The larynx commonly called the voice box. IT is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration.
It changes pitch and volume. The larynx houses the vocal folds (vocal cords), which are essential for phonation& sound. The vocal folds are situated just below where the tract of the pharynx into the trachea and the esophagus.

Structure:-
(1)Cartilages:-Posterior view of the larynx is cartilages (left) and intrinsic muscles (right)
There are nine cartilages, three unpaired and three paired, that support the mammalian larynx and form its skeleton.
 Unpaired cartilages:
• Thyroid cartilage: This forms the Adam’s apple. It is usually larger in males than in females. The thyrohyoid membrane is a ligament associated with the thyroid cartilage that connects the thyroid cartilage with the hyoid bone.
• Cricoids cartilage: A ring of hyaline cartilage that forms the inferior wall of the larynx. It is attached to the top of trachea.
• Epiglottis: A large, spoon-shaped piece of elastic cartilage. During swallowing, the pharynx and larynx rise. Elevation of the pharynx widens it to receive food and drink; elevation of the larynx causes the epiglottis to move down and form a lid over the glottis, closing it off.
 Paired cartilages:
• Arytenoid cartilages: Of the paired cartilages, the arytenoid cartilages are the most important because they influence the position and tension of the vocal folds. These are triangular pieces .
• Corniculate cartilages: Horn-shaped pieces of elastic cartilage located at the apex of each arytenoid cartilage.
• Cuneiform cartilages: Club-shaped pieces of elastic cartilage located anterior to the corniculate cartilages.
Muscles:-The muscles of the larynx are divided into intrinsic and extrinsic muscles.
The intrinsic muscles are divided into respiratory and the muscles (the muscles of phonation). The respiratory muscles move the vocal cords apart and serve breathing. The phonatory muscles move the vocal cords together and serve the production of voice.
The extrinsic, passing between the larynx and parts around; and intrinsic, confined entirely. The main respiratory muscles are the posterior cricoarytenoid muscles. The muscles are divided into adductors .

Introduction: – Morphea, also known as “localized scleroderma”, or “circumscribed scleroderma”, involves isolated patches of hardened skin with no internal organ involvement.
Signs and symptoms:-

Frontal linear scleroderma
Morphea is most often presents as mauls or plaques a few centimeters in diameter, but also may occur as bands or in guttate lesions or nodules.
Morphea is a thickening and hardening of the skin and subcutaneous tissues from excessive collagen deposition. Morphea includes specific conditions ranging from very small plaques only involving the skin to widespread disease causing functional and cosmetic deformities. Morphea discriminates from systemic sclerosis by its supposed lack of internal organ involvement. . This classification scheme does not include the mixed form of morphed in which different morphologies of skin lesions are present in the same individual. Up to 15% of morphed patients may fall into this previously unrecognized category.
Cause:-
Physicians and scientists do not know what causes morphed. Case reports and observational studies suggest there is a higher frequency of family history of autoimmune diseases in patients with morphed. Tests for auto antibodies associated with morphed have shown results in higher frequencies of anti-hailstone and anti-topoisomerase Imia antibodies. Case reports of morphed co-existing with other systemic autoimmune diseases such as primary billiard cirrhosis, vitiligo, and systemic lupus erythematosus lend support to morph as an autoimmune disease.
Treatment:-
Throughout the years, many different treatments have been tried for morphed including topical, intra-lesional, and systemic corticosteroids. Antimalarials such as hydroxychloroquine or chloroquine have been used. Other immunomodulators such as methotrexate, topical tacrolimus, and penicillamine have been tried. Some have tried prescription vitamin-D with success. Ultraviolet a (UVA) light, with or without psoralens have also been tried. UVA-1, a more specific wavelength of UVA light, is able to penetrate the deeper portions of the skin and thus, thought to soften the plaques in morphed by acting in two fashions:
• 1) By causing a systemic immunosuppressant from UV light.
• 2) By inducing enzymes that naturally degrade the collagen matrix in the skin as part of natural sun-aging of the skin.
As with all of these treatments for morphed, the difficulty in assessing outcomes in an objective way has limited the interpretation of most studies involving these treatment modalities.
Epidemiology:-Morphea is a form of scleroderma that is more common in women than men, in a ratio 3:1 Morphea occurs in childhood as well as in adult life.

DEFINITION- Nephritic Syndrome is a primary glomerular disease charactrised by, protenuria hypoalbumineia, oedema, & hyperlipidemia.
ETIOLOGY-
1 Primary glomerular disease – Glomerulo Nephritis
2 Multisystem Diseases – Diabetes Mellitus
3 Drug Cause – NSAID, Penicillamine,
4 Infections
5 Neoplasms
6 Allergic
PATHOPHYSIOLOGY –
Damage of glomerular capillary membrane

Loss of protein (albumin)

Hypoalbumineia

Decrease oncotic pressure

Generalize oedema (anasarca)

Activation of rennin angiotensin system

Sodium retention

Oedema
SIGN & SYMPTOMS –
• Ascites
• Head ache
• Fatigue
• Malaises
• Oedema in eye, brain, kidney
Diagnosis

Urinalysis will be able to detect high levels of proteins and occasionally microscopic haematuria.
Specifically elevated LDL, usually with concomitantly elevated VLDL, is indicative of nephrotic syndrome.
A kidney biopsy may also be used as a more specific and invasive test method. A study of a sample’s anatomical pathology may then allow the identification of the type of glomerulonephritis involved however; this procedure is usually reserved for adults as the majority of children suffer from minimum change disease that has a remission rate of 95% with corticosteroids. A biopsy is usually only indicated for children that are corticosteroid resistant as the majority suffers from focal and segmental glomeruloesclerosis.
Further investigations are indicated if the cause is not clear including analysis of auto-immune markers (ANA, ASOT, C3, cryoglobulins, serum electrophoresis), or ultrasound of the whole abdomen.
MANAGEMENT– The treatment of nephrotic syndrome can be symptomatic or can directly address the injuries caused to the kidney.
Symptomatic
The objective of this treatment is to treat the imbalances brought about by the illness: edema, hypoalbuminemia, hyperlipemia, hypercoagulability and infectious complications.
1. Edema: a return to an unswollen state is the prime objective of this treatment of nephrotic syndrome. It is carried out through the combination of a number of recommendations:
2. Rest: depending on the seriousness of the edema and taking into account the risk of thrombosis caused by prolonged bed rest.
3. Medical nutrition therapy: based on a diet with the correct energy intake and balance of proteins that will be used in synthesis processes and not as a source of calories.

4.Medication: The pharmacological treatment of edema is based on the prescription of diuretic drugs (especially loop diuretics, such as furosemide). In severe cases of edema (or in cases with physiological repercussions, such as scrotal, prenuptial or urethral edema) or in patients with one of a number of severe infections (such as sepsis or pleural effusion), the diuretics can be administered intravenously. This occurs where the risk from plasmatic expansion is considered greater than the risk of severe hypovolemia, which can be caused by the strong diuretic action of intravenous treatment

INTRODUCTION:
The kidneys are bean-shaped organs that serve several essential regulatory roles in vertebrates. Their main function is to regulate the balance of electrolytes in the blood, along with maintaining pH homeostasis.
Located at the rear of the abdominal cavity in the retroperitoneal space, the kidneys receive blood from the paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a ureter which empties into the bladder.
STRUCTURE
The kidney has a bean-shaped structure having a convex and a concave border. It consist of:

1. Renal pyramid • 2. Interlobular artery • 3. Renal artery • 4. Renal vein 5. Renal hilum • 6. Renal pelvis • 7. Ureter • 8. Minor calyx • 9. Renal capsule • 10. Inferior renal capsule • 11. Superior renal capsule • 12. Interlobular vein • 13. Nephron • 14. Minor calyx • 15. Major calyx • 16. Renal papilla • 17. Renal column

BLOOD SUPPLY
The renal circulation supplies the blood to the kidneys via the renal arteries, left and right, which branch directly from the abdominal aorta.
FUNCTIONS
The kidney participates in whole-body homeostasis, regulating acid-base balance, electrolyte concentrations, extracellular fluid volume, and blood pressure. The kidney accomplishes these homeostatic functions both independently and in concert with other organs, particularly those of the endocrine system. Various endocrine hormones coordinate these endocrine functions; these include renin, angiotensin II, aldosterone, antidiuretic hormone, and atrial natriuretic peptide, among others.
Many of the kidney’s functions are accomplished by relatively simple mechanisms of filtration, reabsorption, and secretion, which take place in the nephron. Filtration, which takes place at the renal corpuscle, is the process by which cells and large proteins are filtered from the blood to make an ultrafiltrate that eventually becomes urine. The kidney generates 180 liters of filtrate a day, while reabsorbing a large percentage, allowing for the generation of only approximately 2 liters of urine. Reabsorption is the transport of molecules from this ultrafiltrate and into the blood. Secretion is the reverse process, in which molecules are transported in the opposite direction, from the blood into the urine.

INTRODUCTION: – Diverticulitis is a common digestive disease which involves the formation of pouches (diverticula) within the bowel wall. This process is known as diverticulosis, and typically occurs within the large intestine, or colon, although it can occasionally occur in the small intestine as well. Diverticulitis results when one of these diverticula becomes inflamed.
CAUSES: – The causes of diverticulitis are poorly understood, with approximately 40% due to genes and 60% due to environmental factors. Obesity another risk factor.
PATH PHYSIOLOGY: – Diverticulitis is believed to develop because of changes inside the intestines including high pressures because of faulty contracting of the intestines.
They often evolve from age-related diverticulosis and its associated pathologies resulting from increased intraluminal colonic pressure, including bleeding, abscess, perforation, stricture, fistula formation or impacted fecal matter.
Most people with diverticulosis do not have any discomfort or symptoms; however, symptoms may include mild cramps, bloating, and constipation. Other diseases such as inflammatory bowel disease (IBD) and stomach ulcers cause similar problems, so these symptoms do not always mean a person has diverticulosis.
DIAGNOSIS: – People with the above symptoms are commonly studied with computed tomography, or CT scan. The CT scan is very accurate (98%) in diagnosing diverticulitis. In order to extract the most information possible about the patient’s condition, thin section (5 mm) transverse images are obtained through the entire abdomen and pelvis after the patient has been administered oral and intravascular contrast. Images reveal localized colon wall thickening, with inflammation extending into the fat surrounding the colon. The diagnosis of acute diverticulitis is made confidently when the involved segment contains diverticulae. CT may also identify patients with more complicated diverticulitis, such as those with an associated abscess. It may even allow for radiologically guided drainage of an associated abscess, sparing a patient from immediate surgical intervention.
TREATMENT:-
Most cases of simple, uncomplicated diverticulitis respond to conservative therapy with bowel rest.
Diet
People may be placed on a low residue diet. It was previously thought that a low-fiber diet gives the colon adequate time to heal. Evidence tends to run counter to this with a 2011 review finding no evidence for the superiority of low residue diets in treating diverticular disease and that a high-fiber diet may prevent diverticular disease. A systematic review published in 2012 found no high quality studies, but found that some studies and guidelines favor a high-fiber diet for the treatment of symptomatic disease.
Antibiotics
If bacterial infection is suspected, antibiotics may be used Despite being recommended by several guidelines, the use of antibiotics in mild cases of uncomplicated diverticulitis is supported with only “sparse and of low quality” evidence, with no evidence supporting their routine use.
Complications
In complicated diverticulitis, bacteria may subsequently infect the outside of the colon if an inflamed diverticulum bursts open. If the infection spreads to the lining of the abdominal cavity, (peritoneum), this can cause a potentially fatal peritonitis. Sometimes inflamed diverticula can cause narrowing of the bowel, leading to an obstruction. Also, the affected part of the colon could adhere to the bladder or other organ in the pelvic cavity, causing a fistula, or abnormal connection between an organ and adjacent structure or organ, in this case the colon and an adjacent organ.
• Bowel obstruction
• Peritonitis
• Abscess
• Fistula
• Bleeding
• Strictures

DEFINITION
Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.

RISK FACTORS
1. Genetics
Twin and family studies have shown that people with first-degree relatives (such as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. treatment.
2. Brain Structure and Functioning
Imaging studies have shown differences in the frontal cortex and subcortical structures of the brain in patients with OCD.
3. Environment
People who have experienced abuse (physical or sexual) in childhood or other trauma are at an increased risk for developing OCD.

SIGNS & SYMPTOMS
People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.
Obsessions are repeated thoughts, urges, or mental images that cause anxiety.
Common symptoms include:
• Fear of germs or contamination
• Unwanted forbidden or taboo thoughts involving sex, religion, and harm
• Aggressive thoughts towards others or self
• Having things symmetrical or in a perfect order
Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought.
Common compulsions include:
• Excessive cleaning and/or handwashing
• Ordering and arranging things in a particular, precise way
• Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
• Compulsive counting
Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally:
• Can’t control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
• Spends at least 1 hour a day on these thoughts or behaviors
• Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
• Experiences significant problems in their daily life due to these thoughts or behaviors

TREATMENT

• Medication – Antidepressants are sometimes used in conjunction with therapy for the treatment of obsessive-compulsive disorder. However, medication alone is rarely effective in relieving the symptoms of OCD. fluoxetine , fluvoxamine ,sertraline
• Family Therapy – Because OCD often causes problems in family life and social adjustment, family therapy is often advised. Family therapy promotes understanding of the disorder and can help reduce family conflicts. It can also motivate family members and teach them how to help their loved one.
• Group Therapy – Group therapy is another helpful obsessive-compulsive disorder treatment. Through interaction with fellow OCD sufferers, group therapy provides support and encouragement and decreases feelings of isolation.
• Cognitive behavior therapy- The cognitive therapy component for obsessive-compulsive disorder (OCD) focuses on the catastrophic thoughts and exaggerated sense of responsibility you feel. A big part of cognitive therapy for OCD is teaching you healthy and effective ways of responding to obsessive thoughts, without resorting to compulsive behavior.

INTRODUCTION
A mental health assessment is an overall picture of how well you feel emotionally and how well you are able to think, reason, and remember (cognitive functioning).
A mental health assessment may be done by primary care doctor or by a psychiatrist, psychologist, or social worker.
A mental health assessment for a child is geared to the child’s age and stage of development.
Definition
The mental status examination or mental state examination, abbreviated MSE, is an important part of the clinical assessment process in psychiatric practice. It is a structured way of observing and describing a patient’s current state of mind, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight and judgment.
Why It Is Done
A mental health assessment is done to:

1. Find out about and check on mental health problems, such as anxiety, depression, schizophrenia, Alzheimer’s disease, and anorexia nervosa.
2. Help tell the difference between mental and physical health problems.
3. Evaluate a person who has been referred for mental health treatment because of problems at school, work, or home.
For example, a mental health assessment may be used to find out if a child has learning disabilities or behavior disorders such as attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), or obsessive-compulsive disorder (OCD).
4. Check the mental health of a person who has been hospitalized or arrested for a crime, such as drunken driving or physical abuse.
Components of the Mental Status Exam
• Appearance
• Behavior
• Speech
• Mood
• Affect
• Thought process
• Thought content
• Cognition
• Insight/Judgment

MEANING
The word crisis means both the danger and opportunity. Crisis is a danger because it threatens to overwhelm the individual or his family, and it may result in suicide or a psychotic break .It is also an opportunity because during times of crisis individuals are more receptive to therapeutic influence.
DEFINITION
Crisis is a perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms.(James & Gilliland, 2001)
TYPES OF CRISIS
1. MATURATIONAL CRISES
Maturational crises have to do with the predictable transitions individuals experience as they move from one stage of human development to another: Infancy, Early childhood, Preschool School age, Adolescent, Young adult, Mature adult ,Late adulthood.
2. SITUATIONAL CRISES
Situational crises arise from an external source and are events or circumstances that threaten the physical, social, and psychological integrity of individuals. Such as the loss of a job or death of a child.
3. ADVENTITIOUS CRISES
Adventitious crises have been called events of disaster 1) natural disasters, such as floods, fires, and earthquakes; 2) national disasters, such as airplane crashes, riots, and wars; 3) interpersonal disasters, such as assault and rape; and 4) acts of terrorism.
PHASES OF CRISIS
Phase I
The individual is exposed to a precipitating stressor: anxiety increases; previous problem – solving techniques are employed.
Phase II
Anxiety increases further. The individual further feel a great deal of discomfort at this point. Coping techniques that have worked in the past are attempted, only to create feelings of helplessness and disorganization prevails..
Phase III
All possible resources, both internal and external, are called on to resolve the problem and relieve the discomfort. The individual may try to view the problem from a different perspective, or even to over look certain aspects of it.
Phase IV
Anxiety may reach panic levels. Cognitive functions are disordered, emotions are labile, and behavior may reflect the presence of psychotic thinking.

PRINCIPLES OF CRISIS INTERVENTION
1 Be specific, use concise statements, and avoid over whelming the patient with irrelevant questions or excessive detail.
2 Encourage the expression of feelings.
3 A calm, controlled presence reassures the person that the nurse can help.
4 Listen for facts and feelings, seeking clarification, paraphrasing and reflection are effective strategies.
5 Allow sufficient time for the individuals involved to process information and ask questions.
6 Help patients legitimize feelings by letting them know that others in similar situations have experienced comparable emotions.
7 Clarify distortions by getting persons to look at the situation realistically, focus on what can be changed versus what cannot.
8 Empower person by allowing them to make informed choices.
9 Assist the person in confronting reality.
10 Encourage the person to focus on one implication at a time.

TECHNIQUES OF CRISIS INTERVENTION

1 Catharsis: the release of feelings that takes place as the patient talks emotionally charged areas
2 Clarification: encouraging the patient to express more clearly the relationship between certain events.
3 Manipulation: using the patient’s emotions, wishes or values to benefit the patient in the therapeutic process.
4 Reinforcement of behavior: giving the patient positive reinforcement to adaptive behavior.
5 Support of defenses: encouraging the use of healthy, adaptive defenses and discouraging those that are unhealthy or maladaptive.
6 Increasing self- esteem: helping the patient to regain feelings of self worth.
7 Exploration of solution: examining alternative ways of solving the immediate problem

INTRODUCTION- Chlamydia infection is a common sexually transmitted infection in humans caused by the bacterium Chlamydia trachomatis. The term Chlamydia infection can also refer to infection caused by any species belonging to the bacterial family ChlamydiaceaeChlamydia can be spread during vaginal, anal, or oral sex, and can be passed from an infected mother to her baby during childbirth. Chlamydia infection can be effectively cured with antibiotics. If left untreated, chlamydial infections can cause serious reproductive and other health problems with both short-term and long-term consequences
Signs and symptoms-

Genital disease
Inflammation of the cervix in a female patient from Chlamydia infection characterized by mucopurulent cervical discharge, redness, and inflammation.

Women
Chlamydial infection of the neck of the womb (cervicitis) is a sexually transmitted infection which is asymptomatic for 50–70% of women infected with the disease. The infection can be passed through vaginal, anal, or oral sex. Of those who have an asymptomatic infection that is not detected by their doctor, approximately half will develop pelvic inflammatory disease (PID), a generic term for infection of the uterus, fallopian tubes, and/or ovaries. PID can cause scarring inside the reproductive organs, which can later cause serious complications, including chronic pelvic pain, difficulty becoming pregnant, ectopic (tubal) pregnancy, and other dangerous complications of pregnancy.
Men
In men, those with a chlamydial infection show symptoms of infectious inflammation of the urethra in about 50% of cases. Symptoms that may occur include: a painful or burning sensation when urinating, an unusual discharge from the penis, testicular pain or swelling, or fever.
Eye disease
Chlamydia conjunctivitis or trachoma was once the most important cause of blindness
Joints
Chlamydia may also cause reactive arthritis—the triad of arthritis, conjunctivitis and urethral inflammation—especially in young men.
Infants
As many as half of all infants born to mothers with Chlamydia will be born with the disease. Chlamydia can affect infants by causing spontaneous abortion; premature birth; conjunctivitis,
Other conditions
A different server of Chlamydia trachomatis is also the cause of lymphogranuloma venereum, an infection of the lymph nodes and lymphatic. It usually presents with genital ulceration and swollen lymph nodes in the groin, but it may also manifest as rectal inflammation, fever or swollen lymph nodes in other regions of the body.
Transmission- Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.
DIAGNOSIS
Chlamydia trachomatis inclusion bodies (brown) in a McCoy cell culture.
The diagnosis of genital chlamydial infections evolved rapidly from the 1990s through 2006. Nucleic acid amplification tests (NAAT), such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), and the DNA strand displacement amplification (SDA) now are the mainstays. NAAT for Chlamydia may be performed on swab specimens sampled from the cervix (women) or urethra (men), on self-collected vaginal swabs, or on voided urine.
TREATMENT-
C. trachomatis infection can be effectively cured with antibiotics once it is detected. Current guidelines recommend azithromycin, doxycycline, erythromycin, or ofloxacin. Agents recommended for pregnant women include erythromycin or amoxicillin.

INTRODUCTION – Renal failure or renal insufficiency is a medical condition in which the kidneys fail to adequately filter waste products from the blood. The two main forms are acute kidney injury, which is often reversible with adequate treatment, and chronic kidney disease, which is often not reversible.

CLASSIFICATION –
Kidney failure can be divided into two categories: acute kidney injury or chronic kidney disease. The type of renal failure is differentiated by the trend in the serum creatinine; other factors that may help differentiate acute kidney injury from chronic kidney disease include anemia and the kidney size on sonography as chronic kidney disease generally leads to anemia and small kidney size.
Acute kidney injury – Acute kidney injury (AKI), previously called acute renal failure (ARF), is a rapidly progressive loss of renal function, generally characterized by oliguria (decreased urine production, quantified as less than 400 mL per day in adults less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); and fluid and electrolyte imbalance.
Chronic kidney disease –

Chronic kidney disease (CKD) can also develop slowly and, initially, show few symptoms. CKD can be the long term consequence of irreversible acute disease or part of a disease progression.
SIGNS AND SYMPTOMS –

Symptoms of kidney failure include the following –
• High levels of urea in the blood, which can result in:
o Vomiting and/or diarrhea, which may lead to dehydration
o Nausea
o Weight loss
o Nocturnal urination
o More frequent urination, or in greater amounts than usual, with pale urine
o Less frequent urination, or in smaller amounts than usual, with dark coloured
o urine
o Blood in the urine
o Pressure, or difficulty urinating
o Unusual amounts of urination, usually in large quantities
o Pain in the back or side
MANAGEMENT –
1. Nutritional Therapy
2. Pharmacological Therapy
3. Maintain Intake output chart
4. Administer Antibiotics
5. Administer Diuretics