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Amenorrhea

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What is megaloblastic (pernicious) anemia?
Megaloblastic anemia, also called pernicious anemia, is a blood disorder in which there is anemia with red blood cells that are larger than normal. In addition to the cells being large, the inner contents of each cell are not completely developed. This malformation causes the bone marrow to produce fewer cells that die earlier than the 120-day life expectancy. Instead of being round or disc-shaped, the red blood cells can be oval. Megaloblastic anemia usually results from a deficiency of folic acid or of vitamin B-12.

What’re causes of megaloblastic (pernicious) anemia?
Deficiencies of vitamin B12 and folic acid are the most common causes of megaloblastic anemia. Other causes include:

Digestive diseases. Megaloblastic anemia is caused by certain diseases of the lower digestive tract ( include celiac disease, chronic infectious enteritis, and enteroenteric fistulas). Pernicious anemia is a type of megaloblastic anemia caused by an inability to absorb Vitamin B-12 due to a lack of intrinsic factor in gastric secretions.
Malabsorption. Inherited congenital folate malabsorption, a genetic problem in which infants cannot absorb folic acid in their intestines, can lead to megaloblastic anemia.
Drugs that affect DNA synthesis such as chemotherapy drugs, include phenytoin, primidone, and phenobarbital, can impair the absorption of folic acid.
Other causes are leukemia, myelodysplastic syndrome, myelofibrosis, alcohol abuse.
What’re symptoms of megaloblastic (pernicious) anemia?

The following are the most common symptoms of megaloblastic anemia:
Change in skin color
Diarrhea
Headaches
Loss of appetite
Pale skin color
Sore mouth and tongue
Tingling and numbness of hands and feet
Tiredness
How is diagnosis of megaloblastic (pernicious) anemia?
Megaloblastic (pernicious) anemia is usually discovered during a medical examination through a routine blood test. Diagnostic procedures for megaloblastic (pernicious) anemia may include:
Complete blood count (shows anemia with large red blood cells)
Bone marrow examination (can help show whether your bone marrow is healthy and making enough red blood cells)
Serum B12 (can help show vitamin B12 blood level)
Schilling test (detect vitamin B12 absorption)
Serum folate (can help show whether you have pernicious anemia or another type of anemia)

How is treatment of megaloblastic (pernicious) anemia?
The goal of treatment for megaloblastic (pernicious) anemia include preventing or treating the anemia and its signs and symptoms ; controlling complications, such as heart and nerve damage. The treatment depends on the cause. If the disorder is caused by an absorption problem in the digestive tract, this may need to be treated first. Usually treatment may include vitamin B12 injections and folic acid supplement.

Monthly vitamin B12 injections are prescribed to correct the vitamin B12 deficiency. This therapy corrects the anemia and may correct the neurological complications if taken soon enough. For less severe megaloblastic (pernicious) anemia, you should take large doses of vitamin B12 pills. A vitamin B12 nose gel and spray also are available. A well-balanced diet is essential to provide other elements for healthy blood cell development, such as folic acid, iron, and vitamin b12.

Which foods are contain rich folic acid and vitamin B12:
eggs
meat
poultry
milk
shellfish
fortified cereals

How is prevention of megaloblastic (pernicious) anemia?
If pernicious anemia is caused by a lack of intrinsic factor, you can’t prevent. If megaloblastic (pernicious) anemia is caused by not get enough vitamin B12 and folic acid in their diets, adequate intake of vitamin B-12 and folic acid is helpful.

Submitted by Health Studies on Wed, 04/29/2009 – 20:59
Endocrine Diseases
Hypopituitarism
Treatment for Hypopituitarism include as follow:

1. Glucocorticoid:
Hydrocortisone, a dose is 5 ~ 30mg / d. Medication: if small doses, take after breakfast; if the middle doses, can take 2 / 3 after breakfast, take 1 / 3 in the afternoon. Also use cortisone, a dose is 6.25 ~ 37.5mg / d, or prednisone 2.5 ~ 7.5mg / d. In case of fever, infection, surgery, may be appropriate in amount. After mitigation of complications, down to the normal dose.

2. Thyroid tablets:
Should be started by a small dose, 10 ~ 40mg / d, 2 ~ 4 weeks later increased to 40 ~ 80mg / d. Thyroid tablets with glucocorticoids or with a few days later to prevent crisis-induced. Or levothyroxine tablets (L-T4) 25µg / d, and gradually increase, in the maintenance is about 100 ~ 200µg / d.

3. Artificial cycle treatment for Young women:
Oral diethylstilbestrol 0.25 ~ lmg / night, a total of 20d, after 16 days since taking progesterone intramuscular injection 10mg / d, a total of 5d. If have menstruation period after discontinuation, can take the next cycle after five day; if without menstruation after stopping, can take the next cycle after seven day. Generally consecutive three cycle, then stop for 1 month. Or oral contraceptives, drug withdrawal induced menstruate. If necessary, Ues HMG (human menopausal gonadotropin in urine) to trigger ovulation, after 2 ~ 3 weeks, observat estrogen, if have ovarian response, can use human chorionic gonadotropin.

4. Keto acid pill Sim:
Males can inject with 25mg, 1 ~ 2 / week, women should not exceed monthly dose 250mg.

5. Surgery or radiotherapy:
If Hypopituitarism is caused by pituitary chromophobe cell tumors or intracranial tumor, treatment is surgery or radiation therapy.

6. Crisis management:
1) 50% glucose solution intravenously 40 ~ 60ml rapidly, followed by a 10% glucose infusion to maintain;
2) intravenous hydrocortisone, 300mg / d or more;
3) patient with infected can use antibiotics to control infection, and peripheral circulation failure, should add blood volume, use step-up drug;
4) patient with low-temperature can use thyroid agents, started a small dose for fast-action preparations, such as three-triiodothyronine (T3);
5) inducement of crisis treatment.

Submitted by Health Studies on Wed, 04/29/2009 – 19:36
Endocrine Diseases
Hypopituitarism
Diagnosis of Hypopituitarism is based on clinical manifestations and laboratory tests. Such as pituitary hormone abnormalities and lack of hormone. Sella’s skull X-ray determination will prove the existence of tumor. High-resolution CT or MRI is the preferred tests method. When no high-resolution CT, can use multi-layered sellar radiography. angiography can be use only when the X-ray examination prompted parasellar vascular anomalies or hemangioma. For diameter> 10mm pituitary adenoma, simple and low focus tube pituitary lateral film is the preferred tests.

When suspect Hypopituitarism, the first diagnosis should examine the lack of TSH and ACTH, because these diseases may be life-threatening.

Assessment of thyroid function: radioimmunoassay can measure T4, T3 and TSH. At all levels should be reduced, due to increased TSH that primary thyroid dysfunction. TRH200 ~ 500µg synthetic intravenous injection can identify hypothalamic pituitary lesions. TSH response would typically be found in the peak 30 minutes after injection, the hypothalamus was elevated TSH delay disease.

Assessment of ACTH secretion: Some patients with adrenocortical dysfunction is in the normal range of serum cortisol, but reduced the reserve function of one or more of the ACTH-adrenal axis response to the lower stimulation test. Assessment of ACTH (and GH and PRL) reserve the the most reliable way is to insulin tolerance test, a dose of regular insulin 0.1u/kg weight, in 15 ~ 30 seconds, intravenous injection, zero (before injection of insulin), 20,30,45,60 and 90 minutes and then collecting vein Determination of cortisol and GH blood glucose levels. such as a slight decline in serum glucose less than 50% to <40mg/dl (2.22mmol / L), tests should be repeated. (Note: the test for serious full-pituitary dysfunction or elderly patients with DM and can be There are accidents of ischemic heart disease and epilepsy patients are contraindications). usually have only one of hyperhidrosis, tachycardia, nervous. If a patient complained palpitation, loss of consciousness, seizures, tests should be immediately terminated, intravenous injection of 50 % glucose.

PRL assessment: All patients with Hypopituitarism, PRL is not always suppressed. In fact, the hypothalamus of the disease as a result of the loss of dopamine inhibited PRL, PRL can be increased. Hyperprolactinemia a result, there is often accompanied by low gonadotropin and secondary sexual dysfunction.

GH Tests: adults do not advocate the GH lacking routine screening, because even found the lack of GH, customary no process, unless is short and small patient with epiphyseal closure.

GH tests in children. As a result of decreased thyroid and adrenal gland of patients, GH is usually abnormal reaction, so the provocative test must be performed after hormone replacement therapy. Insulin tolerance test can be most effectively excited about the release of GH. The danger of the smaller and less reliable that GH release test arginine (500mg/kg, intravenous drip for 30 minutes), oral L-dopa (adult 500mg, children 10mg/kg), sleep or 20 minutes after strenuous exercise. clonidine (4µg/kg oral ) GH release is another powerful agent, promising to replace insulin. sleepiness side effects and only a mild drop in blood pressure. Generally speaking, determination of GH> 10ng/ml or stimulated GH response> 5ng/ml sufficient to rule out the lack of GH . GH increase <5ng/ml or excited after <10ng/ml, the result difficult to explain.

Serum LH and FSH assessment: menopausal women who no use exogenous estrogen, in the determination of baseline assessment of these hormones on the pituitary hypofunction most helpful. Such menopausal women, usually GnH is high (> 30mIU/ml). Measuring the basis of LH and FSH on the others very little help. although lower GnH pituitary dysfunction, but with the normal LH and FSH overlap. GnRH100µg intravenous synthesis, LH and FSH response should be increased. GnRH injection after the LH peak about 30 minutes, FSH peak in 40 minutes. However, the normal response to GnRH, the low, the lack of can be found in the hypothalamus – pituitary dysfunction. LH and FSH response to GnRH increased significantly change the normal, with no exogenous GnRH help primary and primary hypothalamic pituitary disease identification.

Assessment of a variety of hormone: simultaneous determination of several pituitary hormones reserve is the most effective diagnosis of pituitary function. Insulin (regular insulin 0.1u/kg), TRH (200µg), GnRH (100µg) with 15 ~ 30 seconds with intravenous Note, 180 minutes, many times Determination of blood glucose, cortisol, GH, TSH, PRL, LH, FSH and ACTH. Another way is to use insulin alone, 120 minutes later, given to TRH and GnRH together. GHRH (1µg/kg) , CRH (1µg/kg) and TRH, GnRH should together intravenous injection.

What is Hirsutism?
Hirsutism is condition that increased density of hairs, and longer and much, more than the normal physiological range in women, the general performance in the face, genitals, armpits, abdomen, back and four limbs increased hair growth and thickening black, some long beard, chest hair and nipples long-haired, often accompanied by irregular menstruation, sex apathy.

What causes Hirsutism in women?
The common causes of hirsutism include adrenal tumors, ovarian tumors, polycystic ovary, ovarian hyperthecosis and primary hirsutism. Possible cause as follow:

1. Congenital: includes family hirsutism, premature disease, male hermaphroditism and primary hirsutism. Primary hirsutism is caused by hair follicle sensitive to endogenous androgen or dihydro testosterone increased.

2. Brain and hypothalamic lesions, such as encephalitis, multiple sclerosis, and hyperplasia of the skull can cause hirsutism.

3. Pituitary hirsutism, such as acromegaly, diabetes, Cushing’s syndrome secondary can cause hirsutism.

4. Youth hypothyroidism can cause hirsutism.

5. Adrenal gland disease Cushing’s syndrome can cause hirsutism.

6. Women with menopause or polycystic ovary or ovarian hyperthecosis or ovarian tumors can cause hirsutism.

7. Women due to use exogenous drugs (such as androgen, phenytoin satisfied, synthetic progesterone, cortisone) or pregnancy, mental anorexia, tension or mental stimulation can cause hirsutism in women.

What are symptoms of Hirsutism in women?
Excessive hair growth at some parts in women, usually occur in the upper and lower extremities, face; the distribution is tendency to man, hair in upper lips, ears, forehead, and neck fast increase. Around the nipple, under umbilicus midline, can found long hair, pubic hair distribution of diamond-shaped, upward and around the development to the anus. Sometimes associated with masculinity, such as occur Adam’s apple, tone low and clitoris hypertrophy.

How is Hirsutism diagnosis?
Some tests use to diagnosis for hirsutism:
1) basal hormone levels test: including serum T, DHEA S, 17A2-hydroxy progesterone, prolactin, LH, FSH and SHBG, on the PCOS, congenital adrenal hyperplasia and ovarian or adrenal tumors have a better screening effect.

2) excitement and inhibition test: not completely congenital adrenal hyperplasia should perform ACTH stimulation test; Cushing syndrome should perform dexamethasone suppression test.

3) abdominal B ultrasound and CT and pituitary magnetic resonance imaging (MRI) is an important method of Hirsutism diagnosis.

How is Hirsutism treatment?
Treatment of Hirsutism is Permanent hair removal surgery (including: laser hair removal, hair removal photon, Intense Pulsed Light hair removal, hair removal electric needle).

Female hirsutism is abnormal hair growth in women, pathological manifestations that distribution of body hair were the characteristics of male. Mild hirsutism that hair is only found in more localized, severe hirsutism that was hairy from head to foot. hirsutism occurred in a family genetic, and tumors, endocrine disorders and certain drugs. In addition, an idiopathic hirsutism accounted for the majority hirsutism women, maybe those women’s hair is too sensitive to androgen. Treatment for hirsutism women, modern medicine use corticosteroid and anti-androgen such as dexamethasone, oral contraceptives, cimetidine, spironolactone and other drugs, but the effect is poor, and after stopping easy to relapse, at the same time, have side effects include loss of libido, depression, dry skin, itching, nausea, high blood pressure.

Specific treatment for hemolytic uremic syndrome will be established by your physician based on your individual condition. There is no known treatment that can stop the progress of the syndrome once it has started. Most treatments are aimed at easing the immediate symptoms and signs of this disease and at preventing further complications.

Typical hemolytic uremic syndrome is a self-limiting disease with spontaneous recovery. Treatment of HUS is supportive, with particular attention to management of intravenous fluids for rehydration and rebalancing of electrolytes like sodium and potassium, which can be lost with the diarrhea.

Hemolytic uremic syndrome treatment may include:

Strict fluid balance monitoring is important in detecting early renal failure. If failure develops, it should be handled aggressively by starting renal replacement therapy (such peritoneal dialysis, hemodialysis).

Blood transfusion are only used for the most severe cases of anemia in which the hemoglobin falls below 6 or 7 g/dL (depending on age, the normal value is 11-16). Blood transfusion given through an intravenous (IV) needle, may help reverse these signs and symptoms.

Plasma exchange (plasmapheresis combined with fresh-frozen plasma replacement) is currently the helpful treatment for HUS. Plasma exchange is removing the plasma and replacing it with donor plasma. It is performed daily until the platelet count normalizes. Plasma exchange is generally reserved for the most severe cases.

Kidney dialysis. Sometimes dialysis is needed to filter waste and excess fluid from the blood. Dialysis is usually a temporary treatment until the kidneys begin functioning adequately again. If the kidney damage is significant, however, permanent kidney failure, requiring long-term dialysis or a kidney transplant.

Good nutrition, you may require intravenous (IV) nutrition if you have severe digestive tract complications.

Antibiotics agents are not recommended as treatments for hemolytic uremic syndrome during the diarrheal stage of the disease. Antibiotic usage in children with E. coli O157:H7 infections show an increased risk of complications from hemolytic uremic syndrome.

Specific treatment for hemolytic anemia will be determined by your physician based on by several factors including your age, overall health, medical history, causes of hemolytic anemia.

Blood transfusion: Symptomatic treatment can be given by blood transfusion, if there is marked anemia. A blood transfusion is a common procedure in which blood is given to you through an intravenous (IV) line in one of your blood vessels.

Medicines: In autoimmune hemolytic anemia, steroid therapy is sometimes necessary. Corticosteroid medicines, such as prednisone, are used to limit or prevent your immune system from making antibodies against red blood cells. If you don’t respond to corticosteroids, your doctor may prescribe other medicines to suppress your immune system.

Surgery: Splenectomy may be the first choice of treatment in some types of hemolytic anemia such as hereditary spherocytosis. The spleen is an organ in the abdomen. A healthy spleen helps fight infection and filters out old or damaged blood cells. An enlarged or diseased spleen may remove more red blood cells than normal, causing anemia. Removing the spleen can stop or reduce high rates of red blood cell destruction. In other cases, such as in autoimmune hemolytic anemia, it is recommended when other measures have failed. Splenectomy is usually not recommended in hemolytic disorders such as cold agglutinin hemolytic anemia.

Bone Marrow Transplants: Blood and marrow stem cell transplants may be used to treat some types of hemolytic anemia, such as thalassemias.

Change in diet: Eat a varied diet rich in vitamin and mineral supplements. If you have autoimmune hemolytic anemia with cold-reactive antibodies, try to avoid cold temperatures. This can help prevent the breakdown of red blood cells. It’s very important to protect your fingers, toes, and ears from the cold. Patients with G6PD deficiency should avoid eating fava beans, and certain medicines (such acetanilid, furazolidone, isobutyl nitrite, nalidixic acid, naphthalene, niridazole).

 

Eosinophilia is an abnormal increase in the eosinophils (type of white blood cell) in blood or body tissues. Eosinophils are produced in the bone marrow existing normally in the bloodstream and gut lining, which helps the body fight infection from parasitic organisms. On an average around 5% to 7% of white blood cells constitute eosinophils but if you have a higher count then it means that you either have borderline eosinophilia or actual progressing eosinophilia that can cause significant health hazards.

Emphasis is placed on the number of eosinophils circulating in the peripheral blood, although an increase in eosinophils can be observed in other body fluids (eg, cerebrospinal fluid, urine) and many body tissues (eg, skin, lung, heart, liver, intestine, bladder, bone marrow, muscle, nerve).

Eosinophils are derived from hematopoietic stem cells initially committed to the myeloid line and then to the basophil-eosinophil granulocyte lineage. Tissues of the pulmonary and gastrointestinal systems are the normal residence for eosinophils, but peripheral, or blood, eosinophilia (absolute eosinophil count more than 600 per cubic millimeter) indicates an eosinophilic disorder. Eosinophilia can be categorized as mild (less than 1500 eosinophils per cubic millimeter), moderate (1500 to 5000 per cubic millimeter), or severe (more than 5000 per cubic millimeter). An increase in tissue eosinophilia may be seen with or without concurrent peripheral eosinophilia.

In general eosinophilia occurs as a response to parasites (such as filaria or helminths), or from allergy as occurs with asthma and allergic rhinitis, or in some gastrointestinal disorders that may be associated with food allergy. A few drugs or inhaled allergens can cause inflammatory tissue changes accompanied by eosinophilia in susceptible people.

Parasites are a common cause of eosinophilia, and there is often an association with asthma. In occasional patients, an idiopathic hypereosinophilic syndrome occurs, with an eosinophil count in excess of 1500 cells per cubic millimeter of blood, and the heart or nervous system may be affected. Other causes that may be responsible for eosinophilia include collagen-vascular diseases or skin diseases such as pemphigus. Thus, there are numerous rare causes of eosinophilia to consider, although sometimes there is no obvious disease in some people who have prolonged persistence of the high eosinophil count. It is not unusual for the abnormality to eventually clear up without treatment.

 

What’re the symptoms and signs of bacteremia?
Usually, bacteremia that results from ordinary events such as dental procedures causes no symptoms. People with bacteremia from other causes sometimes have fever. If people with bacteremia have a fever, a rapid heart rate, rapid breathing, and multiple organ failures, sepsis is likely.

The list of signs and symptoms mentioned in various sources for Bacteremia includes some symptoms listed below:

fever over 38.3°C
chills
malaise
abdominal pain
nausea
vomiting
diarrhea
anxiety
shortness of breath
confusion
How is bacteremia diagnosed?
The diagnosis of bacteremia is made from a blood culture, in which a sample of blood is allowed to incubate with a medium that promotes bacterial growth. This test requires 24 to 48 hours for the results to come back. Since blood is normally sterile, this process does not normally lead to the isolation of bacteria. If, however, bacteria are present in the bloodstream at the time the sample is obtained, the bacteria will multiply and can thereby be detected. Any bacteria that incidentally find their way to the culture medium will also multiply. For this reason, blood cultures must be drawn with great attention to sterile process. Occasionally, blood cultures will reveal the presence of bacteria that represent contamination from the skin through which the culture was obtained. Blood analysis may also reveal an elevated number of white blood cells. Blood pressure is monitored closely; a decline in blood pressure may indicate the onset of septic shock.

 

What is symptoms of anaphylactic shock?
An anaphylactic shock reaction is most likely to occur in susceptible people who’ve been stung by an insect, eaten something they’re allergic to, or taken a medication that they are sensitive to. Even if you’ve only had a mild allergic reaction in the past, you still may be at risk of anaphylaxis. The symptoms of anaphylaxis can vary. In some people, the reaction begins very slowly, but in most the symptoms appear rapidly and abruptly.

1. The most severe and life-threatening symptoms are difficulty breathing and loss of consciousness.

Difficulty breathing is due to swelling and/or spasm in the airways (which can include swelling of the tongue or the airways). In very rare cases, breathing can stop altogether.
Loss of consciousness is due to dangerously low blood pressure, which is called “shock.”
In the most serious cases, the heart can stop pumping altogether.
These events can lead to death from anaphylaxis.
2. While some symptoms are life threatening, others are merely uncomfortable. Generally, a reaction must involve at least two different body systems, such as skin and heart, to be considered anaphylaxis.

General
Tingling or sensation of warmth – Often the first symptom ;
Difficulty swallowing ;
Nausea, vomiting ;
Diarrhea, abdominal cramping, bloating ;
Anxiety, fear, feeling that you are going to die ;
Confusion.
Skin: Most anaphylactic reactions involve the skin.
Hives, welts, or wheals (raised bumps): Hives can cause severe itching ;
Generalized erythema (redness) ;
Swelling in the face, eyelids, lips, tongue, throat, hands, and feet.
Breathing: Swelling of the surrounding tissues narrows the airways.
Difficulty breathing, wheezing, chest tightness ;
Coughing, hoarseness ;
Nasal congestion, sneezing.
Cardiovascular: Blood pressure may drop to dangerously low levels.
Rapid or irregular heart beat ;
Dizziness, faintness ;
Loss of consciousness, collapse.
What is signs of anaphylactic shock?

Abnormal heart rhythm (arrhythmia)
Fluid in the lungs (pulmonary edema)
Hives
Low blood pressure
Mental confusion
Rapid pulse
Skin that is blue from lack of oxygen or pale from shock
Swelling (angioedema) in the throat that may be severe enough to block the airway
Swelling of the eyes or face
Weakness
Wheezing

Amenorrhea is condition that absence of menstruation, stop menstruation after already menstrual cycle. Amenorrhea is a common gynecological disease, divided into two types: primary Amenorrhea and secondary Amenorrhea. primary amenorrhea is that over 14 years of girl had yet to come menstruation, it often is caused by congenital anomalies, including ovarian or mullerian dysplasia. Secondary amenorrhea is that Menstrual period has stopped for over 6 months (except for pregnancy or breast-feeding), and often caused by secondary diseases. True amenorrhea is absence of menstruation that can be caused by the spirit of factors, malnutrition, anemia, tuberculosis, excessive curettage, endocrine disorders. Recessive amenorrhea is a result in congenital hypogenesis or acquired injure to cause reproductive tract adhesions or close, and lead to menstrual discharges.

Amenorrhea causes include functional and organic. The hypothalamus – pituitary – ovarian axis dysfunction induced amenorrhea is a functional amenorrhea; organic factors such as genital hypoplasia, cancer, trauma, chronic wasting disease. According to different anatomical, can divided into amenorrhea uterine, ovarian amenorrhea, pituitary and hypothalamic amenorrhea.

The diagnosis of Amenorrhea need physical examination. Endocrine inspection include the following: basal body temperature, vaginal smears, the crystallization of cervical mucus, endometrial biopsy. Determination of blood hormone levels, including: prolactin, luteinizing hormone and follicle-stimulating hormone, therapeutic check artificial such as progesterone withdrawal test and menstruation cycle test, if necessary, also the determination of adrenal and thyroid function.

If occur amenorrhea, it should be timely to found the cause and symptomatic treatment, generally have better effects. Otherwise, the long term amenorrhea, will be more severe uterine atrophy, treatment effects will be worse. The girl can or can’t cure amenorrhea the depends on the causes of amenorrhea. For example, adolescent secondary amenorrhea, often due to environmental, mood and weight changes, through remove these causes, menstruation can be cured. If amenorrhea that caused by illness, such as polycystic ovary syndrome, thyroid dysfunction, tuberculosis bacteria, through treatment, also can return menstruation period. But some amenorrhea can not be cured, which are the condition such as the birth is not the uterus, uterine endometrium is too small or has been damaged due to disease.