Medical suggestions

MIGRAINE different from headache

2021-04-11T00:20:00.000+05:30

Headache

It is pain in any part of the head. It may occur on one or both sides of the head. Headache can develop gradually and may last for less than an hour or several days depending on its severity.

There are various type pain sensitive areas in cranial structures such as scalp, dura, middle meningeal artery, falx cerebral , circle of wills and proximal segments of pial arteries.

Some insensitive pain structures are ependyma, choroid plexus, pial veins and brain parenchyma.

CLASSIFICATION OF HEADACHE

PRIMARY

· Benign

· Recurrent

· No organic disease

-Primary consist of 3 types:

Tension type

Migraine

Trigeminal autonomic cephalgias ;

cluster headache

- Secondary consist of 5 types:

- Systemic inflation

- Head injury

- Vascular disorder

- Hemorrhage

- Brain tumor(<0.1%){due to

increase in intracranial pressure}

SECONDARY

1. Malignant

2. Organic disease

Tension headache

-most common type of primary headache

· Middle aged females are more prominent of having this type of headache than males, around 20-45years of females experience this headache due to stress and poor diet intake.

· One third of cases associated with depression fullness or tightness or pressure band; doesn’t affect activities of daily living.

· Absence of vomiting, photophobia(sensitivity from light) and phonophobia (sensitivity from sound). Patient is never disturbed from sleep due to headache.

Fundus- no papilloedema(increase intracranial pressure)

Treatment

1.For acute attack some NSAID’s are recommended

2.Chronic tension type headache- prophylaxis with amitryptiline.

Migraine

Episodic headache

Started during school(10-15yrs); attacks increase in frequency and severity over time

Clinical features

-Aura – mainly visual aura is present, auditory is observed in 20% of people ; visual aura relies 20-30 minutes

-typical headache usually holocranial, throbbing pain in front temporal area, nausea present. After headache patient feel lethargic and depressed.

-Presence of zigzag lines

-Fortification spectra

-Scintillating scotoma (blind spot that obstruct part of vision), a days prior to attacks mood changes, irritability and depression can be noticed.

Presence of episodes in 4-72hrs photophobia/phonophobia/osmophobia (olfactophobia-hypersensitivity to odors).

Migraine theories

Vascular theory

Blood vessel dilation

Vasoconstriction “aura”

Vasodilatation –“headache”

Triggers

- Glare

- Alcohol

- Stress

-Bright lights

- Sounds

- Lack of excess sleep

Pathology – CGRP (calcitonin gene related peptide)

Centre- trigemino vascular complex

Serotonin Theory

=Decrease serotonin

Rare types of migraine

1.Opthalmoplegic migraine- is a nervous system problem that affects eye and head; people with this rare condition get headache and pain around the eyeball, weakness of muscle. transient 3^rd nerve palsy-completely reversible.

2.Basilar migraine- these headache starts in lower part of brain (brainstem). transient posterior circulation symptoms{ataxia,tinnitus,diplopia,vertigo}

3.Hemiplegic migraine- transient weakness on one side; changes like vision, speech and sensation may experience by the patient.

4.Retinal migraine- transient monoocular vision loss ; vision changes in one eye and may cause flickering lights or blurred vision.

5.Familial hemiplegic migraine - occurs generally due to change in a specific gene sequence { gene CACNA 1A, the ATPA1A2 gene and SCN1A gene}Calcium channelopathy

Acute migraine management

Mild migraine

Paracetamol or NSAID’s = naproxen 550mg twice a day,Ibuprofen 200-400 mg 3-4 times a day+ antiemetics

Moderate- severe migraine

Triptans, 5 HT beta agonist , oral – Rizatriptan 5-30 mg ,Sumatriptan (oral,nasal)

-other drugs such as ergot alkaloids used in classical migraine; contraindicated in coronary artery disease and cerebrovascular attack patients.

Prophylaxis of migraine

First line- propranolol

TCA {tricyclic antidepressants}- amitryptline

Second line- telmisartan(40mg twice a day)

Venlafaxine(37.5 mg per day)

Valproate

Third line –pizotifen

Flunarazine

Clonidine

Other modalities of treatment

1.Greater occipital nerve block

2.Onabotulinum toxin A

3.Suprorbital transcutaneous stimulation

4.CGRP antagonists

- by Dr. Ravi Ranjan

- by Dr. Tanya Sharma

Latest information about COVID-19

2021-03-26T18:49:00.003+05:30

Covid-19

SOURCE OF INFECTION

Covid-19 is phylogenetically related to severe acute respiratory syndrome-like (SARS-like) bat viruses, therefore bats could be the possible primary reservoir. The intermediate source of origin and transfer to humans is not known, however, the rapid human to human transfer has been confirmed widely.

INCUBATION PERIOD

The incubation period of a pathogen/disease describes the duration between initial exposure and the onset of disease symptoms. In the case of coronavirus, the incubation period is estimated to be 5 – 6 days; however, the exact recommended range is 1 - 14 days.

Regarding specific symptoms, the study findings reveal that the average incubation period to fever onset is 5.7 days. The study has also assumed that out of 10,000 confirmed cases, 101 will develop symptoms after 14 days of isolation.

TRANSMISSION ROUTES

COVID-19 is caused by the SARS-CoV-2 virus, which spreads between people, mainly when an infected person is in close contact with another person.

The virus can spread from an infected person’s mouth or nose in small liquid particles when they cough, sneeze, speak, sing or breathe heavily. These liquid particles are different sizes, ranging from larger ‘respiratory droplets’ to smaller ‘aerosols’.

Other people can catch COVID-19 when the virus gets into their mouth, nose or eyes, which is more likely to happen when people are in direct or close contact (less than 1 metre apart) with an infected person.

Contact transmission can be direct and indirect. Direct contact transmission involves both a direct body surface to body surface contact and physical transfer of microorganisms between an infected or colonized person and a susceptible host. Indirect contact transmission involves contact of a susceptible host with a contaminated intermediate object (e.g. contaminated hands), that carry and transfer the microorganisms

Main clinical symptoms

Common signs and symptoms can include:

Fever

Cough

Tiredness

Early symptoms of COVID-19 may include a loss of taste or smell.

Other symptoms can include:

Shortness of breath or difficulty breathing

Muscle aches

Chills

Sore throat

Runny nose

Headache

Nausea and vomiting

Diagnostic methods

In most situations, a molecular test is used to detect COVID-19 and confirm infection. Polymerase chain reaction (PCR) is the most commonly used molecular test. Samples are collected from the nose and/or throat with a swab. Molecular tests detect virus in the sample by amplifying viral genetic material to detectable levels. For this reason, a molecular test is used to confirm an active infection, usually within a few days of exposure and around the time that symptoms may begin. Rapid antigen tests (sometimes known as a rapid diagnostic test – RDT) detect viral proteins (known as antigens).

Anti-epidemic measures in the outbreak

Use evidence-based methods to increase compliance with infection control precautions, including multimodal strategies (e.g. change in infrastructure, education, posters, reminders, senior management engagement, performance feedback) . Educate HCWs to follow infection control precautions with all patients with acute febrile respiratory illness .

Ensure that adequate infection control supplies are provided , such as: −hand hygiene facilities such as soap and clean running water, alcohol-based hand rub, paper or single use towels; −PPE for patient care (e.g. masks/respirators, gowns, gloves, eye protection); −PPE for heavy duties (e.g. closed protective footwear, waterproof aprons, and rubber gloves); and −an adequate supply of appropriate cleaning and disinfection materials .

Develop plans for the evaluation and management of patients known or suspected to be infected with an ARD of potential concern including rapid screening (establishment of triage) and immediate implementation of infection control precautions .

Develop systems to promptly identify and isolate patients with possible ARD of potential concern and to promptly notify public health authorities

In countries with reported ARDs of potential concern, reinforce the reporting system in HCFs (e.g. post signage at all entrances and clinical evaluation areas such as emergency departments) to alert patients and visitors to report severe acute febrile respiratory illness immediately to health-care providers.

Term of observation of contacts

In a well ventilated single room respectively and refuse all visits.

Household members should stay in a different room or, if that is not possible, maintain a distance of at least one meter from close contacts.

When entering the living space of close contacts, the caregiver should wear a medical mask fitted tightly to the face. Masks should not be touched or handled during use. If the mask gets wet or dirty with secretions, it must be changed immediately. Discard the mask after use and wash your hands after removal of the mask.

Materials used to cover your mouth and nose when coughing or sneezing occasionally can be discarded directly, or cleaned properly after use .

In spirit, nausea, vomiting, diarrhea, headache, palpitation, conjunctivitis, and mild muscle pain in the limbs or lower back, they should seek medical advice immediately. Specific recommendations are as follows:

I.Patients should wear surgical masks or N95 masks on the way to hospital.

II.Avoid public transportation to the hospital and open the windows of the vehicle if possible.

III.Wear a mask and keep hands clean at all times. Stand or sit as far away from others as possible (at least one meter), when in transit and when in the hospital.

IV. Any surfaces that become soiled with respiratory secretions or body fluids during transport should be cleaned and disinfected with chlorine-containing disinfectant .

Basic prevention measures

Regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them with soap and water. This eliminates germs including viruses that may be on your hands.

Avoid touching your eyes, nose and mouth. Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and infect you.

Cover your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately into a closed bin and wash your hands. By following good ‘respiratory hygiene’, you protect the people around you from viruses, which cause colds, flu and COVID-19.

Treatment of covid 19

Symptomatic treatment like for fever diclofenac,paracetamol - 625mg thrice a day is prescribed.

-For cough (dry) acetylcysteine - 10%(3-5ml of 20% solution)through nebulisation is prescribed , cough(expectorate) ambroxal - 30 mg twice a day is prescribed.

- For shortness of breath glucocorticoids are prescribed such as dexamethasone- 0.5mg twice a day.

-For runny nose and congestion antihistaminic drugs such as levocetrizine is prescribed- 5mg twice a day

- For antiviral treatment amoxycillin -500mg,625 mg twice a day

-For sore throat azithromycin- 500mg twice a day and gargle with luke warm water with salt .

= Some dermatologic signs are recently seen such as maculopapular rash are noticed(22%),

discolored lesions of fingers and toes(18%)

Hives(red raised bumps like spots)--22%; these symptoms may range from mild to severe extent in different patients.

Different countries are developing vaccines against covid -19 virus such as Covishield vaccine in INDIA, UK has made Pfizer vaccine .

- by Dr. Ravi Ranjan

ACUTE APPENDICITIS (PATHOLOGY )

2021-01-06T13:58:00.000+05:30

Acute appendicitis

It is non- specific inflammation of the appendix.

Pathological form of acute appendicitis

ü Simple form : appendix is slightly tense, its serosa is hyperemic and edematous.

Lumen –odourless serous fluid

Microscopically-mucosal edema, single erosions

ü Phlegm nous form: thickened appendix, tense, hyperemic, covered with fibrin, abdomen lumen filled with pus.

Microscopically – leukocytes infiltration of the appendix tissue purulent destruction of its walls.

ü Gangrenous form: necrosis in wall perforated walls

Lumen –necrotic debritus

Microscopically- thrombosis of the vessels of the abdomen, necrotic change in its walls.

Provisional diagnosis

Questioning

Complaints: pain in the right iliac region, without irradiation, delayed defecations, low grade fever.

Anamnesis morbi: acute onset, pain occurs in healthy state of patient, pain occurs without provoking factors, epigastric pain, epigastric pain, diffuse pain through the abdomen which shift in the right iliac region(volkovych-kocher’s sign).

Anamnesis vitae: constipation, bad bowel movements, blockage in the lining of the appendix, streptococcal infection, inflammatory bowel disease, ruptures of walls of the appendix.

Physical examination

Visual examination: abdomen is asymmetrical, right iliac region not participate in breathing.

Palpation: superficial palpation-muscle tension and tenderness in the right iliac region.

Deep palpation- increased tenderness in right iliac region.

Percussion : rebound tenderness, pain on percussion, rigidity

Auscultation: bowel sound present but hypoactive.

Pathological signs

Bartomier-Mikhelson’s- pain increases as palpation at the right iliac region as the person being examined lies on left side.

-Rovsing’s sign – if palpation of the left lower quadrant of a person’s abdomen increases the pain felt in right lower quadrant, the patient may have appendicitis.

- Obratsow’s sign –it indicates irritation to the iliopsoas group of hip flexors in the abdomen and consequently indicates that the inflamed appendix is retrocaecal in orientation.

Other two signs are Razdolsky’s sign, voskresensky’s sign.

Complications of appendicitis

· Sudden pain that begins on the right side of the lower abdomen

· Nausea and vomiting

· Abdominal bloating

· Loss of appetite

· Constipation or diarrhea

· Low grade fever that any worsen as the illness progresses

· Ruptured appendix

· Pocket of pus that forms in the abdomen

Differential diagnosis: acute cholecystitis, duodenal ulcer complicated by perforation; gynecological- ectopic pregnancy

Laboratory instrumental methods

Complete blood count(leukocyte left shift

segmented neutrophil increase

urine analysis In urinalysis up to 40% of can have abnormalities

fresh erythrocytes found

Treatment

Surgery and therapeutic (antibiotics, pain relievers

I.V fluid

liquid diet’ needle drainage from abscess

-by Dr. Ravi Ranjan

ATHEROSCLEROSIS

2021-01-06T13:24:00.001+05:30

Atherosclerosis

Atherosclerosis is a thickening and hardening of large and medium-sized muscular arteries, primarily due to involvement of tunica intimae and is characterized by fibrous fatty plaques or atheromas.

The term atherosclerosis derived from athero-(meaning porridge) referring to the soft lipid rich material in the center of atheroma and sclerosis (scarring) referring to connective tissues in the plaques.

Etiology

Cardiovascular disease, mostly related to atherosclerotic coronary heart disease or ischemic heart disease (IHD) is the most common cause of the premature death in the developed countries of the world.

#Major risk factors

(a) Modifiable

- Dyslipidemia

- Hypertension

- Diabetes mellitus

- Smoking

(b) Constitutional

- age

- gender

- genetic factors

- familial and racial factors

# Emergency risk factors

- obesity

- Hormones –estrogen deficiency

- Physical inactivity

- Prothrombotic factors

Pathogenesis

The pathogenesis of atherosclerosis consists of 4 stages :

1. Firstly endothelial injury is the initial triggering event in the development of lesions of atherosclerosis.

2. Endothelial injury causes adherence, aggregation and platelet release reaction at the site of exposed sub endothelial connective tissue and infiltration by inflammatory cells, and as a result causing proliferation of smooth muscle cells.

3. Aggregation of the platelet causes formation of small thrombus.

4. This causes mild inflammatory reaction which together with foam cells is incorporated into the atheromatous plaque.

Clinical effects on various organs

Clinical effect depends on the artery type, size.

Large arteries that get affected most often are the aorta, renal, mesenteric and carotids whereas medium arteries involve cerebral arteries and coronary arteries.

According to the symptoms atherosclerotic disease involves most often the following.

a) Heart- Myocardial infarction, ischemic heart disease

b) Brain- chronic ischemic brain damage, cerebral damage, cerebral infarction and stroke.

c) Aorta- aneurysm, thrombosis and embolisation to other organs.

d) Small intestine- ischemic bowel disease, infarction

e) Lower extremities - intermittent claudication, gangrene.

Diagnosis

Atherosclerosis can be diagnosed by

MRI, CT scans and ultrasounds.

Through blood tests we can also diagnose hdl levels(high density lipoprotein) which increases due to deposition of fats in blood vessels.

TREATMENT

1. FIRSTLY, lifestyle changes should be done in order to prevent the conditions to appearance of atherosclerotic plaques in the vessels. Changes like food eating habits simultaneously with the habit of exercising regularly.

2. SECONDLY, medication treatments like fibrinolytic drugs, anti atherosclerotic drugs and also symptomatic treatment of the risk factors happened to the patient like medication for the hypertension and other.

3. THIRDLY AND LASTLY, surgical treatment is done if it is a severe case atherosclerotic plaque in the vessel which is blocking the way of blood cells and leading to embolisation in the organs.

- by Dr. Ravi Ranjan

SUDDEN ARRYTHMIC DEATH SYNDROME

2020-03-05T03:13:00.000+05:30

Sudden arrhythmic death syndrome (SADS)

This syndrome corresponds to the abrupt death in adults and teenagers, generally during sleep (also known as nocturnal death). Such kinds of deaths occur in the people with complete distinction on the basis of genetic structure.

Reasons for such sudden deaths

According to the research people with such kind of syndrome may have-

1) Past history of heart disease which could be associated with congenital reasons, defective myocardium structure and can also be related to drugs which heavily affects myocardial muscle layers and connective tissue and thus decrease conductivity and pumping ability of heart.

2) As per the name of this syndrome arrhythmia which can be tachycardia or bradycardia is detected in these peoples is also the main cause; sudden increase in the diameter of myocardium (hypertrophy of ventricles) cause these symptoms.

Symptoms

+high blood pressure

+chest pain

+sudden palpitations

+radiating pain left side

+hyper excitability

+loss of consciousness due to heavy exercises

Diagnosis

-ECG

-CT scan

-echocardiography

Treatment

Treatment depends upon the symptomatic state of the patient for instance patient is facing arrhythmia; propanolol, metaprolol like medications can be for relief purpose.

Regular check should be considered for sportsperson who experience exercise related chest pain.

-by Dr.Ravi Ranjan

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

2020-02-26T20:49:00.001+05:30

Chronic obstructive pulmonary disease (copd)

It is a combination of clinical signs of chronic obstructive bronchitis(inflammation of narrowing of bronchi) and emphysema(changes of lung tissue structure).COPD is irreversible disease increasing worldwide because of the increase in smoking in developing countries, the reduction in mortality due to infectious diseases and the widespread use of biomass fuels. Prevalence, incidence and mortality rates increase with age. Prevalence is higher in men, but total mortality is similar in both sexes.

ETIOLOGY

Cigarette smoking

Genetic factors (alpha1-antitrypsin deficiency)

Air pollution, airway infections

PATHOPHYSIOLOGY

*Inflammation –It generally occurs in our body due to foreign particle irritation after getting in contact with our epithelium, in this disease COPD inflammatory response is triggered by increase in activity of protease activity and decrease in anti protease activity which thus cause break down of elastin and connective tissue in our lungs and this causes problems in normal repair processes of tissues. In patients with COPD activated neutrophils and other inflammatory cells release proteases as a part of inflammatory process; protease activity exceeds anti protease activity and tissue destruction and mucous hyper secretion starts.

* Infection – Smoking and airflow obstruction may lead to impaired mucus clearance in lower airways, which predisposes to infection.

* Airflow limitation – due to mucus hyper secretion, mucus plugging, mucosal edema, bronchi spasm all these mechanism occur due to airway obstruction. As alveolar wall destroy due to loss of elastic recoil and lung hyperinflation.

CLINICAL SIGNS

- Productive cough

- Dyspnea

- Wheezing

- Lung hyperinflation

- Decreased heart and lung sounds

- Increased anteroposterior diameter of the thorax

- Cyanosis of skin and lips

DIAGNOSIS

+ Pulmonary function tests- that is forced expiratory volume test (FEV1), Forced vital capacity test (FVC).

+ Instrumental and laboratory tests-chest x-rays, CT scan.

+Adjunctive tests –alpha1-antitrypsin levels, ECG, CBC, Sputum analysis.

TREATMENT

· Inhaled bronchodilators –these includes beta agonists like Fenoterol , salbutamol and anti cholinergic; tiotropium bromide is used over ipratropium as powder formulation , corticosteroids; fluticasone and beclamethasone are used

· Supportive care(stopping smoking, oxygen therapy, pulmonary rehabilitation)

· Metered dose inhalers (MTIs) or dry powder inhaler is preferred over nebulizer home treatment.

· Theophylline, oxygen therapy, vaccinations and pulmonary rehabilitations are widely used.

· Expectorants and mucosolvents lasolvan ,acetylcysteine are used in order to dissolve the drainage function of bronchi

· Antibiotics are recommended for exacerbation in patients with purulent sputum. If the infectious organism is resistant, amoxicillin, fluoroquinolones, cephalosporin’s of 2^nd generation and extended spectrum macrolides are indicated.

-by Dr. Ravi Ranjan

Treatment of novel corona virus

2020-02-21T02:28:00.003+05:30

Treatment of novel Corona Virus

The Taizhou government in Zhejiang province in china announces on Sunday the treatment of most dangerous novel corona virus.

First antiviral drug approved for fighting against corona virus known as Favilavir. It is the first anti-viral drug that has been approved for marketing by the National Medical Products Administration since its outbreak. Developed by Zhejiang Hsian Pharmaceutical Company, the drug is expected to play an important role in preventing and treating the epidemic, the government said on its official WeChat account.

Favilavir is one of three drugs that have shown significantly efficiency in treating the novel corona virus in clinical trials, the minister of science and technology said on Saturday.

The Favilavir antiviral drug approved on Sunday.

China has launched a few trials that test chloroquine, a malarial drug that killed off the new corona virus in cell culture. About 15 trials listed in china’s registry expect to enroll a total of more than 2000 people in studies on a variety of traditional Chinese medicines .one of the largest among them assesses shuanghuanglian , a Chinese herbal medicine that contains extract6s from the dried fruit ,which is purported to have been used for treating infections for more than 2000 years. The trial has 400 participants including a control group given standard care but not a placebo therapy
-BY DR. RAVI RANJAN

RHEUMATIC DISEASE

2020-02-10T02:24:00.000+05:30

RHEUMATIC DISEASE

They are characterized by affect of collagen or connective tissue due to disturbances of immune homeostasis . Disturbances of immune homeostasis leads to development of autoimmune reactions,formation of the toxic immune complexes and sensibilizated cells ,injury of microcirculation with following systemic progressive disorganization of connective tissue.

What are the characteristics of this diseases?

Presence of chronic infectious focus.

Presence of early systemic changes of microcirculation.

Presence of hypersensitivity of immediate type with development of exudative-necrotic reactions and hypersensitivity of delayed type with formation cellular infiltration.

Systemic progressive disorganization of connective tissue that includes : some cellular reactions like swelling and sclerosis.

Genetic and environmental factors are important for development of these diseases.

Ø So much rheumatic diseases are defined in medicine some of which we are going to discuss and get to know about are rheumatic fever ,rheumatic heart disease ,rheumatic valvulitis and about the extra cardiac lesions.

RHEUMATIC FEVER(RF)

Rheumatic fever is an inflammatory process which can involve the heart joints ,central nervous system ,skin and subcutaneous tissues. It generally effects children from 5-15 years age.

· The chronic stage of RF involves all the layers of the heart causing major heart diseases known as rheumatic heart disease; this may lead to some other connected diseases such joint pains and many more.

What is its etiology

The bacteria which causes this disease this is beta-hemolytic streptococci group A. But only a some proportion of patients with this infection may get affected with rheumatic fever; the attack rate generally very low.

The symptoms of RF appear after a delay of 2-3 weeks and are not due to direct infection, these lesions have immune pathogenesis that is due to type 2 hypersensitivity reactions.

RHEUMATIC HEART DISEASE

RHD or cardiac lesions –inflammation that involve the interstitial tissue of all the three layers of the heart (pancarditis).

This includes :

1. Rheumatic endocarditis

2. Rheumatic myocarditis

3. Rheumatic pericarditis

What are its symptoms?

ü Fever

ü Arthralgia that is pain in joints

ü Prolonged PR interval

ü Increased ESR

ü Leucocytosis

ü Nodules formation in joints

ü Erythematic

ü chorea

How can it be diagnosed?

Blood tests

X ray

ECG

MRI and CT scans

Fluid test from joints

Finally how could we treat this diseases

§ Majorly anti inflammatory drugs(ibuprofen, naproxen) and corticosteroids are used as medications for treating joint pain and inflammation.

§ We can also do some physical therapies in patients such as hot and cold therapy

§ Specific exercises can be done to regain joint flexibility and muscle strength

-BY DR.ravi ranjan
-Dr.tanya sharma

CORONAVIRUS,HISTORY, CAUSE,PREVENTION

2020-02-03T21:09:00.004+05:30

CORONAVIRUS

What is CORONA VIRUS?

Corona viruses are a large family of viruses that are common in many different species of animals,including camels,cattle,cats and bats.But nowadays this virus is infecting humans .Severe respiratory illness caused by this virus had spread to lot of countries years before in 2003 and 2004 such as America ,Europe and Asia .But this year disease outbreaks in Wuhan,China and which continues to expand .Person-to-person spread has been reported outside china ,including in United States and other countries .

History of corona virus

As corona virus is a large family of viruses ..this virus came into existence in southern china 2003 named as SARS-CoV(Severe respiratory syndrome with corona virus)and this virus again infected humans and detected in Saudi Arabia 2012 named as MERS-CoV and finally this last year in 2019 this virus enter the human genome through pneumonia like infection named as 2019-nCov(novel corona virus).

How it spreads in humans?

In rare cases,they are what scientists call zoonotic ,meaning they can be transmitted from animals to humans .The virus can make people sick ,usually with a mild to moderate upper respiratory tract illness ,similar to common cold.

Human coronavirus most commonly spread from an infected person to others through :

(i)The air coughing and sneezing.

(ii)Close personal contact such as touching or shaking hands.

(iii)Touching an object or surface with the virus on it ,then touching your mouth,nose or eyes before washing your hands.

(iv)Rarely fecal contamination.

What can be the Symptoms?

runny nose
headache
cough
sore throat
fever
feeling of being unwell
shortness of breath

For those with weakened immune system ,the elderly and the very young,there's a chance the virus could cause a lower and much more serious respiratory tract illness like pneumonia or bronchitis.

Diagnosis

Coronavirus can be diagnosed through DNA tests

Treatment

It’s treatment is not yet found.

How could we prevent us from being infected?

Following proper hygiene by regular hand washing with soap.
Covering mouth and nose when coughing and sneezing
Thoroughly cooking of eggs and meat
Avoid close contact with anyone showing respiratory illness such as coughing and sneezing

If you are mildly sick keep yourself hydrated and stay at home and rest.

-BY DR.RAVI RANJAN

SYSTEMIC LUPUS ERYTHEMATOUS

2020-01-30T01:07:00.001+05:30

SYSTEMIC LUPUS ERYTHEMATOUS

What is Systemic Lupus Erythematous?

It is an autoimmune disorder characterized by inflammation of blood vessels and connective tissue resulting in multi system involvement .The clinical manifestations are variable and the course unpredictable. Childhood SLE is usually more severe and has a poorer prognosis than adult SLE. the hallmark of SLE is the presence of antinuclear antibodies. The female predominance characteristic of adult SLE usually not apparent in young children.

What can be the causes of it?

(i)Genetic factors
(ii)Environmental agents
(iii)Infectious agents
(iv)Ultraviolet rays
(v)Dietary factor
(vi)Effect of drug or chemical agents

SLE is predominately a disease of women with frequency in 1in 700 among women between ages of 20-64 anf female to male ratio of 9:1,so age and gender is also a factor for systemic lupus erythematous.

What is diagnosis criteria for it?

1 Positive immunoserology(antibodies to dsDNA/smith nuclear antigen)

2 Positive findings of antiphospholipid antibodies(IgG/IgM anticardiolipin)

3 Lupus anticoagulants

4 Positive antinuclear antibody test

5 Veneral disesase research laboratory test(VDRL)

What can be the symptoms of this disease?

The symptoms of SLE is can be checked by physical examination of the patient as a lot of signs of it can be identified through it, for example:

(i)The malar rash which is virtually pathognomic of SLE, may not be apparent initially.It involves the cheek, bridge of nose and lower eyelids but spares the nasolabial folds .

(ii)Discoid lesions are rare in childhood onset SLE.

(iii)Oral ulcerations may involve the buccal mucosa or palate and characteristically painless
(iv)Some children may have frontal alopecia.
(v)Arthritis is usually mild and always non erosive.
(vi)Renal involvement is a dreaded complication of SLE and one the commonest causes of mortality in children.

Neurological features may include psychosis ,seizures and chorea .There may be no correlation between the severity of clinical involvement and findings on neuroimaging .

Hematologic abnormalities include a Coombs' positive hemolytic anemia,leukopenia,lymphopenia and thrombocytopenia . In addition there may be coagulation abnormalities due to secondary antiphospholipid antibody syndrome .Cardiac manifestations may include pericarditis,myocarditis or verrucous(Liebman-sacks) endocarditis.

Serological diagnostic values in diagnosis of this disease

+Almost all patients with SLE have demonstrable antinuclear antibodies.Presence of anti-double stranded DNA antibodies is highly specific of SLE.The titers of these antibodies usually correlate with disease activity .

+Anti-histone antibodies are characteristic of drug-induced lupus(e.g following phenytoin,isoniazid,hydralazine) but in such cases anti dsDNA antibodies are usually absent and serum complement level is not decreased.

+Anti-ro antibodies are believed to play a role in the development of congenital heart block characteristic of neonatal lupus syndromes.These heart blocks are permanent.Anti-Sm antibodies are a marker for CNS lupus.

What shall be the treatment and therapies for such disease?

Glucocorticoids and hydroxychloroquine form the main stay of therapy of lupus .

Prednisolone is started in doses of 1-2 mg/kg/day and gradually tapered over several months ,according to disease activity.

Arthritis usually responds to NSAID's.

Life threatening complications (such as nephritis,myocarditis) may warrant use of intravenous pulses of methlyprednisolone(30mg/kg/day)for 3-5days

Rituximab, monoclonal antibody to CD20 has also been found to be effective in such situations .

Use of monthly pulses of IV cyclophosphamide has considerably improved the long term outcomes

Infections must be treated aggressively with appropriate antimicrobial s and the steroid dose hiked up during such episodes .

-BY DR. RAVI RANJAN

-BY DR. TANYA SHARMA

BRONCHIAL ASTHMA

2020-01-25T21:26:00.003+05:30

BRONCHIAL ASTHMA

What is Bronchial Asthma ?

"Bronchial asthma is a disease characterized by an increased responsiveness of the airways to various stimuli .It manifests by widespread narrowing of the airways causing paroxysmal dyspnea ,wheezing or cough.The diffuse obstruction to the airflow is reversible in a large majority of cases,either spontaneously or in response to treatment .Bronchial reactivity is a necessary component of asthma".

What can be the risk factors of it?

+Viral infections:more frequently it triggers airway narrowing as viral infections interfere with integrity of mucous surfaces by opening up tight inter-epithelial cell junctions and induce shedding of epithelium.

+Weather change:sudden change in the weather might result in:-

(i)loss of heat and water from lower airways.

(ii)sudden release of airborne allergens in atmosphere resulting in severity of asthma.

+Emotional factors:emotional stress operated through the vagus nerve ,initiates smooth muscle contractility of bronchi.

+Endocrine factors:some endocrine changes including puberty may increase symptoms of asthma.

What could be the clinical

The clinical features of asthma are variable.

(1)Acute asthma usually begins with cold and spasmodic coughing.

(2)Dyspnea with prolonges expiration and wheezing.

(3)Sweating profusely,cyanosis may develop and may get fatigued easily and feel restless.

(4)feeling of airhunger and wheezing sound while breathing out.

(5)Loss of appetite

(6)Complaints like tightnes of chest and chest hurting.

(7)In chronic cases chest becomes barrel shaped.

Which criteria tells us about diagnosis of asthma?

A prolonged whistling sound heard at the mouth during expiration (that is wheezing),a recurrent attacks of wheezing indicate Bronchial Asthma .

Cough,which is associated with asthma generally worsens during exercise.Chronic spasmodic cough may associates with asthma.

INVESTIGATIONS

Absolute eosinophil counts
chest x-ray film
allergy test: skin test and radioallergosorbent allergen specific IgE have limited usefulness.
spirometry

Pharmotherapy

Use of medications that relax smooth muscle and dilate the airways and that decrease inflammation and thereby prevent severness of disease

The medications used for longterm treatment of asthma includes bronchodilators,steroids mast cellstabilizers ,leukotriene modifiers and theophylline.

Drugs such as salbutamol can be used as bronchodilators ,inhaled steroids like beclamethasone and montelukast like can be used in children above 12 years of age.

Management

The effective long term management of asthma involves :

(i)identification and elimination of factors causing asthma such as passive smoking,allergic disorders,inadequate ventilation at home leading to dampness,cold air ,cold food ,smoke,dust and pets in family.

(ii)wet mopping of floor should be done in home because dry dusting increases exposure to house dust.

(iii)adolescents should be refrain from smoking

(iv)exposure to strong or pungent odors such as wet paint,disinfectants and smoke should be minimized.

Monitoring and modification of treatment

After starting of treatment patients should be seen every 4-12 weeks.on each visit a detailed history regarding frequency of symptoms,sleep disturbance,physical activity,need for bronchodilators.

!SAY NO TO SMOKING!


   -BY DR. RAVI RANJAN
-BY DR.TANYA SHARMA

DIABETES MELLITUS

2020-01-14T03:33:00.002+05:30

DIABETES MELLITUS

“Diabetes mellitus is increase amount of glucose inside the body because body doesn't produce enough amount of insulin for utilizing the glucose.”

CAUSES :
Hypo-function of beta-cells inside the
pancreas,smoking,alcohol,hypertension ,obesity, age is also a factor for the disease, genetic cause or heredity and it also depend on the topical region of living on the basis of race and backgrounds.

PATHOGENESIS(mechanism):
Diabetes mellitus is a condition in which functioning of pancreas is mainly associated as disturbance of insulin production and working takes place in this particular Heterocrine(having both endocrine and exocrine function) gland which play a major role in human body. Pancreas works for some of the major processes such as controlling the blood sugar levels and also controls metabolism of our body.
Pancreas consists of three cells which are involved in controlling of blood sugar levels.

Alpha cells= secretion of Glucagon is done by these cells when blood glucose levels are low
Beta cells=secretion of Insulin is done by these cells when blood glucose levels are high
Delta cells=these cells release a special enzyme called Somatostatin which maintain the levels of insulin and glucose release.

So the conclusion is that if beta cells doesn’t secrete enough Insulin and our cells stop responding to the insulin produced by the body then these are the signs of diabetes mellitus starting to show its effect on the organs of the human body.

CLASSIFIED INTO TWO TYPES

1.TYPE I Diabetes mellitus

2.TYPE II Diabetes mellitus

TYPE I{JUVENILE DIABETES}

It is insulin dependent diabetes mellitus in which our immune system attack the beta cells of pancreas and due this no insulin or less amount of insulin is produced that is why a person have to depend on insulin to control the blood sugar.

CAUSE:
When the immune system and the body system fighting against infections due to this the immune cells destroy the beta cells of pancreas or by the genetical and environmental factor such as viral infectionsj

SYMPTOMS

weight loss
blurred vision
fatigue
dehydration
mood swings
specific smell in urine
polyphagia
dysuria

TREATMENT: Insulin injections intravenously depends on the dose required in patient body (insulin injections dose is decided by the doctors as per the laboratory tests)

TYPE II{ ADULT ONSET DIABETES}

It is non-insulin dependent diabetes in which body produce enough amount of insulin but body resists to the effect of insulin that is why also called as insulin resistant diabetes but if a person do not take enough diet and medications to treat the type 2 diabetes it can progress and can lead to type 1 diabetes which happens due to decreasing ability of pancreas to produce insulin for the body.

CAUSE:Genetics ,overweight and environmental factors.

SYMPTOMS

Slow healing
hearing impairment
cataract
hypertension
ketone bodies in urine
neuropathy
retinopathy
sleep apnea

TREATMENT:

Anti-diabetic drugs
Regular exercises
Diet (eating food in 3-4 hour intervals in small portions)
Control blood pressure and cholesterol level

“Blood glucose levels should be between 80 to 130mg/dl before the meals (fasting) and less than 180 mg/dl before taking meals.”

DIAGNOSIS

Blood glucose measurements
Fasting glucose tests
Oral glucose tolerance test
Urine culture (for ketone bodies)

"TIPS:PRECAUTION IS BETTER THAN CURE!"

-By DR.RAVI RANJAN

NEURO AIDS

2020-01-12T21:28:00.000+05:30

Neuroaids The neurological implications of the HIV infection caused by direct influence of the virus on the nervous system

Causes: By HIV virus

1. The atypical aseptic meningitis - It develops acutely during the acute febrile phase of HIV infection. The clinical picture is presented by general infections (temperature to 39 C, chills, intense headache, weakness,sopor, sometimes there are hallucinations) and meningeal syndromes (the stiff neck, hyperesthesia and kernig’s signs are possibles)

Treatment: In absolute majority of cases the meningitis passes without treatment in 2-4weeks. The treatment is symptomatic

2. The HIV associated encephalopathy( the aids dementia)- It is the chronic encephalitis .the clinical picture of the encephalopathy includes the progressing depression of intelligence. First of all the memory and attention is affected, it becomes difficult to read and solve complex problems. When encephalopathy progresses, the motor disorders like tremor , ataxia may be present and disorder of behaviour like apathy, abulia join.

Pathological changes: The brain atrophy, expansion of the brain ventricles.

3.The peripheral HIV neuropathies - Include the distal sensory polyneuropathy and antiretroviral toxic neuropathy. In typical cases the symptoms are bilateral ;they begin gradually with the pain

,burning sensation and morbid numbness . They are the most express in the area of the soles. The Clinical implications of the distal sensory polyneuropathy and anti-retrovirus toxic neuropathy are similar and it’s difficult to differentiate them.

Treatment:anti- CMV therapy, correction of metabolic wastes.

By Dr. RAVI RANJAN