Osteoporosis is the bone condition characterised by low bone mass, which is associated with with reduced bone strength and an increased risk of fractures. Osteoporosis occurs most commonly in postmenopausal women. Low bone mass may be related to either inadequate peak bone mass acquisition and/or ongoing bone loss. 

Risk factors for osteoporosis (causing bone loss):

• Overactive thyroid (hyperthyroidism)
• Advanced age
• Previous fracture
• Long term glucocorticoid therapy
• Low body weight (less than 58kg)
• Family history of hip fracture
• Cigarette smoking
• Excessive alcohol intake
• Drop in estrogen (late onset of menstrual periods, absent or infrequent periods and premature early menopause before age of 45)
• Pituitary gland failure (hypopituitarism)
• Chronic illness such as chronic liver disease, chronic kidney disease, coeliac disease, rheumatoid arthritis, systemic lupus erythematosus
• Lack of physical activity
• Low Vit D
• Low Calcium intake
• Eating disorders such as anorexia nervosa and bulimia

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Tinea is a fungal infection of skin, nail and hairs. Tinea is usually caused by filamentous fungi such as Trichophyton, Microsporum and Epidermophyton. Among those fungi, Trichophyton is the most common cause of Tinea in human skin.

Tinea can be spread by skin to skin contact or indirectly through sharing of towels, clothes or walking with barefoot on floors. Tinea tends to grow on warm, sweat prone areas of the body.

There are few types of Tinea which depends on the locations of the body affected:

• Tinea corporis- Infection of body surfaces other than feet, groin, face, scalp hair or beard hair
• Tinea pedis- Infection of the foot (Athelete's foot)
• Tinea cruris- Infection of the groin (Jock itch)
• Tinea capitis- Infection of scalp hair
• Tinea unguium (dermatophyte onchomycosis)- Infection of the nail

Symptoms:

• Itching and stinging
• Circular red scaly rash with central clearing (usually happens on body, groin, arms and legs)
• Blister scaly rash due to intense inflammatory reaction 
• Yellow or white discolouration of the nails. Loosening or separation of fingernail or toenail from its bed
• Bald spots on the scalp known as Kerion

Treatment:

• Antifungal cream such as Lamisil cream can be used to treat Tinea but it takes time to work and can be expensive. Canestan cream does not work well in treatment of Tinea
• Terbinafine tablet. More effective but also take time to work. The medication is generic and therefore, even without approval from PBS authority, the price is still reasonable to purchase privately
• Azole tablets such as Itraconazole and Fluconazole  
• Griseofulvin

Coeliac disease is also known as gluten-sensitive enteropathy and nontropical sprue which affects approximately one in 70 Australians. Coeliac disease usually present between the ages of 10 and 40 years. Children with life-threatening malabsorption from coeliac disease are rarer nowadays due to longer periods of breast-feeding and the later introduction of gluten in the infant diet. Foods thats contain gluten caused damage to lining of small intestine and impair absorption of nutrients. This leads to malnutrition, osteoporosis, depression, infertility, iron deficiency anaemia and small increased risk of lymphoma of bowel. It also can cause skin rash such as dermatitis herpertiformis. Coeliac disease is closely associated with type 1 diabetes mellitus and polyglandular autoimmune syndrome type III (autoimmune thyroiditis).

Foods that contain gluten are as follows:

• Barley
• Rye
• Oats - consumption should be limited to 50 to 60g/day in mild disease or those in remission. Patients with severe coeliac disease should avoid oats altogether
• Wheat

 Many patients with coeliac disease can have secondary lactose intolerance.

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