Disease Topics

Allergy is an over-reaction of the body's immune system to innocuous foreign substances or allergens.¹ Allergens, by definition, are proteins that have the ability to elicit powerful T helper lymphocyte type 2 (Th2) responses, culminating in IgE antibody production (atopy).² It has been proposed that allergens are linked by their ability to activate the innate immune system of mucosal surfaces, triggering an initial influx of innate immune cells that subsequently promote Th2-polarized adaptive immune responses.²

Allergens are derived from a variety of environmental sources, such as plants, fungi, arthropods, and other mammals.² Allergens constitute a diverse range of molecules, varying in size from small to large multi-domain proteins.² It should be noted that, reductive experimental systems aside, natural exposure is not to single, purified proteins, but to a complex mixture of molecules.²

Anesthesiology is the medical speciality that encompasses study and use of anesthesia; general, regional and local.

Historically surgery was performed without adequate pain relief, usually following the administration of alcohol, which was ineffective as an analgesic. In the mid 19th Century the discovery of the pain relieving properties of nitrous oxide by Horace Wells, and ether by William Morton, led to the birth of modern anesthesia. The main benefit of ether was that, in a vaporised form, it did not cause respiratory depression and allowed the airway to be kept open by inexperienced anesthetists.¹

Angiology is the medical specialty that involves pathology and treatment of vessels whatever their nature; blood (veins, arteries, capillaries) or lymphatic vessels.

Cardiovascular diseases remain the major cause of death across Europe, and are a major cause of morbidity and loss of quality of life.¹ Each year, more than 4 million Europeans die of cardiovascular disease.¹ The large majority of these cardiovascular events are due to atherosclerosis.¹

In 2008, cardiovascular diseases (CVD) were responsible for 17.3 million deaths worldwide - almost a third of global deaths. However death rates vary worldwide with the low and middle-income countries representing 80% of these deaths.¹

In Europe Coronary Heart Disease and Stroke have the highest death rates killing 1.92 million and 1.24 million respectively each year.²

The central nervous system (CNS) is composed of the brain, brain stem, cerebellum and spinal cord. At a cellular level the CNS is made up of highly specialised cells called neurones, whose electrical excitability can transmit signals in the form of action potentials. In addition to neurones the CNS also contain astrocytes, oligodendrocytes, microglia and ependymal cells.¹

There are many diseases that affect the CNS, including epilepsy, schizophrenia, Alzheimer’s disease and mood disorders (depression, anxiety, bipolar disorder).

Clinical laboratories are usually located within hospitals and are responsible for processing biochemical tests.

A lot can be discovered about the health of a patient by testing the components of their bodily fluids (blood, urine and faeces). The clinical laboratory is responsible for performing these tests in an accurate manner. The areas of testing include; haematology, microbiology, chemistry and immunology.¹

Complementary and alternative medicine (CAM) is the diagnosis, treatment and/or disease prevention which complements mainstream medicine. CAM contributes to a common whole by satisfying a demand not met by orthodoxy, or by diversifying the conceptual frameworks of medicine.¹ This area of medicine has benefited from a gradual recognition in Europe since the 1990’s.²

The use of CAM has dramatically increased worldwide over the past twenty years.³ In the countries of the European Union, for which statistics are available, CAMs are used by 20-50% of the population.² This means that currently more than 100 million Europeans use CAM.³ Therapies most commonly used in Europe are; homeopathy, acupuncture, herbal medicine, anthroposophical medicine, naturopathy, traditional Chinese medicine, osteopathy and chiropracty.³ However, the recognition and the using of these practices differ widely between European countries.³

Intensive care is the hospital based specialty dedicated to treating critically ill and high risk patients who require aggressive treatment and continuous monitoring.¹ Patients in intensive care units (ICUs) are usually complex, with illnesses involving multiple systems and in some cases multiple diseases.¹

The main functions of ICUs can be divided into two groups; firstly treatment of emergency patients with potentially reversible organ damage. Secondly to provide organ function support and vital monitoring of patients who have undergone elective surgery with the potential for organ failure.²

Dermatology is the branch of medicine that deals with the skin, mucous membranes, hair and nails.

The skin is the largest and heaviest organ of the body.¹ It plays several key roles such as; protection against external substances, control of temperature, synthesis (vitamin D) and it also has a immune function.¹ The skin has three layers; the epidermis (which is in permanent renewal) the dermis and the hypodermis which provide the fibrous framework.² Skin color, texture and the arrangement of folds is also undeniably a psychosocial feature.¹

The endocrine system, through its organs and glands, produces and secretes hormones which control and regulate several body functions: reproduction and sexual differentiation, development and growth, homeostasis, regulation of metabolism and nutrient supply.^1,2

The thyroid, for example, through the secretion of the hormones T4 and T3, regulates the development of different organs, notably the brain (neuronal proliferation, migration and differentiation).¹ The actions of these hormones are essential during the critical period: from in utero to 2 years old.¹ As this gland needs iodine to produce its hormones, some programs of iodization have been set up in areas of iodine deficiency. The aim is to prevent cretinism and development of goitre or, at least, to limit its size when it is already developed. Around 1/3 of the world population live in iodine deficient zones which are mountainous areas in South-East Asia, Latin America and Central Africa.³

Otorhinolaryngology (literally "study of the ear, nose and larynx") is the branch of medicine that specialises in the diagnosis and treatment of diseases affecting the region of the head and neck.

The head and neck combines a set of organs with distinct but related functions.¹ Ears, nose and mouth are sensory organs that allow us to hear, smell, and taste.¹ Oral and nasal cavities also allow the passage of air and nutrients essential to the body.¹

Emergency medicine, also called oxiology, combines medical and surgical techniques to deal with a life-threatening emergency, in other words, a situation where, in the absence of treatment, the patient risks dying or having irreversible after-effects within a short time.

In addition to general medicine, the specific skills used in the context of emergency medicine are anaesthesiology, traumatology and toxicology.

Anaesthesiology plays an important role in both the treatment of pain in emergency medicine, and in the sedation of seriously ill people. The maintenance of a patient’s airway is a crucial aspect of emergency medicine. This is most commonly achieved either by non-invasive ventilation (face or nasal mask) or rapid sequence induction intubation, the latter of which requires intravenous sedation and a short-acting neuromuscular blocker.^1,2 Sedation is also used to aid procedures such as the reduction of large joint dislocations and long bone fractures.² 

Ophthalmology is the branch of medicine that encompasses the treatments of diseases of the eye and its annexes.

The eye is the primary organ of vision and it is embryologically an extension of the central nervous system.¹ It shares many common anatomical and physiological properties with the brain; both are protected by bony walls, have firm fibrous coverings and are perfused by fluids of like composition and are under equivalent pressures.¹

Family medicine or general practice is a specialty, often practiced in the community, which provides primary treatment for many diseases.¹ It is a specialty that diagnoses and treats patients of all ages, and is not limited a specific group of diseases. However, if more specialist knowledge is required, patients are often referred to hospital based colleagues. This has led to general physicians actively co-ordinating patient care.

Children are monitored from birth to ensure that they grow and develop normally, both physically and mentally. Vaccination programmes were introduced in 1974 and are followed to protect children from potentially fatal or disabling infectious diseases, thus reducing childhood morbidity and mortality rates.²

Gastroenterology is the medical specialty that involves the study of the digestive system and its associated glands. It also encompasses the treatment of many diseases that affect the organs or glands of the digestive system.

The role of the digestive system is to ensure the ingestion and digestion of food in order to extract energy and nutrients necessary for survival of the organism and excrete what can not be absorbed.¹ The digestive system is made up of a series of hollow organs linked together to form a tube that connects the mouth to the anus, and includes; the oral cavity, oesophagus, stomach, duodenum, small intestine, large intestine or colon, and rectum.¹ The digestive system also includes organs that lie outside the digestive tract; salivary glands, liver, gallbladder and pancreas, but they secrete enzymes and juices necessary to digest food chemicals.¹

Gerontology is the science of human aging¹, its implications and its involvement in the broadest sense. Its purpose is to study the modalities and the causes of the changes that age imparts to the functioning of living beings, on all levels (biological, psychological and social) and at all levels of complexity (molecule, cell, organ, organism and population). It is a meeting point of multiple disciplines.

Geriatrics is the branch of medicine that specialises in the care of older people.¹ A number of disorders occur almost exclusively in these patients. Osteoporosis is a prevalent disease, affecting mainly postmenopausal women and is characterised by bone loss.¹ Complications, such as fractures occurring from minor trauma (jarring movement, small falls) can lead to a degradation of quality of life, sometimes transitory but often definitive.²
Other disorders that affect people of all ages may cause different symptoms or complications in older people, for example; depression usually causes younger adults to become tearful, withdrawn, and noticeably unhappy.¹ In older people, depression sometimes causes confusion, loss of memory, and apathy without a sense of sadness.¹ Polypathology (co-existence of several chronic diseases in the same individual) is also common and therefore an understanding of polypharmacy (chronic consumption of more than four different drugs) is important.³

Haematology encompasses the study of blood formation (haemopoiesis) and function, as well as the diagnosis and treatment of diseases of the blood.¹

Anaemia is a disease that causes an abnormally low erythrocyte cell mass, either by reduced production or increased break down of these cells.² The most common cause of anaemia is a lack of iron, causing reduced production of haemoglobin and reduced oxygen distribution. This is easily treated with iron supplements and a healthy balanced diet.³ It is a disease in its own right, but it is also associated with many others (heart disease,^4,5 cancer⁶ and diabetes⁷).

Hepatology is the medical specialty detailing the study, diagnosis and treatment of diseases relating to the liver and biliary tree.

The liver originates from endoderm and forms as an outgrowth of the duodenum. It is divided into right and left lobes; the former is approximately six times larger than the latter.¹ The liver receives oxygenated blood from the hepatic artery; however, it also receives blood through the hepatic portal vein. The latter contains the products of digestion that have been absorbed from the intestines. The main role of the liver is to metabolise the products of digestion, drugs and alcohol. It also syntheses blood proteins.²

HIV exists in two forms: HIV-1 (most common) and HIV-2. Type 2 is rare and impacts specifically in West Africa.²

The first identification of people with AIDS was in 1981 but the link between HIV and AIDS was not established until 1984.¹

Immunology is the branch of biology that studies the immune system, and the mechanisms involved in the defense of an organism when it is confronted with a foreign substance (antigen).

The innate immune system has evolved over billions of years by the interaction of micro-organisms with antigens.¹ The emergence of the adaptive immune system seems, however, more recent and coincided with the arrival of the first jawed vertebrates, some 400 million years ago.² This system, which was more accurate and efficient, gave better protection against virulent pathogens, or pathogens that were difficult to remove.²

An infectious disease is caused by the transmission of a pathogen (bacterium, fungus, virus, parasite, prion) that will cause a harmful or lethal disorder in the host-organism.¹

Infectious diseases kill more than 14 million people each year, mainly in developing countries.² Nearly 90% of these deaths are attributable to five major infectious diseases (AIDS, tuberculosis, malaria, and acute diarrheal and respiratory infections in children).² In Europe, programs against infectious diseases have controlled, and even eliminated some of these diseases (cholera³, polio⁴). However, during the last ten years, European physicians have seen the appearance or reappearance of some diseases^5,6 which are threatening the economy and global public health.²

Internal medicine is described by the European Federation of Internal Medicine as "the core medical discipline that is responsible for the care of adults with one or more complex, acute, or chronic illnesses".¹ This patient centered specialty encompasses both hospital and community care, with a major role in the management of different subspecialties.¹

This broad specialty can be divided into many further subspecialties; adolescent medicine, allergy and immunology, cardiology, critical care, endocrinology, gastroenterology, geriatrics, haematology, infectious disease, nephrology, oncology and rheumatology.

Medical genetics is the specialty that studies the heredity and genetic causes of disease. Increased knowledge of genetics, medical genetics in particular, has been particularly important in recent years. The human population is not homogenous in terms of risk of disease, every human being has a uniquely defined risk based on their genetic constitution and the environmental characteristics.¹

Using ovarian cancer as an example, a genetic predisposition is found in 10% of confirmed cases.2 Mutations of the BRCA genes are responsible for a large proportion of hereditary cases. The identification of predisposing genes, and the development of molecular diagnosis of the genetic risk, has permitted effective screening and disease prevention.²

Andrology and urology are specialties that involve the study, diagnosis and treatment of male reproductive system and urinary tract dysfunction.

The male reproductive system consists of; the scrotum containing the testes, the epididymis and vas deferens connecting the testes to the prostate, the prostate itself, and the urethra connecting the prostate to the final component, the penis.¹

Pain, discomfort and loss of function in the back, neck and extremities are common among working people. These ailments are commonly termed musculoskeletal disorders (MSDs).¹

MSDs  include a wide range of inflammatory and degenerative conditions affecting the muscles, tendons, ligaments, joints, peripheral nerves, and supporting blood vessels.² These include clinical syndromes such as tendon inflammations and related conditions (tenosynovitis, epicondylitis, bursitis), nerve compression disorders (carpal tunnel syndrome, sciatica), and osteoarthrosis, as well as less well standardised conditions such as myalgia, lower back pain and other regional pain syndromes not attributable to known pathology.² Body regions most commonly involved are; the lower back, neck, shoulder, forearm, and hand, although recently the lower extremity has received more attention.²

Perinatal and neonatal medicine encompasses the care of newborn babies immediately prior to and during birth, and in the following 28 days.

Birth is a critical time for both mother and baby; however, due to the routine introduction of antenatal screening and scanning, congenital abnormalities and any potential problems that could arise during birth are usually foreseen. When there is significant benefit to the fetus pre-natal surgery is performed, but this occurs on a case by case basis as there is a high risk of premature birth. The malformations that are sometimes eligible for surgery are; congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, sacrococcygeal teratoma and urinary tract obstructions.¹ Alternatively the time to plan effective post-natal treatment, and to ensure that the birth occurs in a specialist centre, can lead to the best possible outcome.²

Neurology is the branch of medicine dealing with all diseases of the nervous system, including those of the brain, spinal cord and nerves.¹

The nervous system is a highly specialised and complex structure.² It is an information-processing system that regulates all physiological functions of the body.² When a disease affects this system, it can result in difficulty moving, speaking, breathing or problems with memory or behaviour.²

Nutrition is the process of consuming, absorbing, and using nutrients needed by the body for growth, development, and maintenance of life.¹ Nutrition is also the multi-disciplinary science that studies metabolic processes (digestion) and eating behaviours (environmental factors and individual characteristics).

Human foods consumed in the daily diet contain as many as 100,000 substances, but only 300 are classified as nutrients.¹ Some of these are essential nutrients because the body can not synthesise them, meaning they must be consumed in the diet (most vitamins and all minerals).¹

Oncology is the medical specialty which encompasses the study, diagnosis and treatment of cancer. A cancer is a group of cells (usually derived from a single cell) that has lost its normal control mechanisms, and thus has unregulated growth.¹ Cancerous cells can develop from any tissue, within any organ, and can spread throughout the body (metastasize).¹ Cancerous tissue can be divided into those of the blood and blood-forming tissues, and solid tumors; carcinomas or sarcomas.¹

Leukemias and lymphomas are cancers of the blood and blood-forming tissues respectively.¹ Cancerous cells often harm the body by crowding out normal blood cells in the bone marrow and bloodstream, so that normally functioning cells are gradually replaced by cancerous blood cells.¹ Non-Hodgkin's lymphoma and chronic myeloid leukemia are the most common, but still rare.

The specialty of orthopaedics encompasses the surgical aspects of musculoskeletal and sports medicine. This broad specialty involves the treatment of patients of all ages, although the prevalence of specific disorders changes with age.

Paediatric orthopaedic surgery includes the treatment of congenital disorders; dysplasia of the hip, foot malformations (metatarsus adductus, metatarsus varus and clubfoot) and spinal deformities (kyphosis and scoliosis).¹ However, musculoskeletal trauma is the most common reason for children to require orthopaedic treatment. Fractures are more prevalent in children due to weaknesses at the epiphysial growth plates and they perform more physical activity than adults.²

Paediatric medicine is the specialty that encompasses the care of young people below the age of 16.¹ The period of a person's life from neonate to adolescent includes many developmental milestones, and the body undergoes many changes (physical growth and neurological and psychological development). For these reasons there are many sub-specialties within paediatrics (neonatology and perinatology, paediatric emergency medicine, paediatric rehabilitation medicine and paediatric equivalents of adult subspecialties).²

The physiology and metabolism of children is different from that of adults, although this becomes less pronounced with age.³ Development and growth are exclusive to paediatric medicine; these milestones are useful to monitor the health of the child.³ It is however important to understand the physiology of the child at specific stages to allow for effective disease treatments.

Pain management is the specialty that diagnoses and treats pain with the aim to reduce patient suffering. Pain occurs for many different reasons; however, these can be broken down into three main groups: somatic, visceral and neuropathic pain.¹

Somatic and visceral pain is often symptomatic of an underlying problem, either injury or illness, which reduces in line with recovery.¹ The management of this pain must consider the side-effects of any treatment. Management of short-term pain is primarily through analgesics such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). Despite being one of the most commonly prescribed drugs worldwide, NSAIDs may have serious side effects (gastrointestinal toxicity, dyspepsia and ulcers) and should not be used long-term.²

Palliative medicine is the branch of medicine that deals with inter-professional approaches to palliative care.¹ According to the World Health Organization (WHO, 2007), palliative medicine aims to improve the quality of life of patients and their families facing the problems associated with "life-threatening illness.² This can be achieved through preventive measures and early treatment, the correct diagnosis of the disease, early recognition and treatment of pain and other problems, physical, psychosocial and spiritual".²

Palliative care is active and ongoing care practiced by an interdisciplinary team in institutions or at home.³ The aim is to relieve pain, alleviate psychological suffering, safeguard the dignity of, and support, the patient.³ The palliative care team will relate to people of all ages with a serious, progressive disease that is life-threatening, advanced or terminal. The care is designed to improve comfort and quality of life while relieving symptoms; it includes physical, psychological, spiritual and social support for the patients and their families.³

Plastic surgery and aesthetic medicine, or cosmetic surgery as it is more commonly known, are often associated with the enhancement of normal appearance. However, these specialties also include reconstructive surgeries following cancer or severe burns and the repair of congenital abnormalities.

Treatment for many cancers involves the surgical removal of the tumor which, in the case of breast and skin cancers, can leave a visible change in appearance. The immediate reconstruction of the breast following a mastectomy has become common practice; providing better outcomes, and reducing the economic burden of secondary hospitalisation.¹

Podiatry is the medical science detailing the study, prevention, diagnosis and appropriate management of diseases of the foot and ankle.

The foot plays an essential role in standing and locomotion.¹ It supports the body's weight during standing, levers it forward during walking, and absorbs shock during running and jumping.¹ The foot is exposed to forces between two and four times a person's bodyweight during running, and jumping.² This intense and repeated exposure makes the foot the site of many problems.²

Preventive medicine is the branch of medicine that aims to prevent the appearance, the aggravation or the extension of disease at individual and collective levels.¹

Preventive medicine has four components; disease prevention, screening, epidemiology and health education.² It gives advice (cleanliness, diet, and physical activity), educates people about risk behaviors (smoking and alcohol) and sets up monitoring and screening campaigns (cancer and hypertension).² This discipline has developed since the end of the 19th century, following numerous discoveries in bacteriology and immunology.¹

Psychiatry is the medical specialty dealing with mental illnesses, including prevention, diagnosis and treatment of these disorders.

Psychiatric disorders include a large number of very different diseases that affect thinking, emotion and/or behaviour.¹ These disorders are caused by complex interactions between physical, psychological, social, cultural and hereditary influences.¹

Radiology is the science that studies, and medical specialty that uses radiography; which includes techniques for producing images of the internal structure of a patient with X-rays. It also includes other non-radiographic techniques of medical imaging, such as ultrasound or magnetic resonance imaging (MRI).

The inventor of the first X-rays was the German professor Wilhelm Roentgen (1845-1923).1 During his work, he discovered an unknown type of radiation which passed through the glass and paper, but was stopped by lead and platinum.1 He decided to name this radiation by the letter of the mathematical unknown; X-ray. In 1895, Roentgen made history when he used his wife’s hand to create the first X-ray image.¹

Respiratory medicine is the medical specialty that focuses on the study of the respiratory system, and on the diagnosis and the treatment of diseases of the lungs and bronchi.

In Europe, and worldwide, respiratory diseases are a leading cause of morbidity and mortality.¹ Overall, in terms of incidence, prevalence, cost and mortality, they are placed second, behind cardiovascular disease.¹ In 2003, the total financial cost of lung disease in Europe was estimated at 102 billion Euros.¹ The most common respiratory diseases are; lung cancer, chronic obstructive pulmonary disease (COPD), asthma, pneumonia, and tuberculosis.¹

Rheumatology is the medical specialty that focuses on the diagnosis and treatment of diseases of the musculoskeletal system (bones, joints, muscles, tendons, and ligaments).¹

The specialty of rheumatology encompasses more than 150 diseases such as; rheumatoid arthritis (RA), osteoarthritis, osteoporosis, scleroderma, ankylosing spondylitis, systemic lupus erythematosus, Sjogren's disease and vasculitis.¹

Sexually transmitted infections or diseases (STIs or STDs) are infectious diseases caused by various micro-organisms (viruses, bacteria, fungi or parasites) that are transmitted during sexual contact.¹ Historically, these diseases were known as venereal diseases, named after Venus, the Greek goddess of love.²

Nowadays, the most common STIs are AIDS, genital herpes, syphilis, gonorrhea, genital warts, chlamydia and trichomoniasis.¹ Some of these infections can be fatal (AIDS, syphilis), others cause a predisposition to the development of malignancies (hepatitis B, human papillomavirus) or cause infertility (gonorrhea, chlamydia).²

Sleep medicine is a specialty or subspecialty devoted to the diagnosis and treatment of sleep disturbances and disorders. From the middle of the 20th century, research has provided increased knowledge about the circadian rhythm, and has answered many questions surrounding the impact of sleep, or lack of it.¹

Sleep represents more than a third of life, however, the sustained rhythms of life imposed by society unsettle and affect sleep; through stress, jet-lag, and shift work.²

Sports medicine is the specialty that encompasses the different medical aspects of sport. The generic term "sport" covers a multitude of activities¹ carried out in different ways, and with widely varying intensities and frequencies.² Amateurishness (educational practice, mass sport and recreational sport) can simply be distinguished from the competitive or top level sport.¹

Sports medicine studies the physiology and psychology of sport; energy metabolism, nutrition, the body’s adaptations to effort, blood doping, training and over-training, recovery, fatigue or stress.¹ It includes accident prevention in athletes, the diagnosis and management of injuries due to sporting activities.³ Some injuries are very common in sport, often due to excessive practice or a lack of training (stress fracture, tendonitis, tendon injuries and other sprains and pulled muscles).³

Surgery is the term traditionally used for treatments that involve cutting or stitching tissue.¹

Surgery is one of the oldest forms of medicine; evidence of its activity has been found since prehistoric times, mainly through acts of trepanation.² Patient survival has been dependent on technical and scientific advances that have marked the centuries.³ The invention of writing, and then printing, allowed for the acquisition and transfer of knowledge.³ The discovery of germs and antiseptics, caused a reduction of postoperative mortality, and the development of imaging techniques has improved surgical practices.³

As clinicians, we are all familiar with the knowledge that clinical trials bring in terms of drugs and how management strategies compare with each other. However, the relationship between clinical trials and real-world practice is uncertain. Clinical trials enforce standard protocols which may not reflect what really happens in everyday practice. Registries are emerging as important and give us valuable insights into current clinical practice.

AF (atrial fibrillation) is well known as a risk factor for stroke; effective anticoagulation is essential to reduce the impact of AF-related stroke on patients. Concomitant medical conditions, such as coronary artery disease or angina, increase the risk of AF and can influence its subsequent management. Data from several large registries recently presented at the European Society of Cardiology (ESC) congress, held in Munich from 25 to 29 August 2012, promise to help improve our understanding of this clinical problem.

Transplantation is the transfer of living cells, tissues or organs from one person to another, or from one part of the body to another.¹ The most common type of transplantation is a blood transfusion, which is used to treat millions of people each year. Some organs or tissues, such as kidney, heart and cornea can also be transplanted.¹

In 2007, more than 275,000 Europeans were living with an organ transplant and thousands more were waiting for a transplant.² The rise of chronic diseases and an aging population has resulted in increased indications for transplantation.2 Indeed, organ transplantation is often the only option for conditions leading to irreversible loss of function of vital organs.²

Tropical medicine is the specialty that encompasses the study and the treatment of diseases endemic to tropical and subtropical countries.

Malaria, tuberculosis (TB) and HIV are the three major tropical diseases, although there are many others emerging or remerging (avian influenza, chikungunya, West Nile virus, polio, leprosy, schistosomiasis, lymphatic filariasis and dracunculiasis).¹

Urology is the medical and surgical specialty that studies the kidneys and urinary tracts of men and women, and the male reproductive system (male urogenital tract). It also encompasses the diagnosis and treatment of diseases of the kidneys, ureters, bladder, urethra and male reproductive system.

Kidneys produce urine by continuous blood filtration. Each kidney is composed of approximately one million nephrons which represent the functional unit. The nephrons are composed of glomeruli, tubules and tubulointerstitial spaces; it is these areas that are often affected during renal diseases.¹ Nephritic,² nephrotic,³ asymptomatic proteinuria and hematuria syndromes⁴ are all paediatric disorders of the glomerulus that result in the presence of large molecules in the urine. Tubulointerstitial nephritis is a disorder which causes the inflammation of the tubules and tubulointerstitial tissue and is the cause of 15% to 27% of all acute kidney injuries.⁵

Vaccines are preventative treatments which are used to control infectious diseases. The effective use of vaccines has led to the reduction, and in one case the eradication (smallpox 1979¹), of many diseases that pose a hazard to human health.

The adaptive immune system plays a vital role in the use of vaccines.² This is a specialised system that protects the body against foreign pathogens through the mechanisms of antigen recognition and memory.² On the first encounter with a pathogen, the cells of the immune system identify the antigen and T and B lymphocytes are activated.² B lymphocytes differentiate into plasma cells and produce specific antibodies against the antigen which will assist in destroying the pathogen.² After infection, cells are stored, giving effective protection in the event of subsequent encounter by the same pathogen.²

The specialty of gynaecology encompasses the study, diagnosis, and treatment of diseases of the female reproductive organs. Obstetrics specifically includes pregnancy, labour and birth.

Menstruation is a natural process in post-pubescent and pre-menopausal women, with the average menstrual cycle lasting 28 days.¹ Menstrual disorders include: premenstrual syndrome (PMS),² dysmenorrhea,¹ amenorrhea,¹ and polycystic ovary syndrome (PCOS).³ PCOS is a common and perplexing endocrine disorder of women in their reproductive years, with a prevalence of up to 10%.⁴