression. Gastric Adenocarcinoma, endemic  Burkitt Lymphoma, Hodgkins Lymphoma, large B cell lymphoma, Nasopharyngeal Carcinoma has been associated with HHV4.

Autoimmune diseases:

High viral EBV has been found to be associated with SLE and its flares. Similarly, high amount of  EBV infected B cells have been found in Synovium and joints of patient affected with Rheumatic Arthritis. Antibodies directed against EBV has been found in patients with Sjogren Syndrome and they have been found to have higher incidences of lymphoid malignancies like MALT, Non hodgkin's Lymphoma. 

EBV has been found as an environmental trigger in the development of various Systemic Autoimmune disease.

Lymphoproliferative diseases associated with HIV

EBV when occurs simultaneously with HIV, it predisposes to various lymphoproliferative diseases. It is mostly secondary to immunosuppression and are of B cell origin. About half of HIV defining cancers are associated with EBV like Hodgkins Lymphoma, Burkitt lymphoma, diffuse large B cell Lymphoma, peripheral T cell Lymphoma but more specific and  associated with HIV with EBV include Plasma Blastic lymphoma (PBL) of oral cavity, Primary effusion lymphoma (PEL), HIV related CNS lymphomas.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766599/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314581/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346501/

http://www.ijcem.com/files/ijcem0012377.pdf

Hypertension in Community: Rule of halves

Hypertension in Community, the rule of halves.

Hypertension is a common public health problem. The trend of prevalence of hypertension is increasing with the development of newer technological, easy life style, less physical activities and increasing amount of processed food consumption.

Of the total population, 50% have hypertension both diagnosed and undiagnosed. Only 50% out of all hypertensive cases 50% seek medical attention. Of the total 50% of diagnosed cases, 50% take medicine and 50% do not. Of the 50% who take medicine, only 50% are adeuately treated and the rest 50 % are not.

Hypertension in Community, the rule of halves.

Anatomical Structures of Various length

There are various structure with similar length. These are favourite question of anatomy professors. Some structures of similar lengths are given below.

45 cm structures

Femur

Spinal cord

Thoracic Duct

Vas/ Ductus deferens

25 cm Structures

Descending colon

Duodenum

Oesophagus

Stomach

Ureter 

12cm Structures 

Heart (Apex to base)

Pancreas

Pharynx

Rectum 

Spleen

10 cm structures

Abdominal aorta 

Corpus Callosum 

Duodenum 3rd part 

Fallopian Tube 

Gall Bladder

Trachea 

7.5cm Structure

Bile duct 

Spermatic cord

Uterus 

Vagina (Anterior wall)

5 cm Structures

1st part of Duodenum

Ampulla of Fallopian tube                                  

Ascending Aorta 

Cysterna Chyli 

Left Bronchi

Nasal cavity 

Parotid Duct 

Pulmonary Trunk 

Seminal vesicle

Sub mandibular galnd 

Testis 

Thyroid glnnd 

4cm Structures

Common Hepatic Duct 

Cystic Duct 

Female Urethra

Inguinal Canal 

List of All named Hernias (Hernia Eponyms/Special Hernia)

Hernia is the abnormal protusion of a viscous or a part of it through an opening with a sac covering it. It could either be internal or external and not necessarily from the abdominal cavity. The most commonly encountered are the inguinal hernias and femoral hernia. But there are certain hernias that are named and arise from its specific location or contain specific content.

Hernia Eponyms on the basis of their similarity with the adjacent ones

Name of Hernia	Description
Bochdalek’s Hernia	Congenital Posterolateral Hernia of Diaphargm
Morgagni Hernia4	Through Larry’s space in Diaphargm
Larry’s Hernia4
Gibbon Hernia	Hernia with Hydrocele
Bergers Hernia	Hernia in Pouch of Douglas
Romberg Hernia1	Concurrent Ipsilateral Direct and indirect Inguinal Hernia
Saddle Hernia1
Dual Hernia1
Lumbar Hernia	Hernia in lumbar triangles of type Petit’s and Grynfelt
Obturator Hernia	Hernia through Obturator Canal
Grynfelt Hernia	Upper Lumbar triangle Hernia
Petit’s Hernia	Lower Lumbar Triangle Hernia
Femoral Hernia	Hernia medial to Femoral Vein in Femoral canal
Cooper’s Hernia6	Femoral Hernia with two sacs
Bilocular femoral Hernia6
Cloquet’s Hernia	Hernia Through Pectineal aponeurosis
Callison-Cloquet Hernia	Through Pectineus Muscle and its fascia
Narath’s Hernia	Behind Femoral Artery in congenital dislocation of Hip
Hesselbach’s Hernia	Lateral to Femoral Artery
Serofini’s Hernia	Behind Femoral Vessels
Laugier’s Hernia	Through Lacunar Ligament
Teale’s Hernia5	In front of Femoral Vessels
Velpeau Hernia5
Richter’s Hernia	Part of circumference of bowel wall is entrapped
Littre’s Hernia	Contains Meckel Diverticulum
Sliding Hernia	Hernia with a part of the wall formed by the viscus
Hernia En Glissae	Hernia with a part of the wall formed by the viscus
Maydl’s Hernia2	Two loops of bowel in Hernia sac with remaining part in abdomen
W Hernia/Hernia in W2
Retrograde Hernia2	Two loops of bowel in Hernia sac with remaining part in abdomen
Phantom Hernia	Localised Muscle Bulge following Muscle Paralysis
Mery’s Hernia7	Through the perineal floor
Perineal Hernia7
Spigelian Hernia	Hernia through Speligian Fascia
Sciatic hernia	Hernia through greater or lesser sciatic foramen
Little’s hernia3	Appendix in inguinal  Hernial Sac
Amyand hernia3
De Garengeots Hernia	Incarceration of appendix within Femoral Hernia
Beclards Hernia	Femoral Hernia Through Saphenous Opening
Barth’s Hernia	Hernia Between Adbominal wall and Persistent Vitellointestinal Duct
Holthouse’s Hernia	Inguinal Hernia That has turned outward into the groin
Grubers Hernia	Internal Mesogastric Hernia
Mesocolic hernia	Transmesenteric Hernia
Kronlem Hernia	Inguinoproperitoneal Hernia
Trietz Hernia	Paraduodenal Hernia
Rieux Hernia	Retrocaecal Hernia

Hernia Eponyms in alphabetical order

Name of Hernia	Description
Amyand hernia3	Appendix in inguinal hernia Sac
Barth’s Hernia	Hernia Between Adbominal wall and Persistent Vitellointestinal Duct
Beclards Hernia	Femoral Hernia Through Saphenous Opening
Bergers Hernia	Hernia in Pouch of Douglas
Bilocular femoral Hernia6	Femoral Hernia with two sacs
Bochdalek’s Hernia	Congenital Posterolateral Hernia of Diaphargm
Callison-Cloquet Hernia	Through Pectineus Muscle and its fascia
Cloquet’s Hernia	Hernia Through Pectineal aponeurosis
Cooper’s Hernia6	Femoral Hernia with two sacs
De Garengeots Hernia	Incarceration of appendix within Femoral Hernia
Dual Hernia1	Concurrent Ipsilateral Direct and indirect Inguinal Hernia
Femoral Hernia	Hernia medial to Femoral Vein in Femoral canal
Gibbon Hernia	Hernia with Hydrocele
Grubers Hernia	Internal Mesogastric Hernia
Grynfelt Hernia	Upper Lumbar triangle Hernia
Hernia En Glissae	Hernia with a part of the wall formed by the viscus
Hesselbach’s Hernia	Lateral to Femoral Artery
Holthouse’s Hernia	Inguinal Hernia That has turned outward into the groin
Kronlem Hernia	Inguinoproperitoneal Hernia
Larry’s Hernia4	Through Larry’s space in Diaphargm
Laugier’s Hernia	Through Lacunar Ligament
Little’s hernia3	Appendix in inguinal  Hernial Sac
Littre’s Hernia	Contains Meckel Diverticulum
Lumbar Hernia	Hernia in lumbar triangles of type Petit’s and Grynfelt
Maydl’s Hernia2	Two loops of bowel in Hernia sac with remaining part in abdomen
Mery’s Hernia7	Through the perineal floor
Mesocolic hernia	Transmesenteric Hernia
Morgagni Hernia4	Through Larry’s space in Diaphargm
Narath’s Hernia	Behind Femoral Artery in congenital dislocation of Hip
Obturator Hernia	Hernia through Obturator Canal
Perineal Hernia7	Through the perineal floor
Petit’s Hernia	Lower Lumbar Triangle Hernia
Phantom Hernia	Localised Muscle Bulge following Muscle Paralysis
Retrograde Hernia2	Two loops of bowel in Hernia sac with remaining part in abdomen
Richter’s Hernia	Part of circumference of bowel wall is entrapped
Rieux Hernia	Retrocaecal Hernia
Romberg Hernia1	Concurrent Ipsilateral Direct and indirect Inguinal Hernia
Saddle Hernia1	Concurrent Ipsilateral Direct and indirect Inguinal Hernia
Sciatic hernia	Hernia through greater or lesser sciatic foramen
Serofini’s Hernia	Behind Femoral Vessels
Sliding Hernia	Hernia with a part of the wall formed by the viscus
Spigelian Hernia	Hernia through Speligian Fascia
Teale’s Hernia5	In front of Femoral Vessels
Trietz Hernia	Paraduodenal Hernia
Velpeau Hernia5	In front of Femoral Vessels
W Hernia/Hernia in W2	Two loops of bowel in Hernia sac with remaining part in abdomen

The number in superscript suggest that the hernias with the same number are actually same with various names.

Sources

SRB’s Manual Of Surgery

https://medicallegends.blogspot.com/2015/08/named-hernias.html

http://lessons4medicos.blogspot.com/2009/07/different-eponymous-types-of-hernia.html

Internet