Health Care And Blood Testing Society (SAVING LIVES)

To the community of viewers

2013-06-21T23:24:00.003+05:00

DEAR VIEWERS AND COMENTATORS:
Your comments ,your clicks on my articles are beyond my thinkings and it has always encouraged me to write something more then i have written .i haven't written any article for many months because m working on new web:healthbarriers.com .I m doing so because some errors related web hacking occured and it disturebed my viewers during readind article as many of them compliant about it .so,on behalf of thoes complain i quit uploading articles on the web .but,its not an end i have gathered much more research articles and other health issues which will be uploaded soon on new wed adress mentioned above.I hope my viers and comentators will support my courage as they did in blogspot .

WHAT'S CSD

2013-01-24T16:21:00.000+05:00

Sudden cardiac death (SCD) is a sudden, unexpected death caused by loss of heart function (sudden cardiac arrest). It is responsible for the majority of ''natural deaths'' in the U.S., causing about 325,000 adults to die each year. SCD is responsible for half of all heart disease deaths
.SCD occurs most frequently in adults in their mid-30s to mid-40s, and affects men twice as often as it does women. SCD is rare in children, affecting only 1 to 2 per 100,000 children each year.

Recommended Related to Heart Disease:

Sudden cardiac arrest can be reversed if treated within the first few minutes. The American Heart Association promotes the following four steps, called "the chain of survival:"

1. Early Access to Care.
Quick contact with emergency care is essential. Call at emergency number of your

2. Early Cardiopulmonary Resuscitation (CPR).
Learning CPR is the greatest gift you can give your family and friends. If performed properly (see below), CPR can help save a life until emergency medical help arrives.

3. Early Defibrillation.
In most adults, sudden cardiac death is related to ventricular fibrillation. Quick defibrillation (delivery of an electrical shock) is necessary to return the heart rhythm to a normal heartbeat. Many public places, such as malls, golf courses, and airports, have automated external defibrillators (AEDs; see below) available for use in emergency situations.

4. Early Advanced Care.
After successful defibrillation, most patients require hospital care to treat and prevent future events.

These four steps can increase survival as much as 90% if initiated within the first minutes after sudden cardiac arrest. Survival decreases by about 10% each minute longer.

CPR:
CPR (cardiopulmonary resuscitation) is an emergency technique used to help someone whose heart and/or breathing has stopped.

When a person's heart stops, blood stops circulating throughout the body. If a person stops breathing, the blood can't get oxygen. Therefore, it is vital for people in this emergency situation to receive medical treatment, such as CPR, within the first few minutes of the event.
How to do CPR:
By administering a combination of manual chest compressions and artificial, or "mouth-to-mouth," respiration, the rescuer can breathe for the victim and help circulate some of the blood throughout their body.

CPR does not restart a heart that has stopped, but it can keep a victim alive until more aggressive treatment (defibrillation) can be administered.

CPR is not difficult to learn, and many organizations offer courses in CPR, including the American Heart Association, the American Red Cross, and local community centers, health clubs, and YMCAs.

AED:

An AED, an automatic external defibrillator, is a device used to administer an electric shock through the chest wall to the heart. The device has built-in computers that assess the victim's heart rhythm, judge whether defibrillation is needed, and then administer the shock. Audible and/or visual prompts guide the user through the process.

Who Can Use an AED?

Most AEDs are designed to be used by non-medical people such as fire department personnel, police officers, lifeguards, flight attendants, security guards, teachers, and even family members of high-risk persons.

The goal is to provide access defibrillation when needed as quickly as possible. CPR along with AEDs can dramatically increase survival rates for sudden cardiac arrest.

Can an AED Shock a Person Who Is Not in Cardiac Arrest?

No, the AED treats only a heart in an abnormal rhythm suitable for defibrillation. If a person is in cardiac arrest without such a rhythm, the heart will not respond to electric currents. CPR should be administered until medical help arrives

snake bite managment....

2013-01-21T00:33:00.000+05:00

If snake who has bitten is not poisonous then manage the bite as a wound..but if its poisonous....

Keep in mind the snake appearence:

Describe the snake to emergency staff according to which treatment protocols will be suggested

Dealing with the victum :

While waiting for emergency call response:

Move the person beyond striking distance of the snake.
Have the person lie down with wound below the heart.
Keep the person still to keep venom from spreading.
Cover the wound with loose, sterile bandage.

Do not:

Cut a bite wound
Attempt to suck out venom
Apply tourniquet, ice, or water
Give the person alcohol or caffeinated drinks

Follow Up

If you treat the bite at home:
Contact a health care provider. The person may need a tetanus shot. Tetanus boosters should be given every 10 years.

At the hospital, treatment will depend on the type of snake.
If the snake was venomous, the person will be given anti-venom treatment.
A tetanus shot may be given, depending on date of last injection.

Emergency Department Care

Physicians who have little experience treating snakebites frequently care for such patients.
Regional centers often have more experience in the care of snakebite victims. Surgical evaluation for an envenomation victim is paramount.
Definitive treatment includes reviewing the ABCs and evaluating the patient for signs of shock (eg, tachypnea, tachycardia, dry pale skin, mental status changes, hypotension).
Evenomation grading determines the need for antivenin in victims of pit viper envenomations. Grades are defined as mild, moderate, or severe.
Mild envenomation is characterized by local pain, edema, no signs of systemic toxicity, and normal laboratory values.
Moderate envenomation is characterized by severe local pain; edema larger than 12 inches surrounding the wound; and systemic toxicity including nausea, vomiting, and alterations in laboratory values (eg, decreased hematocrit or platelet count). Moderate envenomation is shown in the image below.Snakebite. Moderate rattlesnake envenomation in a toddler after treatment with antivenom. Photo by Sean Bush, MD.
Severe envenomation is characterized by generalized petechiae, ecchymosis, blood-tinged sputum, hypotension, hypoperfusion, renal dysfunction, changes in prothrombin time and activated partial thromboplastin time, and other abnormal test results defining consumptive coagulopathy.
Grading envenomations is a dynamic process. Over several hours, an initially mild syndrome may progress to a moderate or even severe reaction.
Horse-serum antivenin has been available since 1956; a purer antivenin with improved properties was released in 2000 (see Medication). With the reduced side-effect profile of antigen-binding fragment antivenom (FabAV) and the improvement in tissue injury with antivenin administration, the threshold for dosing is lower. One study from the southwest United States demonstrated a reduction in rate of fasciotomy after more liberal FabAV dosing.[7] In a randomized study of scheduled versus as-needed FabAV dosing in patients whose symptoms were worsening, the Rocky Mountain Poison and Drug Center demonstrated a reduction in pain and other venom effects but noted a 20% acute and 23% delayed drug reaction.[8]
Although copperhead bites are generally self-limiting, morbidity was reduced in moderate envenomation 4 hours after 4 vials of FabAV in 88% of cases. The cases that failed to respond were not changed by further FabAV doses.[9]
FabAV is generally considered safe for children, as many of the studies did not discriminate in age. One large study from Mexico demonstrated no immediate or late allergic reactions to FabAV when administered according to grade of envenomation.[6]
Give antivenin for coral snakebites as a standard of care if the patient presents within 12 hours of the bite, regardless of local or systemic signs. Neurotoxicity may develop without warning and lead to respiratory failure.
Although FabAV helps control local tissue effects and hemotoxicity, aggressive antivenom therapy does not usually ameliorate neurotoxic effects such asmyokymia (spontaneous, fine fascicular contractions of muscle without muscular atrophy or weakness) and major muscle fasciculations. The physician must maintain continuous monitoring of those patients with myokymia especially of the shoulders, chest, and diaphragm for the development of respiratory failure and need for mechanical ventilation.[10, 11]
refference:
http://emedicine.medscape.com/article/168828-treatment
http://firstaid.webmd.com/snakebite-treatment

Health Care And Blood Testing Society (SAVING LIVES): Moxifloxacin: (mox'' i flox' a sin)

2013-01-20T12:42:00.001+05:00

Health Care And Blood Testing Society (SAVING LIVES): Moxifloxacin: (mox'' i flox' a sin): It’s a 4th generation floroquino...

Sick Building Syndrome

2013-01-18T18:38:00.002+05:00

An illness usually occurs by spending time in building that cannot be attributed to any other specific illness or cause. Symptoms that building occupants may come across are headache, dry cough, and fatigue. Most people with this syndrome report relief soon after leaving the building.

If illness is identified then it may be charracterised as the term "building related illness" (BRI),this term is used when symptoms of a diagnosable illness are identified and can be attributed directly to airborne building contaminants.The complaints of sick building syndrome may be localized in a particular room or zone, or they may be widespread throughout the building. The excessive complaints may be due to indoor air quality (IAQ).Often, this condition is temporary, but some buildings have long-term problems.Sometimes, indoor air problems are a result of poor building design or occupant activities.

Symptoms:

Possible symptoms of sick building syndrome may include:

Headache
Eye, nose, or throat irritation
nausea
dry throat
difficulty in breathing
Dry cough
Dry or itchy skin
Dizziness and nausea
Difficulty in concentrating
Fatigue
Sensitivity to odors.
Symptoms of building related illness

related illness (BRI) may complain of symptoms such as:

Cough
Chest tightness
Fever
Chills
Muscle aches.

Complainants may require prolonged recovery times after leaving the building.
It is important to note that complaints may result from other causes. These may include:

An illness contracted outside the building
Acute sensitivity (for example, allergies)
Job-related stress or dissatisfaction
Other psychosocial factors.

Nevertheless, studies show that symptoms may be caused or exacerbated by indoor air quality (IAQ) problems.

Causes

There are several possible causes of (or contributing factors to) sick building syndrome. These possible causes of sick building syndrome may include:

Inadequate ventilation
Chemical contaminants from indoor sources
Chemical contaminants from outdoor sources
Biological contaminants.

Inadequate Ventilation

In the early and mid-1900s, building ventilation standards called for approximately 15 cubic feet per minute (cfm) of outside air for each building occupant, primarily to dilute and remove body odors. As a result of the 1973 oil embargo, however, national energy conservation measures called for a reduction in the amount of outdoor air provided for ventilation to 5 cfm per occupant.In many cases, these reduced outdoor air ventilation rates were found to be inadequate to maintain the health and comfort of building occupants. Inadequate ventilation, which may also occur if heating, ventilating, and air conditioning (HVAC) systems do not effectively distribute air to people in the building, is thought to be an important factor in sick building syndrome. In an effort to achieve acceptable IAQ while minimizing energy consumption, the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) recently revised its ventilation standard to provide a minimum of 15 cfm of outdoor air per person (20 cfm per person in office spaces). Up to 60 cfm per person may be required in some spaces (such as smoking lounges), depending on the activities that normally occur in that space

Biological Contaminants

Types of biological contaminants include:

Bacteria
Molds
Pollen
Viruses.

These contaminants may breed in stagnant water that has accumulated in ducts, humidifiers, and drain pans or where water has collected on ceiling tiles, carpeting, or insulation. Sometimes, insects or bird droppings can be a source of biological contaminants.

Physical symptoms related to biological contamination include:

Cough
Chest tightness
Fever
Chills
Muscle aches
Allergic responses (such as mucous membrane irritation and upper respiratory congestion).

One indoor bacterium, Legionella, has caused both Legionnaire's disease and Pontiac fever.
These elements may act in combination and may supplement other complaints, such as inadequate temperature, humidity, or lighting. Even after a building investigation, however, the specific causes of the complaints may remain unknown.

Solutions to Sick Building Syndrome

Solutions to sick building syndrome usually include combinations of the following:

Removing or modifying sources of pollution
Increasing ventilation rates
Air cleaning
Education and communication(educate patient or attendent of patient about how to minimize or eliminate the cause)

Obsessive-compulsive disorder

2013-01-07T11:23:00.000+05:00

An anxiety disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), or behaviors that make them feel driven to do something (compulsions).Disorder may also be called as Obsessive-compulsive neurosis; OCD.

Often the person carries out the behaviors to get rid of the obsessive thoughts, but this only provides temporary relief. Not performing the obsessive rituals can cause great anxiety.
Obsessive-compulsive disorder (OCD) is more common than was once thought. Most people who develop it show symptoms by age 30.There are several theories about the cause of OCD, but none have been confirmed. Some reports have linked OCD to head injury and infections. Several studies have shown that there are brain abnormalities in patients with OCD, but more research is needed.About 20% of people with OCD have tics, which suggests the condition may be related to Tourette syndrome. However, this link is not clear.

Symptoms

Obsessions or compulsions that are not due to medical illness or drug use
Obsessions or compulsions that cause major distress or interfere with everyday life
There are many types of obsessions and compulsions. Examples include:
Checking and rechecking actions (such as turning out the lights and locking the door)
Excessive counting
Excessive fear of germs
The compulsion to repeatedly wash the hands to ward off infection
The person usually recognizes that the behavior is excessive or unreasonable.

Pathophysiology
OCD can be interpreted in the light of physiology after consideration of various approaches (phenomenology, neuropsychology, neuroimmunology and neuroimagery) that contribute to proposing the central role of several cortical and subcortical regions, especially the orbitofrontal cortex (OFC), the anterior cingulate cortex (ACC), the dorsolateral prefrontal cortex (DLPC), the head of the caudate nucleus and the thalamus. The OFC is involved in the significance attributed to the consequences of action, thereby subserving decision-making, whereas the ACC is particularly activated in situations in which there are conflicting options and a high likelihood of making an error. The DLPC plays a critical part in the cognitive processing of relevant information. This cortical information is then integrated by the caudate nucleus, which controls behavioral programs. A dysfunction of these networks at one or several stages will result in the emergence and maintenance of repetitive thoughts and characteristic OCD behavior.
Signs and tests

Your own description of the behavior can help diagnose the disorder. A physical exam can rule out physical causes, and a psychiatric evaluation can rule out other mental disorders.

Questionnaires, such as the Yale-Brown Obsessive Compulsive Scale (YBOCS), can help diagnose OCD and track the progress of treatment.

Treatment
OCD is treated using medications and therapy.
The first medication usually considered is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). These drugs include:

Citalopram (Celexa)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)

If an SSRI does not work, the doctor may prescribe an older type of antidepressant called a tricyclic antidepressant. Clomipramine is a TCA, and is the oldest medication for OCD. It usually works better than SSRI antidepressants in treating the condition, but it can have unpleasant side effects, including:

Difficulty starting urination
Drop in blood pressure when rising from a seated position
Dry mouth
Sleepiness

In some cases, an SSRI and clomipramine may be combined. Other medications, such as low-dose atypical antipsychotics (including risperidone, quetiapine, olanzapine, or ziprasidone) have been shown to be helpful. Benzodiazepines may offer some relief from anxiety, but they are generally used only with the more reliable treatments.
Note:
warning about taking cautions regarding use of medicine

if one medicine donot respond or treats the disorder then in such cese medicine category should be changed but it should be kept in mind that before starting next category patient should take a gap of almost two week so that previous medicine eliminates totaly from blood.
combination of two different medicine to treat such dis order is highly not authorized(contraindicated)

Cognitive behavioral therapy (CBT) has been shown to be the most effective type of psychotherapy for this disorder. The patient is exposed many times to a situation that triggers the obsessive thoughts, and learns gradually to tolerate the anxiety and resist the urge to perform the compulsion. Medication and CBT together are considered to be better than either treatment alone at reducing symptoms.

Psychotherapy can also be used to:

Provide effective ways of reducing stress
Reduce anxiety
Resolve inner conflicts

Expectations (prognosis)

OCD is a long-term (chronic) illness with periods of severe symptoms followed by times of improvement. However, a completely symptom-free period is unusual. Most people improve with treatment.

Complications

Long-term complications of OCD have to do with the type of obsessions or compulsions. For example, constant handwashing can cause skin breakdown. However, OCD does not usually progress into another disease.

References
Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA. Personality and personality disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 39.
Feinstein RE, deGruy FV III. Difficult patients: Personality disorders and somatoform complaints. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 46.
Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB, et al. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. 2007;164:5-53.
Stein DJ, Denys D, Gloster AT, et al. Obsessive-compulsive disorder: diagnostic and treatment issues. Psychiatr Clin North Am. 2009;32:665-685.

Review Date: 3/7/2012.

Reviewed by: Fred K. Berger, MD, Addiction and Forensic Psychiatrist, Scripps Memorial Hospital, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

what causes asthma

2012-11-28T18:36:00.001+05:00

Dry milk:use of dry milk cause asthma, depressive thoughts,cockroaches,
Cold:protect yourself from cold in winter season so keep your self warm specially chest and feet.
Pests:furs of animal pests aggrevates asthma symptoms..

Dust:keep mask with you when you are out to save from dust it irritates lungs.
Take coffee tea soups .dates. to keep yourself internally warm.
Donot limit your activites i.e schooling, job etc,
Massage your chest with wicks etc, it give you soothing effect and comfortable sleep if you do this at night.
Dry air can make you cough
Take healthy diet it helps to bear circumstances of disease.
Donot or limit use of pain killers as they increase severity.
Acidity(chest burning) is one of the major cause consult doctor for that.
Seasonal changes increase chances of severe attacks so take cautions in thoes days
Donot sit in air conditioned enviorments.
Don't eat sour stuffs or cold things.

Common symptoms:

Symptoms of a mild asthma attack:

cough, wheeze
some shortness of breath
still able to speak in full sentences between breaths

Symptoms of a moderate asthma attack:

continual cough, moderate to loud wheeze
obvious difficulty breathing
only able to speak in short phrases between breaths

Symptoms of a severe asthma attack:

severe difficulties breathing
speak no more than a few words at a time
wheeze is often quiet
sucking in of the throat and rib muscles
pale and sweaty
may have blue lips
very distressed and anxious

If you or someone else is having a severe attack, you should call an ambulance immediately.

As well as experiencing some of the above symptoms, young children may appear restless, unable to settle and may have problems eating or drinking. They may also have severe coughing or vomiting.

Cockroach aggrevates asthma:

Recent cockroach allergy research studies have found a strong association between the presence of cockroaches and increases in the severity of asthma symptoms in individuals who are sensitive to cockroach allergens.
These pests are common, even in the cleanest of crowded urban areas and older dwellings. They are found in all types of neighborhoods.
The proteins found in cockroach saliva are particularly allergenic, but the bodies and droppings of cockroaches also contain allergenic proteins.

Preventive Strategies for Cockroach Allergy

Methods of preventing cockroach allergy can include:

Keep food and garbage in closed, tight-lidded containers. Never leave food out in the kitchen.
Do not leave out pet food or dirty food bowls.
Eliminate water sources that attract these pests, such as leaky faucets and drain pipes.
Mop the kitchen floor and wash countertops at least once a week.
Plug up crevices around the house through which cockroaches can enter.
Limit the spread of food around the house, and especially keep food out of bedrooms.
Use bait stations and other environmentally safe pesticides to reduce cockroach infestation.

Patient learnings about managing asthma:

Phsycian should educate the patient about appearance of initial symptoms of attacks of asthma .Generaly initiation of symptoms are characterised by cough, least mucous feeling,which progress to sound in chest(wheezing).Certain points should be told to the patient regarding mangment of asthma attacks

Double the dose of medicine
Use oral steroids e.g prednisolone (dose of upto 40mg /day in 2 divided doses)
Take almost double the puffs of the normal dose of inhalor.
Inhale steam.
Do massage of inhalants like wicks on chest.twice a day

Asthma & Sex

under control

exercise-induced asthma

Self Help

Try to stop smoking completely and avoid second-hand smoke
Avoid contact with anyone who has a cold or a chest infection and wash your hands often
If you think you have a chest infection, see your doctor
Get an influenza vaccine every autumn
Try to do some gentle exercise every day. Ask your doctor for advice
Dry air can make you cough; make the air more moist with a humidifier or by placing a bowl of water on a window ledge
Breathing through your mouth can make you dehydrated, so try to drink plenty of fluids such as water and fruit juices
Try to eat little and often, for example, five small meals rather than three large ones. A full stomach after a large meal will make it more difficult for you to breathe

REFFERENCE

http://allergies.emedtv.com/cockroach-allergy/cockroach-allergy.html

rheumatide arthritis

2012-11-27T19:39:00.000+05:00

Any painful disorder of the jointor muscles or connective tissues

OR:an autoimmunedisease that occurs when the body's own immune system mistakenly attacks the synovium.Rheumatoid arthritis is a chronic disease

NOTE:

Rheumatide arthritis is a joint disease that can occur at any age bt arthritis is a term used for joint disease that occur only in old bronze age

Difference in physical appearence of signs between rheumatide arthritis and gout is that in gout no joint inflammations are seen but in arthritis

Causes

joint pain
stiffness
swelling
loss of joint function

Drug Classification :

Ø NSAIDS.

Ø DMARDs

Ø Immunosuppressant

Ø Glucocorticoids

Ø Antibiotic

Dmards :

These are charracterised as disease

modifying Anti-rheumatic drugs

Classified as:

1:Synthetic dmards

2:Biologic dmards

Synthetic DMARDS:

v Methotrixate

v Sulfasaline

v Leflunomide

v Hydroxichloroquinine

v monocycline

BIOLOGIC DMARDS

¨ Abatacept

¨ Rituximab

¨ Tocilizumab

(these are some TNF recepter inhibitiors)

Leflunomide:

Mechanism of action:

IT ACTS ON DIHYDROORATE

DEHYDROGENASE ENZYME

Clinical uses

v Reduces pain

v Slows progression of Stuctural damage

Adverse Effects:

v Diarrhea

v Headache

v Nausea

v Skin rashes

v Mild alopecia

v hypertention

Contraindications

v contraindicated in pregnancy.

v Use with caution in hepatic patients

v Use with caution in patients with renal insufficency .

Salfasaline:

Mechanism of action:

v Decreases production of IgA & IgM

v Suppression of t cell response

v Inhibition of in vitro b cell proliferation

Clinical uses:

v Effective in rheumatoid arthritis

v Effective in radiologic disease progression

Adverse effects:

v Nausea

v Vomiting

v Headache

v rashes

Minocycline:

minocycline is one of the tetracycline

used in early, mild case of

rheumatic arthritis

Mechanism of action:

Not well known but do have

anti inflammatory effect INCLUDING ABILITY TO DESTROY COLLAGENASE

ENZYME (this enzyme has ability to desolve bone)

¨ Dose:

have daily dose of 200mg.

Adverse effects:

adverse effects are uncommon except for dizziness for 10 percent

¨ refferences

¨ Lippincot

¨ katezeng

Cyclosporine

Cyclosporine are Immunosuppressant involve in the production of therapeutics effects in rheumatism.

Mechanism of Action

It inhibit production of interleukin 1, interleukin 2.

Secondarily it inhibit macrophage –T cell interaction and T cell responsiveness.

Indication

Approved in use in arthritis.

Retard the appearance of new bony erosion.

Adverse effects

Nephrotoxicity

Hypertension

Gold salts

The class of drugs having ability to prevent further rheumatic injury, but cannot repair the existing damage

Drugs Available.

Auranofin

Mechanism of Action

It retard the progressing and articular distruction.

They inhibit cyclooxygenase (cox) enzyme.

Adverse effects

• They cause serious toxicity that’s why not used majorly.

• Metallic taste in mouth.

• Skin rashes.

• Leucopenia.

Toxic Reaction of Gold Salts

Skin (minor reaction).35/60

Mouth .. .. .. .. .. .. 7/60

Kidney…………………. 5/60

General .. .. .. .. .. .. 4/60

Skin (major reaction). 2/60

Glucocorticoids

Effects of This class of therapy are prompt and are capable of slowing.

Available Drugs

Prednisolone

Dexamethasone

Prednisone

Mechanism of Action

It inhibit the production of archidonic acid.

Inhibits accumulation lymphocytes at injury area. And suppresses phagocytic activity.

Adverse Effects

Prolong use cause disabling toxic effects.

Withdrawal effects

NSAIDs

Non steroidal anti inflammatory drug.

Usually, only one such NSAID should be given at a time.If the pain and swelling persist then combination therapy with NSAIDs should use.

Mechanism Of Action

NSAIDs work by blocking the production of certain chemicals (cox1 & cox2) in the body that cause inflammation.

Adverse effects

GI/Ulcers
Hepatotoxicity
Nephrotoxicity
Bleeding – antiplatelet
Rash

References::

Basic pharmacology by lipencoart.

Basic pharmacology by katzeng.

www.webmd.com

Restless legs syndrome

2012-11-03T19:41:00.001+05:00

Intro...

Unpleasant creeping discomfort that seems to arise deep within the legs & occasionally the arms.it occurs especially when person is in rest state,

especially lying down or in sitting and it lead to or force to move about leg. They also occurs in night and delays onset of sleep.Usualy restlessness occurs from knee to ankle joint.A sleep disorder associated with periodic movement during sleep may also occurs.Restless leg syndrome (RLS) occurs most often in middle-aged and older adults. Stress makes it worse.

It occurs in with:

Anemic patients
Diabetic patients
Uremic patients
Neuropathic patients
Patient with chronic acidity
Asthematic patients

Treatment

is aimed at reducing stress and helping the muscles relax. The following techniques may help:

Gentle stretching exercises
Massage
Warm bathsMedication

medication

Gabapantine(300mg once daily)
Diazepam(5mg once daily)
cLonazepam(5mg once daily)
Iron supplements(10ml twice)
Levodopa-carbidopa
iron supplements
vitamin b(as directed)
vitamin c(1000mg)

Most beneficial among these medicine is gabapentine and iron supplements.it should be taken until symptoms disappears.

REFFERENCES:
KATZANG'S BASIC & CLINICAL PHARMACOLOGY BY11TH EDITION EDITED BY BERTRAM G. KATZANG,MD,PhD

http://www.botanical2000ltd.com/treatments.htm

Biller J, Love BB, Schneck MJ. Sleep and its disorders. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 72.

Lang AE. Other movement disorders. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 417.

heartburn

2012-10-28T18:53:00.000+05:00

Today It becomes general problem of people and a leading cause of stomach ulcer.its actually back movement of stomach acid.people use to have cold drink to get relief from burning but it do so for the time being, later it aggravates the situation .

Heart burn is condition that generally develops after having meal.its actually the overproduction of stomach acid which leaks from stomac ,enters esophagus causing burning in chest.this acid actually functions in digestion of the food that we eat. the acid enters the food pipe and thus burning begins.it may be due to the H.pylori infection .this is associated with acidic nature of food also.patient feels extreme burning inside chest .food pipe tends to swells(esophagitis).so,tea,coldrink,coffee,acidic food(burgers etc),fried things and alcohol should be prevented.patient should consult doctor earlier otherwise longterm treatment is required as well as food pipe(esophagus) swells and blister forms which requires medication .patient should take cabbage ,cucumber with meal as it relieves burning.

What happens if it progresses untreated?

· Neurologic problems

o When blood becomes so acidic person suffers fits,

o Unconsciousness.

o vomiting.

o Neurologic pain in leg

· Muscular problems

o Muscular pain,less muscle activity,cramps.

· General weakness

· Respiratory problems

o Person feels difficulty in breathing

· Ulceration
all of the above mention data is not reffered from any book or medical web sites but collected from the patient criticaly suffering from acidity
specially in rural areas

Moxifloxacin: (mox'' i flox' a sin)

2012-10-18T13:37:00.000+05:00

It’s a 4th generation floroquinolons antibiotic.mostly available in oral dosage form (Avelox) but in some countries parentral and ophthalmic prepration (Vegamox) are also use.marketed in hydrochloride form.

Use of this drug is quite limited because of certain side effects;
(it is contra indicated with many drugs as well as some herbal products) it is used in last when no antibiotic is effective.
Systematic (IUPAC) name:
1-cyclopropyl-7-[(1S,6S)-2,8-diazabicyclo
[4.3.0]non-8-yl]-6-fluoro-8-methoxy-4-oxo- quinoline-3-carboxylic acid
Available form:

Oral, IV, local (eyedrops)

Mechanism of action:

Moxifloxacin is a broad-spectrum antibiotic that is active against both Gram-positive and Gram-negative bacteria. It inhibits DNA gyrase, a type II topoisomerase, and topoisomerase IV, enzymes necessary to separate bacterial DNA, thereby inhibiting cell replication.

Advantages of moxifloxacin over other floroquinolons:
The most apparent advantage of the IV generation lies in the fact that the drugs act by inhibiting topoisomerases II and IV in both +ve & -ve. (Whereas other floroquinolons were active against topoisomerase IV in gm +ve and topoisomerase II in gm -ve)

It would therefore appear that resistance to these drugs may not occur as a spontaneous mutation at two levels at once.

Resistance:

A possible mechanism of drug resistance development to this generation has been postulated - resistance at the bacterial cell wall by increased eflux (remains to be seen).

Uses:

Respiratory tract infections
Cellulitis, anthrax
Intra-abdominal infections
Endocarditis
Meningitis
Tuberculosis
Conjunctivitis

FDA has approved this drug in

Acute Exacerbations of Chronic Bronchitis (AECB) (restricted use)
Acute Bacterial Sinusitis (ABS) (restricted use)
Community Acquired Pneumonia (CAP)(restricted use)

Additional indications were approved by the FDA as follows:

April 2001: Uncomplicated Skin and Skin Structure Infections (uSSSI)
May 2004: Community Acquired Pneumonia caused by multi-drug resistant Streptococcus pneumonia.
June 2005: Complicated Skin and Skin Structure Infections (cSSSI)
November 2005: Complicated Intra-Abdominal Infections (cIAI).

Note:
Moxifloxacin only be prescribed when other antibiotics that have been initially recommended for treatment cannot be used or have failed.
Moxifloxacin only be prescribed when other antibiotics that have been initially recommended for treatment cannot be used or have failed.

Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness. Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless told to do so by your doctor. A different medication may be necessary in that case.Laboratory and/or medical tests (e.g., liver function, complete blood count, blood glucose) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.
Donot use if you have:

Doesn’t use in Liver complication, if necessary adjust its dose to its decreased quantity.
If you have muscular weakness take this medicine with some supplements.
If your body or body parts shivers (seizures) avoid it.
Do not use it in pregnancy it may harm the fetus.
Don’t use if you are taking steroids.Drug interactions:

NSAID, theophylline, warfarin (hepatic biotransformation)
May be given after food, but not with chelating agents - upto 8 hours after taking antacids & 1-2 hours before taking antacids.
Antacids (aluminum, calcium,or magnesium-containing)
Laxatives (magnesium-containing, or sucralfate or Zinc)
Ferrous sulfate and Bismuth salicylate

Precautions:

History of hypersensitivity to the quinolones (Steven Johnson's type syndrome may occur).
For systemic administration - hepatic and renal impairment needs to be considered.
Achilles tendinitis and tendon rupture reported 2-42 days after systemic administration.

Contraindicated in pts. With history of convulsions.

Pregnancy category C - NOT to be given to pregnant mothers, lactating mothers (Adequate animal studies, inadequate human studies).

Pharmacokinetics:

Approximately 52% of an oral or intravenous dose of moxifloxacin is metabolized via glucuronide and sulfate conjugation.
The cytochrome P450 system is not involved in moxifloxacin metabolism.
Half life is 11-15 hrs.
Eliminate through urine and feces 45 % of the drug is excreted unchanged.

Adverse effects:

Severe allergic reactions (rash; hives; itching)

1-Breathing problems:

Difficulty breathing or swallowing; tightness in the chest; seizures;

Swelling of the mouth, face, lips, or tongue; unusual hoarseness)
Bloody or tarry stools; burning,
2-Muscular problem:

Numbness, tingling, pain, or weakness of the arms, hands, legs, tiredness or weakness; or feet; cramps; seizures; decreased urination;

3-Heart problems:

Fainting; fast, slow, or irregular heartbeat;

4-Mental illness includes: hallucinations; mood or mental changes (eg, new or worsening anxiety, agitation, confusion, depression, nervousness, paranoia, restlessness); muscle pain or weakness; nightmares; suicidal thoughts or actions.

5-Liver problems:
Symptoms of liver problems (eg, dark urine; loss of appetite; pale stools; yellowing of the skin or eyes); tremor; trouble sleeping; unusual bruising or bleeding; unusual swelling or weight gain;
6-Unusual vaginal yeast infection
7-Vision changes:
Vision changes (eg, blurred vision).
8-Miscellaneous:
pain, soreness, redness, swelling, weakness, or bruising of a tendon or joint area; persistent sore throat; red, swollen, blistered, or peeling skin; severe or persistent diarrhea; severe or persistent dizziness, headache, or light-headedness; stomach pain.

9-Others:
Fever, chills, or unusual cough; inability to move or bear weight on a joint or tendon area; moderate to severe sunburn.

tonsolitis

2012-10-10T12:24:00.002+05:00

Tonsils

Tonsils are the aggregations of lymphoid tissues that are present beneath but in contact with epithelium of digestive tract.

tonsillitis

membrane over the tonsils BECOMES enlarged and sore lymph glands CAUSING sore throat and temperature

general symptoms:

The main symptoms of tonsillitis are inflammation and swelling of the tonsils, sometimes severe enough to block the airways. Other symptoms include:

Throat pain or tenderness
Redness of the tonsils
A white or yellow coating on the tonsils
Painful blisters or ulcers on the throat
Hoarseness or loss of voice
Headache
Loss of appetite
Ear pain
Difficulty swallowing or breathing through the mouth
Swollen glands in the neck or jaw area
Fever, chills
Bad breath

In children, symptoms may also include:

Nausea
Vomiting
Abdominal pain
cough and rhinitis are evidence against group A streptococcal infection

TYPES

Depending on their localisation we distinguish between

Palatine tonsils
Lingual tonsils
pharyngeal tonsils

Palatine tonsils: (THE tonsils), which are located in the lateral wall of the oropharynx and covered by a stratified squamous epithelium,The palatine tonsils (what the term tonsils generally refer to) are two lymphatic tissue masses. There is one located on each side of the oral pharynx, in the back of the throat. The function of palatine tonsils has yet to be discovered, however they are part of the immune system and are thought to assist in defending the body from respiratory infections.

lingual tonsils: which are situated in the lamina propria at the root of the tongue and also covered by a stratified squamous epithelium, and

Pharyngeal tonsils (also called nasopharyngeal tonsils or adenoids) which are located in the upper posterior part of the throat (nasopharynx) and covered by a pseudostratified ciliated epithelium with goblet cells.

significant causative agents:

beta-haemolytic streptococci (groups A, C and G)
adenoviruses
Epstein-Barr virus
Influenza virus
Parainfluenza viruses
Enteroviruses
Herpes simplex virus

other causative agents:

various bacteria and viruses which are rare and with little significance on treatment

Diagnosis of tonsillitis

The aim is to:

reliably identify group A streptococcal infections

during epidemics testing is also done for group C and G streptococci

Diagnosis of tonsillitis 2

group A streptococcal infection cannot be reliably diagnosed on clinical symptoms and findings (A)

antibiotic treatment should be based on isolation of beta-haemolytic streptococci from the throat (A)

the main bacteriological investigation is a throat swab (the only acceptable one during an epidemic) (A)

use of “on the spot” testing methods is justifiable only if results are available whilst the patient waits

a positive “on the spot” test result is reliable – a negative one should be counterchecked by bacterial culture

Antimicrobial therapy of tonsillitis

First choice:

Penicillin V 1-1.5 mega units twice daily for 10 days (more relapses with shorter treatment period (A))

Second choice:

first generation cephalosporins (cefalexin 750 mg twice daily or cefadroxil 1g daily) or

procaine penicillin 1.2 – 1.5 mega units daily

for 10 days

macrolides – with caution (if local resistance patterns accept their use or they are indicated by sensitivity testing)

Treatment of tonsillitis 2

about 90% of patients with pharyngitis are asymptomatic within a few days of symptom onset whether they received antibiotics or not

Antibiotic treatment aims at:

relieving patient’s symptoms sooner (A) and

preventing both complications (A) and epidemics

Symptomatic pain relief should also be remembered. Painkillers have a significant effect on pain, including pain on swallowing. (A)

Recurrent episodes of tonsillitis

4 or more episodes of group A streptococcal infections per year

90-96% carry beta-lactamase producing bacteria in the normal flora of their throat

Other reasons:

poor compliance with treatment

new infection from a close contact

frequent episodes of viral infections in carriers

Treatment:

1. cefalexin or cefadroxil or

2. clindamycin 300mg twice daily for 10 days
3.cephradin 500mg twice for 5 days
4.ciprofloxacin 250mg 7days ,500mg 5 days
5.ofloxacin dose same as ciprofloxacin.

Quality criteria for the treatment of tonsillitis

antibiotic therapy based on microbiological confirmation

the majority of patients treated with narrow spectrum antibiotics

treatment decision made within 24 hours

patient informed also about symptomatic pain relief

Tonsil Tests

Throat (pharynx) swab: A doctor rubs a cotton swab on the tonsils and throat and sends the swab for tests. Usually this is done to check for bacteria such as Streptococcus.
Monospot test: A blood test can detect certain antibodies, which can help confirm that a person’s symptoms are due to mononucleosis.
Epstein-Barr virus antibodies: If a monospot test is negative, antibodies in the blood against EBV might help diagnose mononucleosis.
Tonsil Conditions
Acute tonsillitis: A bacteria or virus infects the tonsils, causing swelling and a sore throat. The tonsil may develop a gray or white coating (exudate).
Chronic tonsillitis: Persistent infection of the tonsils, sometimes as a result of repeated episodes of acute tonsillitis.
Peritonsillar abscess: An infection creates a pocket of pus next to the tonsil, pushing it toward the opposite side. Peritonsillar abscesses must be drained urgently.
Acute mononucleosis: Usually caused by the Epstein-Barr virus, “mono” causes severe swelling in the tonsils, fever, sore throat, rash, and fatigue.
Strep throat: Streptococcus, a bacterium, infects the tonsils and throat. Fever and neck pain often accompany the sore throat.
Enlarged (hypertrophic) tonsils: Large tonsils reduce the size of the airway, making snoring or sleep apnea more likely.
Tonsilloliths (tonsil stones): Tonsil stones, or tonsilloliths, are formed when this trapped debris hardens, or calcifies

FOR MORE INFORMATION YOU CAN READ ITS ANATOMY AND HISTOLOGY

Anatomy

The tonsils consist of two glandular tissues similar to hundreds of other lymph glands in the human body, present on either side of the back side of the throat. They are normal body organs just like lungs, skin and eyes. They are visible just behind the tongue, when the mouth is opened with slight force. They may vary in size. They are soft to touch and may either be bright red or pink-grayish in color.

Physiology

Tonsils, like any other body organ, have a specific role to play. Rather, tonsils have been allotted the vital task of checking if there are certain intruders such as bacteria, virus, allergens, etc attempting to attack the human body. Tonsils being lymphoid tissues, they produce the special cells called Lymphocytes. The Lymphocytes are similar to the white blood cells (Leukocytes) with which they form an immunological network of self-defense.

Growth

Tonsils tend to reach their largest size near puberty, and they gradually undergo atrophy thereafter. However, they are largest relative to the diameter of the throat in young children.

Tonsils can become enlarged or inflamed (tonsillitis) and may be surgically removed in tonsillectomy. This may be indicated if they obstruct the airway or interfere with swallowing. In older patients, asymmetric tonsils (also known as ) may be an indicator of virally infected tonsils, or tumors such as lymphoma or squamous cell carcinoma.

Some doctors who are not ear, nose and throat (ENT) specialists are conservative on recommending the removal of tonsils , because the tissue cannot be put back, and some claim that removal decreases the power of the immune system. ENT specialists generally recommend removal if there are frequent recurrent tonsillitis, adenotonsillar hyperplasia causing symptomatic partial upper airway obstruction or asymmetry.

Tonsil enlargement can affect speech, making it hypernasal and giving it the sound of velopharyngeal incompetence.

HISTOLOGICALY

The tonsils are accumulations of lymphoid tissue surrounding the openings of the digestive and respiratory tracts. The tonsils and smaller accumulations of lymphoid tissue, which may be found between them, are also called Waldeyer's ring.

2012-10-04T13:41:00.000+05:00

PILES
these are group/clumps of enlarged veins tissues(generally hypertrophy of veins of anus/rectum) developing either internally or externally in rectum or anus characterized by persistent painful elimination of feces

Hemorrhoid:
hemorrhoid /hem·or·rhoid/ (hem´ah-roid) prolapse of an anal cushion, resulting in bleeding and painful swelling in the anal canal. the hemorrhoids become larger, they protrude with any exertion or may actually stay outside the rectum all of the time.
The blood from hemorrhoids is usually bright red and not mixed with the bowel movement. It may vary in amount from streaks on the toilet tissue to quantities sufficient to make the water in the toilet bowl red. Protracted bleeding may result in anemia(reference http://zerohemorrhoids.blogspot.com/)

External hemorrhoid
                           one in a vein of the inferior rectal plexus,
below the pectinate line and covered with modified anal skin.
Prolapsed hemorrhoid:
   an internal hemorrhoid that has descended
   below the pectinate line and protruded outside the anal sphincter.
Strangulated hemorrhoid
a prolapsed hemorrhoid whose blood supply
   has become occluded by constriction of the anal sphincter.

Thrombosed hemorrhoid
                           one containing clotted blood.
(Reference: http://medical-dictionary.thefreedictionary.com/internal+hemorrhoid)

Common Causes of Piles
Generally piles develops due to the increased pressure on walls of rectum so to overcome that pressure veins of rectum increased in size in a way that progresses to formation of thrombus that uncommonly comes along the feces with irritating pain. Pressure increase due to :

· Low fiber diet

· Pregnancy

· Aging

· Hereditary

· Chronic constipation

· Anal intercourse

· Bad eating habits and poor diet which does not contain adequate quantities of fiber from fruits and vegetables

· Insufficient fluid intake

· lack of exercise and general physical inactivity

· Long stay in a standing or sitting positions

· Work requiring high muscular effort

· Prolonged and frequent constipation (increased effort during straining at stools)

· childbirth

· Advanced age (that decreases the elasticity of the anal layer )

· Some lesions, such as the presence of large tumors in the abdomen and pelvis, liver cirrhosis (in 30% of cases)

· Diarrhea

· Frequent vomiting

· Heart failure

· Hypertension (high blood pressure)

· Rectal cancer

· Congenital weakness of the anal sphincter muscles
Internal haemorrhoids:

These form in the back passage about 2-4 cm above the rim (opening) of the anus. Their severity and size are classified into grades 1 to 4:
Grade 1 are small swellings on the inside lining of the back passage. They cannot be seen or felt from outside the anus. Grade 1 haemorrhoids are common. In some people they enlarge further to grade 2 or more.
Grade 2 are larger. They may be partly pushed out (prolapse) from the anus when you go to the toilet, but quickly spring back inside again.
Grade 3 hang out (prolapse) from the anus. You may feel one or more as small, soft lumps that hang from the anus. However, you can push them back inside the anus with a finger.
Grade 4 permanently hang down from within the anus, and you cannot push them back inside. They sometimes become quite large.

Symptoms can vary. Small haemorrhoids are usually painless. The most common symptom is bleeding after going to the toilet. Larger haemorrhoids may cause a mucous discharge, some pain, irritation, and itch. The discharge may irritate the skin around the anus.
External haemorrhoid (sometimes called a perianal haematoma)

This is less common than internal hemorrhoids. An external hemorrhoid is a small lump that develops on the outside edge of the anus. Many do not cause symptoms. However, if a blood clot forms in the hemorrhoid (a thrombosed external hemorrhoid) it can suddenly become very painful and need urgent treatment. The pain due to a thrombosed external hemorrhoid usually peaks after 48-72 hours, and then gradually goes away over 7-10 days. A thrombosed external hemorrhoids may bleed a little for a few days. It then gradually shrinks to become a small skin-tag.

Some people develop internal and external hemorrhoids at the same time.

Treatment of piles:

Keep the faeces (sometimes called stools or motions) soft, and don't strain on the toilet. You can do this by the following:
Eat plenty of fibre such as fruit, vegetables, cereals, wholemeal bread, etc.
Have lots to drink. Adults should aim to drink at least two litres (10-12 cups) per day. You will pass much of the fluid as urine, but some is passed out in the gut and softens faeces. Most sorts of drink will do, but alcoholic drinks can be dehydrating and may not be so good.
Fibre supplements. If a high-fibre diet is not helping you can take fibre supplements (bulking agents) such as ispaghula, methylcellulose, bran or sterculia.. Methylcellulose also helps to soften faeces directly which makes them easier to pass.
Avoid painkillers that contain codeine such as co-codamol, as they are a common cause of constipation.
Toileting. Go to the toilet as soon as possible after feeling the need. Some people suppress this feeling and plan to go to the toilet later. This may result in bigger and harder faeces forming which are then more difficult to pass. Do not strain on the toilet. Haemorrhoids may cause a feeling of fullness in the rectum and it is tempting to strain at the end to try to empty the rectum further. Resist this. Do not spend too long on the toilet, which may encourage you to strain. (For example, do not read whilst on the toilet.)

                    Home Remedies for Piles
Tip 1:
Take 1 tbsp black cumin seeds (shah jeera), roast and mix with 1 tbsp of unroasted black cumin seeds and powder both
together. Take 1/2 a tsp with a glass of water once a day.

Tip 2:
Radish juice taken in the morning and night. Start with 1/4 a cup and increase to 1/2 a cup gradually over a period of 1 month.

Tip 3:
Wash 3-4 figs. Soak in a glass of water over night. Eat them first thing in the morning. Again repeat in the night.

Tip 4:
Boil 1 ripe banana in 1 cup of milk, mash well. Take 3-4 times a day.

Tip 5:
Crush bitter gourd leaves and extract the juice. Mix 3 tsp in 1 glass of buttermilk, and drink on an empty stomach every morning, for a month.

Tip 6:
Drink a glass of buttermilk with 1/4 tsp carom seed powder (ajwain) and a pinch of salt

Reference: http://www.medindia.net/homeremedies/piles.asp
                        Types

Internal haemorrhoid
External haemorrhoid

Internal haemorrhoid
These form in the back passage about 2-4 cm above the rim (opening) of the anus. Their severity and size are classified into grades 1 to 4:
Grade 1 are small swellings on the inside lining of the back passage. They cannot be seen or felt from outside the anus. Grade 1 haemorrhoids are common. In some people they enlarge further to grade 2 or more.
Grade 2 are larger. They may be partly pushed out (prolapse) from the anus when you go to the toilet, but quickly spring back inside again.
Grade 3 hang out (prolapse) from the anus. You may feel one or more as small, soft lumps that hang from the anus. However, you can push them back inside the anus with a finger.
Grade 4 permanently hang down from within the anus, and you cannot push them back inside. They sometimes become quite large.

Symptoms can vary. Small haemorrhoids are usually painless. The most common symptom is bleeding after going to the toilet. Larger haemorrhoids may cause a mucous discharge, some pain, irritation, and itch. The discharge may irritate the skin around the anus.

External haemorrhoid (sometimes called a perianal haematoma)

This is less common than internal hemorrhoids. An external hemorrhoid is a small lump that develops on the outside edge of the anus. Many do not cause symptoms. However, if a blood clot forms in the hemorrhoid (a thrombosed external hemorrhoid) it can suddenly become very painful and need urgent treatment. The pain due to a thrombosed external hemorrhoid usually peaks after 48-72 hours, and then gradually goes away over 7-10 days. A thrombosed external hemorrhoids may bleed a little for a few days. It then gradually shrinks to become a small skin-tag.

Some people develop internal and external hemorrhoids at the same time.

Treatment of piles:

Keep the faeces (sometimes called stools or motions) soft, and don't strain on the toilet. You can do this by the following:
Eat plenty of fibre such as fruit, vegetables, cereals, wholemeal bread, etc.
Have lots to drink. Adults should aim to drink at least two litres (10-12 cups) per day. You will pass much of the fluid as urine, but some is passed out in the gut and softens faeces.
Most sorts of drink will do, but alcoholic drinks can be dehydrating and may not be so good.
Fibre supplements. If a high-fibre diet is not helping you can take fibre supplements (bulking agents) such as ispaghula, methylcellulose, bran or sterculia.. Methylcellulose also helps to soften faeces directly which makes them easier to pass.
Avoid painkillers that contain codeine such as co-codamol, as they are a common cause of constipation.
Toileting.
Go to the toilet as soon as possible after feeling the need. Some people suppress this feeling and plan to go to the toilet later. This may result in bigger and harder faeces forming which are then more difficult to pass. Do not strain on the toilet.
Haemorrhoids may cause a feeling of fullness in the rectum and it is tempting to strain at the end to try to empty the rectum further. Resist this.
Do not spend too long on the toilet, which may encourage you to strain. (For example, do not read whilst on the toilet.)

Home Remedies for Piles

Tip 1:Take 1 tbsp black cumin seeds (shah jeera), roast and mix with 1 tbsp of unroasted black cumin seeds and powder bothtogether. Take 1/2 a tsp with a glass of water once a day.
Tip 2:
Radish juice taken in the morning and night. Start with 1/4 a cup and increase to 1/2 a cup gradually over a period of 1 month.
Tip 3:
Wash 3-4 figs. Soak in a glass of water over night. Eat them first thing in the morning. Again repeat in the night.
Tip 4:
Boil 1 ripe banana in 1 cup of milk, mash well. Take 3-4 times a day.
Tip 5:
Crush bitter gourd leaves and extract the juice. Mix 3 tsp in 1 glass of buttermilk, and drink on an empty stomach every morning, for a month.
Tip 6:
Drink a glass of buttermilk with 1/4 tsp carom seed powder (ajwain) and a pinch of salt

Reference: http://www.medindia.net/homeremedies/piles.asp

peptic ulcer

2012-10-03T13:44:00.000+05:00

Peptic ulcer:

Abnormal secretions of gastric gland in stomach resulting in destruction of stomach mucosal lining ,the defense wall of stomach, leading to bleeding in stomach characterized by intense pain, vomiting, burning.

1.its mainly removal of mucosa of stomach.

2.increased HCL in stomach due to acidic food or H.pylori

3. excessive use of painkillers

Origin & symptoms:

Its does not occurs directly but its exaggeration of gastroesophageal reflex disease including symptoms:

Burning in stomach
Chest burning
Vomiting after meal
Pain in stomach
People should notice these changes in body and consult physician otherwise it leads to
Wounds in stomach which if goes unnoticed may lead to
Decrease pH of blood i.e. acidic Ph causing :
Unconsciousness
Cramps in body
Fits
Respiratory depression

Diet in ulceration

Avoid taking:

Patient should avoid taking following things in stomach ulcer

Avoid smoking

Tea

Alcohol consumptions

Meals with red chillies

Cold drinks

Avoid fried food

Coffee

Avoid citrus fruits

Friendly food:

Eat salads

Take milk

Take cooked foods devoid of red chillies

Medication & dose regimen for ulcer:

Medicine	Advice	Nature	Dose	Brand name in market	Combination
Omeprazole Esomeprazole Ribaprazole Lansoprazole	Empty stomach supplements & increase dose if listed dose is not effective .take for 3 months	These All are PPis & should be taken with Ca++	20mg 40mg 20mg 30mg(they should be taken twice a day )	Risek,lazole Esold Cara rib sopra	ANY ONE OF THESE(EMTY STOMACH)+ULSONIC(EMTY STOMACH)RANAX +ANTACIDS+ CA++ SUPLEMENTS+IFRON.ALL THESE AFTER MEAL
SUCRALFATE	EMPTY STOMACH AS COURSE CONTINUES	PROSTA GLANDINGS. PROTECTS STOMACH	1g
Rinatindine Fomatidine Cematidine	For 20 days AFTER MEAL In patient having depression should take anti depresents	H₂recptor antagonis.TheyMay cause depression	150mg twice	Ranax,nulcer	SAME AS ABOVE
Antacids	As required (AFTER MEAL)		5ml=child 10ml=adult	Gaviscon,mucain	SAME AS ABOVE
Calcium supplements	3 months		1 tab	Qalsan D	SAME AS ABOVE
Iron supplements	As medication continues		1tab	IRO.F,IFERO TRIHEMIC	SAME AS ABOVE

SMOKING AND WEIGHT GAIN

2012-08-28T23:19:00.000+05:00

The two main causes of weight gain when quitting smoking are:

1) Eating more food:

Many smokers find their eating habits change when they quit cigarettes. Some people experience increased hunger as a withdrawal symptom, but research suggests their eating patterns eventually return to normal.

2) The effect of nicotine on the body:

Nicotine is the addictive substance in tobacco that causes smokers to continue their habit. Although nicotine isn’t thought to cause cancer, it does speed up the body’s food processing system, the metabolism. After many years of smoking, smokers tend to weigh slightly less than non-smokers.

The average weight gain is between five to six kilograms in the first year after stopping smoking. Research shows that in the long term, the average body weight of ex-smokers is similar to people who have never smoked.
Smoking appears to change the distribution of fat in women to a less healthy male ‘apple’ pattern. Women who smoke tend to put on more fat around their waist compared to women who do not smoke. Fat in this area is associated with risks such as stroke, heart disease, type 2 diabetes and a general increased death rate.
When women quit smoking, any weight gain that occurs is in the normal and safer female pattern, with a preference to the hips rather than the waist.
The best approach is to focus on strategies to keep healthy rather than on weight control. These include making realistic goals for healthy eating, getting regular exercise and getting enough sleep. These strategies can also help minimize weight gain. However, it can be helpful to be prepared to accept at least a small increase in weight.
It can be difficult to quit cigarettes and manage weight at the same time, because both activities require effort and commitment. If this is the case for you, concentrate first on quitting. See your doctor or dietitian for further information and advice if weight gain is a problem.

If you put on weight after quitting smoking:

If you’ve gained weight despite your best efforts, don’t despair. A few extra kilograms are a much lower risk compared to the risk of continuing to smoke. You would have to gain over 40 kilograms above your recommended weight to equal the risk of heart disease posed by smoking.
Don’t think that taking up smoking again will mean you will shed the weight – sometimes it doesn’t. Concentrate on improving your diet and increasing your physical activity. See your doctor or dietitian for help and advice.

Things to remember:

About 80 per cent of smokers put on weight after they quit.
The causes of weight gain may include the effect of nicotine on the body, and the ex-smoker’s inclination to eat more food.
You would have to gain over 40 kilograms above your recommended weight to equal the risk of heart disease posed by smoking.

REFRENCE:
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Smoking_weight_gain_and_quitting

parkinsonism

2012-06-29T13:28:00.002+05:00

An intro to parkinsonism

Parkinson’s disease develops as a result of the inability of nerves to carry signals within the brain due to diminished excretion of chemical called dopamine which normaly regulate body movement due to death of cell making it..

The term "parkinsonism" refers to any condition that involves the types of movement changes seen in Parkinson's disease.Symptoms of Parkinson’s disease

Alternative Names

Parkinsonism - secondary OR Atypical Parkinson’s disease

The Primary Symptoms :

Tremor – in limbs as well the head, neck, face and jaw in up to 25% of people with Parkinson’s disease

Rigidity - (stiffness) in the muscles leads to rigidity mostly during movement. A mask-like expression of the face is caused by rigidity in some Parkinson’s disease sufferers.

Bradykinesia (slowness of movement). This is caused by the nerves in the brain . Therefore the afflicted person is slow to respond and slow to carry out tasks.

Poor Balance - Falls are often caused by a sudden change in position of the body after the muscle receives a message from the brain.

Walking Problems - People with Parkinson’s disease often use short, shuffling steps with reduced arm swings. Some may have sudden freezing spells due to a lapse in nerve transmission.

Secondary parkinsonism

Secondary Parkinson disease is similar to Parkinson's disease, but it is caused by certain medicines, a different nervous system disorder, or another illness.

Whats the Causes:

Parkinson's disease is one of the most common nervous system disorders affecting the elderly.

Secondary parkinsonism

Secondary Parkinson disease is similar to Parkinson's disease, but it is caused by certain medicines, a different nervous system disorder, or another illness.

Whats the Causes:

Parkinson's disease is one of the most common nervous system disorders affecting the elderly.

it may be caused by health problems, including:

AIDS
Encephalitis
Meningitis
Stroke
Diffuse Lewy body disease
Multiple system atrophy
Progressive supranuclear palsy

Certain medications can cause secondary parkinsonism, including:

Antipsychotics (haloperidol)
Metoclopramide
Phenothiazine medications

Other causes of secondary parkinsonism include:

Brain damage caused by anesthesia drugs (such as during surgery)
Carbon monoxide poisoning
Mercury poisoning and other chemical poisonings
Overdoses of narcotics

There have been cases of secondary parkinsonism among IV drug users who injected a substance called MPTP, which can be produced when making a form of heroin. These cases are rare and have mostly affected long-term drug users.

Common Symptoms:

Common symptoms include:

Decrease in facial expressions
Difficulty starting and controlling movement
Loss or weakness of movement (paralysis)
Soft voice
Stiffness of the trunk, arms, or legs
Tremor

Confusion and memory loss may be more likely in secondary parkinsonism. This is because the diseases that cause secondary parkinsonism often lead to dementia.

For a more detailed description of symptoms, see Parkinson's disease.

Daignosis Tests

The health care provider may be able to diagnose secondary parkinsonism after performing a physical exam and asking questions about your medical history and symptoms. However, the symptoms may be difficult to assess, particularly in the elderly.

Examination may show:

Difficulty starting or stopping voluntary movements
Increased muscle tone
Problems with posture
Slow, shuffling walk
Tremors

Reflexes are usually normal.

Tests may be used to confirm or rule out other disorders that can cause similar symptoms.

Treatment

If the condition is caused by a medication, your doctor may recommend changing or stopping the medicine. However, the benefits of the medication should be weighed against the severity of symptoms. Medications should be stopped or changed if the risks outweigh the benefits.

Treating underlying conditions such as stroke or infections can reduce symptoms.

If your symptoms make it hard to do everyday activities, your doctor may recommend medication. Many of the medications used to treat this condition can cause severe side effects. It is important that you see your doctor for check-ups. Secondary parkinsonism tends to be less responsive to medical therapy than Parkinson's disease. However, medications are worth trying if the cause of the condition is not treatable.

For a more detailed description of treatment, see Parkinson's disease.

Support Groups

See: Parkinson's disease - support group

Outlook (Prognosis)

Secondary parkinsonism caused by antipsychotics or other medications is usually reversible if identified soon enough. However, it may not be reversible if it is caused by:

Drug-related brain damage
Infections
Toxins

All other causes are not reversible and tend to get worse over time.

Possible Complications

Difficulty performing daily activities
Difficulty swallowing (eating)
Disability (varying degrees)
Injuries from falls
Side effects of medications

Side effects from loss of strength (debilitation):

Aspiration
Deep vein thrombosis
Malnutrition

When to Contact a Medical Professional

Call your health care provider if:

Symptoms of secondary parkinsonism develop, come back, or get worse
New symptoms appear, including:

Changes in alertness, behavior, or mood
Delusional behavior
Dizziness
Hallucinations
Involuntary movements
Loss of mental functions
Nausea or vomiting
Possible side effects of medications
Severe confusion or disorientation

Discuss the situation with your health care provider if you are unable to care for the person at home (after treatment begins).

Prevention

Treating conditions that cause secondary parkinsonism may decrease the risk.

People with conditions that require long-term use of antipsychotics should be carefully monitored to prevent the development of secondary parkinsonism. Newer antipsychotic medications are less likely to cause secondary parkinsonism.

Medication

most of the medications used to treat the condition are aimed at replacing this chemical.

TUBERCULOSIS

2012-06-27T10:36:00.003+05:00

INTRODUCTION
Tuberculosis, or TB, is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs.
It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease.
In healthy people, infection with Mycobacterium tuberculosis often causes no symptoms, since the person's immune system acts to “wall off” the bacteria. The symptoms of active TB of the lung are coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats. Tuberculosis is treatable with a six-month course of antibiotics.

Symptoms

Signs of TB in the lungs may include

A bad cough that lasts 3 weeks or longer
Weight loss
Coughing up blood or mucus
Weakness or fatigue
Fever and chills
Night sweats
have chest pain when you cough

Excessive sweating, especially at night

Risk for active TB:
The following people are at higher risk for active TB:

· Elderly
· Infants
· People with weakened immune systems, for example due to AIDS, chemotherapy, diabetes, or certain medications

Your risk of contracting TB increases if you:

· Are in frequent contact with people who have TB
· Have poor nutrition
· Live in crowded or unsanitary living conditions

The following factors may increase the rate of TB infection in a population:

· Increase in HIV infections
· Increase in number of homeless people (poor environment and nutrition)
· The appearance of drug-resistant strains of TB

In the United States, there are approximately 10 cases of TB per 100,000 people. However, rates vary dramatically by area of residence and socioeconomic status.

Transmission

In the lung, the organism is taken up by alveolar macrophages and carried to lymph nodes, from where it may spread to multiple organs. Two to eight weeks after infection, cell mediated immunity (CMI) and hypersensitivity (DTH) develop leading to the characteristic reaction to the tuberculin test and, in immunocompetent individuals, containment of infection. Inflammatory immune responses eventually result in lung damage.

How is TB treated?

In many countries, vaccination against TB is routinely practised. The Bacillus Calmette-Guerin (BCG) vaccine is a live, attenuated strain of Mycobacterium bovis which was introduced in 1922. However, the true efficacy of BCG is unknown. Early clinical trials in Europe showed up to 80% protection, but more recent trials in India and Africa showed little value.

The first effective treatment for TB was developed in the 1940s - streptomycin.
Online tutorial: Domagk, Fleming, Waksman & the Third Man

TB is currently treated by means of combination therapy, using cocktails of 3-4 drugs with different properties:

Antibacterial activity: e.g. isoniazid, rifampin, streptomycin
Inhibiting the development of resistance: e.g. isoniazid, rifampin, ethambutol

What are Mycobacteria?

Tuberculosis complex organisms are:

Obligate aerobes growing most successfully in tissues with a high oxygen content, such as the lungs.
Facultative intracellular pathogens usually infecting mononuclear phagocytes (e.g. macrophages).
Slow-growing with a generation time of 12 to 18 hours (c.f. 20-30 minutes for Escherichia coli).
Hydrophobic with a high lipid content in the cell wall. Because the cells are hydrophobic and tend to clump together, they are impermeable to the usual stains, e.g. Gram's stain.
Known as "acid-fast bacilli" because of their lipid-rich cell walls, which are relatively impermeable to various basic dyes unless the dyes are combined with phenol. Once stained, the cells resist decolorization with acidified organic solvents and are therefore called "acid-fast". (Other bacteria which also contain mycolic acids, such as Nocardia, can also exhibit this feature.)

Signs and tests

The doctor or nurse will perform a physical exam. This may show:

Clubbing of the fingers or toes (in people with advanced disease)
Swollen or tender lymph nodes in the neck or other areas
Fluid around a lung (pleural effusion)
Unusual breath sounds (crackles)

Tests may include:

Biopsy of the affected tissue (rare)
Bronchoscopy
Chest CT scan
Chest x-ray
Interferon-gamma blood test such as the QFT-Gold test to test for TB infection
Sputum examination and cultures
Thoracentesis
Tuberculin skin test (also called a PPD tests)

Complications

· Pulmonary TB can cause permanent lung damage if not treated early.
· Medicines used to treat TB may cause side effects, including liver problems. Other side effects include:
· Changes in vision
· Orange- or brown-colored tears and urine
· Rash

Disseminated tuberculosis

Disseminated tuberculosis (TB) is a contagious bacterial infection that has spread from the lungs to other parts of the body through the blood or lymph system.

Indications

he disease may also alter the results of the following tests:

· Complete blood count (CBC)

· Peripheral blood smear

· Blood calcium level

Complications of disseminated TB

Complications of disseminated TB can include:

Adult respiratory distress syndrome (ARDS)
Liver inflammation
Lung failure
Relapse of the disease

Medicines used to treat TB may cause side effects, including liver problems. Other side effects include:

Changes in vision
Orange- or brown-colored tears and urine
Rash

A vision test may be done before treatment so your doctor can monitor any changes in your eyes' health over time.

The disease may also alter the results of the following tests:

· Complete blood count (CBC)
· Peripheral blood smear
· Blood calcium level

Treatment

The goal of treatment is to cure the infection with drugs that fight the TB bacteria. Treatment of active pulmonary TB will always involve a combination of many drugs (usually four drugs). All of the drugs are continued until lab tests show which medicines work best.

The most commonly used drugs include:

Other drugs that may be used to treat TB include:

Amikacin
Ethionamide
Moxifloxacin
Para-aminosalicylic acid
Streptomycin

You may need to take many different pills at different times of the day for 6 months or longer. It is very important that you take the pills the way your health care provider instructed.

When people do not take their TB medications as recommended, the infection may become much more difficult to treat. The TB bacteria may become resistant to treatment, and sometimes, the drugs no longer help treat the infection.

When there is a concern that a patient may not take all the medication as directed, a health care provider may need to watch the person take the prescribed drugs. This is called directly observed therapy. In this case, drugs may be given 2 or 3 times per week, as prescribed by a doctor.

You may need to stay at home or be admitted to a hospital for 2 - 4 weeks to avoid spreading the disease to others until you are no longer contagious.

Your doctor or nurse is required by law to report your TB illness to the local health department. Your health care team will be sure that you receive the best care for your TB.

Tuberculosis and Pregnancy

Introduction

Untreated tuberculosis (TB) disease represents a greater hazard to a pregnant woman and her fetus than does its treatment. Treatment of pregnant women should be initiated whenever the probability of TB is moderate to high. Infants born to women with untreated TB may be of lower birth weight than those born to women without TB and, in rare circumstances the infant may be born with TB. Although the drugs used in the initial treatment regimen for TB cross the placenta, they do not appear to have harmful effects on the fetus.

Testing

The tuberculin skin test is considered both valid and safe to use throughout pregnancy. The TB blood test is safe to use during pregnancy, but has not been evaluated for diagnosing M. tuberculosis infection in pregnant women. Other tests are needed to show if a person has TB disease.

Treatment

Latent TB Infection (LTBI) – Isoniazid (INH)
( administered either daily or twice weekly for 9 months is the standard regimen for the treatment of LTBI in pregnant women). Women taking INH should also take pyridoxine (vitamin B6) supplementation.Caution: The 12-dose regimen of INH and Rifapentine (RPT) is NOT RECOMMENDED for pregnant women or women expecting to be pregnant within the next 3 months.

TB Disease –
Treatment regimen :
The preferred initial treatment regimen is

INH,
rifampin (RIF),
ethambutol (EMB) (daily for 2 months)

followed by INH and RIF daily, or twice weekly for

7 months (for a total of 9 months of treatment).

Streptomycin should not be used because it has been

shown to have harmful effects on the fetus. In most

cases, pyrazinamide (PZA) is not recommended to be

used because its effect on the fetus is unknown.

HIV Infection :

. TB treatment regimens for HIV-infected pregnant women should include a rifamycin. Although the routine use of PZA during pregnancy is not recommended in the United States, the benefits of a TB treatment regimen that includes PZA for HIV-infected pregnant women may outweigh the undetermined potential risks to the fetus.

Contraindications

The following antituberculosis drugs are contraindicated in pregnant women:

Streptomycin
Kanamycin
Amikacin
Capreomycin
Fluoroquinolones

Women who are being treated for drug-resistant TB should receive counseling concerning the risk to the fetus because of the known and unknown risks of second-line antituberculosis drugs.

Breastfeeding

Breastfeeding should not be discouraged for women being treated with the first-line antituberculosis drugs( because the concentrations of these drugs in breast milk are too small to produce toxicity in the nursing newborn).
For the same reason, drugs in breast milk are not an effective treatment for TB disease or LTBI in a nursing infant.
Breastfeeding women taking INH should also take pyridoxine (vitamin B6) supplementation.

Patient advice:

Advice the patient to sit in open enviornment.
sit in area where there is necessary light
avoid siting in dark room as it gives strength to bacteria in growing ,making colonies.
Mantain dietry intake eat more n more apples,pomegranate,beet root.

DIABETES

2012-05-21T21:12:00.000+05:00

Diabetes mellitus is a group of metabolic diseases

characterized by high blood sugar (glucose) levels,

that result from de.fects in insulin secretion, or action, or both.

Acute: dangerously elevated blood sugar, abnormally low blood

sugar due to diabetes medications may occur.

Chronic: disease of the blood vessels (both small and large) which

can damage the eye, kidneys, nerves, and heart may occur

Impacts of diabetes:

diabetes can lead to

Ø blindness,

Ø kidney failure,

Ø nerve damage

Ø hardening and narrowing of the arteries (atherosclerosis),

strokes,

Ø coronary heart disease,

Ø large blood vessel diseases referred to as macrovascular disease

diabetes type 1:

The body stops producing insulin or produces too

little insulin to regulate blood glucose level.

involves about 10% of all people with diabetes in the United States.

Type 1 diabetes is typically diagnosed during childhood or adolescence. It used to be referred to as juvenile-onset diabetes or insulin-dependent diabetes mellitus

Factors:

Ø Destruction of pancrease by alcohol

Ø By surgical removel

Ø By destruction of beta cells

Treatment:

People with type 1 diabetes require insulin treatment daily to sustain life.

Type 2

the body of someone with type 2 diabetes is partially or completely

unable to use this insulin. This is sometimes referred to as insulin resistance

onset of type 2:

The pancreas tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they fail to secrete enough insulin to cope with their higher demands

Point to ponder:

At least 90% of adult individuals with diabetes have type 2 diabetes.

Type 2 diabetes is typically diagnosed in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus. These names are no longer used because type 2 diabetes does occur in younger people, and some people with type 2 diabetes require insulin therapy.

Controlling manuals of type 2:

Type 2 diabetes is usually controlled with

Ø diet,

Ø weight loss,

Ø exercise,

Ø oral medications.

treatment,

more than half of all people with type 2 diabetes require insulin to control their blood sugar levels at some point in the course of their illness.

Gestational diabetes (GDM)

is a form of diabetes that occurs during the second half of pregnancy.

Although gestational diabetes typically resolves after delivery of the baby.

Women with gestational diabetes are more likely to have large babies.

Metabolic syndrome

(also referred to as syndrome X) is a set of abnormalities in which

insulin-resistant diabetes (type 2 diabetes) is almost always present

along with :

Ø hypertension (high blood pressure),

Ø high fat levels in the blood (increased serum lipids,

Ø predominant elevation of LDL cholesterol,

Ø decreased HDL cholesterol, and elevated triglycerides),

Ø central obesity,

Ø abnormalities in blood clotting

Ø inflammatory responses

. A high rate of cardiovascular disease is associated with metabolic syndrome.

Prediabetes:

is a common condition related to diabetes., the blood sugar

level is higher than normal but not yet high enough to be

considered diagnostic of diabetes.

Risk factor:
Prediabetes increases a person's risk of developing

type 2 diabetes,

heart disease,

stroke.

TREAMENT:

Prediabetes can typically be reversed (without insulin or medication) with lifestyle changes such as

Ø losing a modest amount of weight

Ø increasing physical activity levels.

Weight loss can prevent, or at least delay the onset of type 2 diabetes.

Point to ponder:

An international expert committee of the American Diabetes

Association redefined the criteria for prediabetes, lowering

the blood sugar level cut-off point for prediabetes. Approximately

20% more adults are now believed to have this condition and may

develop diabetes within 10 years if they do make lifestyle changes

such as exercising more and maintaining a healthy weight.

About 17 million Americans (6.2% of adults in North America) are

believed to have diabetes. AIt has been estimated that about one third

of adults with diabetes do not know they have diabetes.

About 1 million new cases of diabetes is diagnosed occur each year,

and diabetes is the direct or indirect cause of at least 200,000 deaths

each year.

The incidence of diabetes is increasing rapidly. This increase is due to many

factors, but the most significant are the increasing incidence of obesity associated with the prevalence of a sedentary lifestyle

Complications of diabetes

Both type 1 and type 2 diabetes ultimately lead to high blood sugar levels, a condition called hyperglycemia. Over a long period of time, hyperglycemia damages

Ø the retina of the eye,

Ø the blood vessels of the kidneys,

Ø the nerves,

Ø other blood vessels.

Damage to the organs mentioned above are the leading cause of

o Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness.

o Damage to the kidneys from diabetes (diabetic nephropathy) is a leading cause of kidney failure

o Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of foot wound and ulcers, which frequently lead to foot and leg amputation.

o Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastroparesis), chronic diarrhea, and an inability to control heart rate and blood pressure during postural changes.

o Diabetes accelerates atherosclerosis, (the formation of fatty plaques inside the arteries), which can lead to blockages or a clot (thrombus). Such changes can then lead to heart attack, stroke, and decreased circulation in the arms and legs (peripheral vascular disease).

Diabetes predisposes people to elevated blood pressure, high levels of cholesterol and triglycerides. These conditions both independently and together with hyperglycemia, increase the risk of heart disease, kidney disease, and other blood vessel complications.

acute (short-lived) medical problems :

Diabetes can contribute to a number of acute (short-lived) medical problems.

1. Many infections are associated with diabetes, because the body's normal ability to fight infections is impaired. To compound the problem, infections may worsen glucose control, which further delays recovery from infection.

2. Hypoglycemia or low blood sugar, occurs intermittently in most people with diabetes. It can result from taking too much diabetes medication or insulin (sometimes called an insulin reaction), missing a meal, exercising more than usual, drinking too much alcohol, or taking certain medications for other conditions. It is very important to recognize hypoglycemia and be prepared to treat it at all times. Headache, feeling dizzy, poor concentration, tremor of the hands, and sweating are common symptoms of hypoglycemia. A person can faint or have a seizure if blood sugar level become too low.

3. Diabetic ketoacidosis (DKA) is a serious condition in which uncontrolled hyperglycemia (usually due to complete lack of insulin or a relative deficiency of insulin) over time creates a buildup of ketones (acidic waste products ) in the blood. High levels of ketones can be very harmful. This typically happens to people with type 1 diabetes who do not have good blood glucose control. Diabetic ketoacidosis can be precipitated by infection, stress, trauma, missing medications like insulin, or medical emergencies such as a stroke and heart attack

Diabetes Causes;

Type 1 diabetes:

Type 1 diabetes is believed to be an autoimmune disease. The body's immune system specifically attacks the cells in the pancreas that produce insulin.

A predisposition to develop type 1 diabetes may

Ø run in families, but genetic causes (a postitive family history) are much more common for type 2 diabetes.

Ø Environmental factors, including common unavoidable viral infections, may also contribute to type 1 diabetes.

Ø Type 1 diabetes is most common in people of non-Hispanic, Northern European descent (especially Finland and Sardinia), followed by African Americans, and Hispanic Americans. It is relatively rare in those of Asian descent.

Ø Type 1 diabetes is slightly more common in men than in women.

Type 2 diabetes:

Type 2 diabetes has strong genetic links, meaning that type 2 diabetes tends to run in families. Risk factors for developing type 2 diabetes include the following: :

Ø High blood pressure

Ø High blood triglyceride (fat) levels

Ø Gestational diabetes or giving birth to a baby weighing more than 9 pounds

Ø High-fat diet

Ø High alcohol intake

Ø Sedentary lifestyle

Ø Obesity or being overweight

Ø Aging: Increasing age is a significant risk factor for type 2 diabetes. Risk begins to rise significantly at about age 45 years, and rises considerably after age 65 years.

Symptoms of type 1 diabetes: are often dramatic and come on very suddenly Type 1 diabetes is usually recognized in

Ø childhood

Ø early adolescence,

often in association with an illness (such as a virus or urinary tract infection) or injury.

The extra stress can cause diabetic ketoacidosis. Symptoms of ketoacidosis include:

Ø nausea and vomiting.

Ø Dehydration and often-serious disturbances in blood levels of potassium follow.

Ø Without treatment, ketoacidosis can lead to coma and death.

Symptoms of type 2 diabetes are often subtle and may be attributed to

Ø aging

Ø obesity.

A person may have type 2 diabetes for many years without knowing it.

People with type 2 diabetes can develop:

ü hyperglycemic

ü hyperosmolar nonketotic syndrome.

Type 2 diabetes can be precipitated by

Ø steroids

Ø stress.

If not properly treated, type 2 diabetes can lead to complications such as

blindness,

Ø kidney failure,

Ø heart disease,

Ø nerve damage.

Common symptoms of type 1 and type 2 diabetes

include:
Fatigue,
constantly tired:

In diabetes, the body is inefficient and sometimes unable to use glucose for fuel. The body switches over to metabolizing fat, partially or completely, as a fuel source. This process requires the body to use more energy. The end result is feeling fatigued or constantly tired.

Unexplained weight loss:

People with diabetes are unable to process many of the calories in the foods they eat. Thus, they may lose weight even though they eat an apparently appropriate or even an excessive amount of food. Losing sugar and water in the urine and the accompanying dehydration also contributes to weight loss.

Excessive thirst (polydipsia)

: A person with diabetes develops high blood sugar levels, which overwhelms the kidney's ability to reabsorb the sugar as the blood is filtered to make urine. Excessive urine is made as the kidney spills the excess sugar. The body tries to counteract this by sending a signal to the brain to dilute the blood, which translates into thirst. The body encourages more water consumption to dilute the high blood sugar back to normal levels and to compensate for the water lost by excessive urination.

Excessive urination (polyuria):

Another way the body tries to rid the body of the extra sugar in the blood is to excrete it in the urine. This can also lead to dehydration because a large amount of water is necessary to excrete the sugar.
Excessive eating (polyphagia):

If the body is able, it will secrete more insulin in order to try to manage the excessive blood sugar levels. Moreover, the body is resistant to the action of insulin in type 2 diabetes. One of the functions of insulin is to stimulate hunger. Therefore, higher insulin levels lead to increased hunger. Despite increased caloric intake, the person may gain very little weight and may even lose weight.

Poor wound healing:

High blood sugar levels prevent white blood cells, which are important in defending the body against bacteria and also in cleaning up dead tissue and cells, from functioning normally. When these cells do not function properly, wounds take much longer to heal and become infected more frequently. Long-standing diabetes also is associated with thickening of blood vessels, which prevents good circulation, including the delivery of enough oxygen and other nutrients to body tissues.

Infections:

Certain infections, such as frequent yeast infections of the genitals, skin infections, and frequent urinary tract infections, may result from suppression of the immune system by diabetes and by the presence of glucose in the tissues, which allows bacteria to grow. These infections can also be an indicator of poor blood sugar control in a person known to have diabetes.

Altered mental status:

Agitation, unexplained irritability, inattention, extreme lethargy, or confusion can all be signs of very high blood sugar, ketoacidosis, hyperosmolar hyperglycemia nonketotic syndrome, or hypoglycemia (low sugar). Thus, any of these merit the immediate attention of a medical professional. Call your health care professional or 911.

Blurry vision:

Blurry vision is not specific for diabetes but is frequently present with high blood sugar levels

Diabetic amputations

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Diabetes Diagnosis

The health care professional will take a history including information about the

Ø patient's symptoms,

Ø risk factors for diabetes,

Ø past medical problems,

Ø current medications,

Ø allergies to medications,

Ø family history of diabetes,

or other medical problems such as high cholesterol or heart disease, and personal habits and lifestyle.

A number of laboratory tests are available to confirm the diagnosis of diabetes.

Finger stick blood glucose: This is a rapid screening test that may be performed anywhere, including community-based screening programs.

Although a not as accurate as testing the patient's blood in the hospital laboratory, a fingerstick blood glucose test but is easy to perform, and the result is available right away.

The test involves sticking the patient's finger for a blood sample, which is then placed on a strip. The strip goes into a machine that reads the blood sugar level. These machines are only accurate to within about 10%-20% of true laboratory values.

Fingerstick blood glucose values tend to be most inaccurate at very high or very low levels, so this test is only a preliminary screening study. Fingerstick is the way most people with diabetes monitor their blood sugar levels at home.

Fasting plasma glucose: The patient will be asked to eat or drink nothing for 8 hours before having blood drawn (usually first thing in the morning). If the blood glucose level is greater than or equal to 126 mg/dL (without eating anything), they probably have diabetes.

confirmatory test If the result is abnormal, the fasting plasma glucose test may be repeated on a different day to confirm the result, or the patient may undergo an oral glucose tolerance test or a glycosylated hemoglobin test (often called "hemoglobin A1c") as a confirmatory test.

If fasting plasma glucose level is greater than 100 but less than 126 mg/dL, then the patient has what is called impaired fasting glucose, or IFG. This is considered to be prediabetes. These patients do not have diabetes, but they are at high risk of developing diabetes in the near future.

Oral glucose tolerance test:

This test involves drawing blood for a fasting plasma glucose test, then drawing blood for a second test at two hours after drinking a very sweet drink containing up to 75 grams of sugar.

If the blood sugar level after the sugar drink is greater than or equal to 200 mg/dL, the patient has diabetes.

If the blood glucose level is between 140 and 199, then the patient has impaired glucose tolerance (IGT), which is also a prediabetic condition.

Glycosylated hemoglobin or hemoglobin A1c:

This test is a measurement of how high the blood sugar levels have been over approximately the last 120 days (the average life-span of the red blood cells on which the test is based).

Excess blood glucose hooks itself on to the hemoglobin in red blood cells and stays there for the life of the red blood cell.

The percentage of hemoglobin that has had excess blood sugar attached to it can be measured in the blood. The test involves having a small amount of blood drawn.

A hemoglobin A1c test is the best measurement of blood sugar control in people known to have diabetes. A hemoglobin A1c result of 7% or less indicates good glucose control. A result of 8% or greater indicates that blood sugar levels are too high, too much of the time.

The hemoglobin A1c test is the best test for diabetes follow-up care, than to diagnose diabetes. Still, a hemoglobin A1c result greater than 6.1% is highly suggestive of diabetes. Generally, a confirmatory test would be needed before diagnosing diabetes.

The hemoglobin A1c test is generally measured about every 3 to 6 months for people with known diabetes, although it may be done more frequently for people who are having difficulty achieving and maintaining good blood sugar control. This test is not used for people who do not have diabetes or are not at increased risk of diabetes.

Normal values may vary from laboratory to laboratory, although an effort is under way to standardize how measurements are performed.

Diagnosing complications of diabetes

A person with diabetes should be checked regularly for early signs of diabetic complications. A health care professional can order some of these tests; for others, the patient should be referred to a specialist.

Ø The patient should have their eyes checked at least once a year by an eye specialist (ophthalmologist) to screen for diabetic retinopathy, a leading cause of blindness.

Ø The patient's urine should be checked for protein (microalbumin) on a regular basis, at least one to two times per year. Protein in the urine is an early sign of diabetic nephropathy, a leading cause of kidney failure.

Ø Sensation in the legs should be checked regularly using a tuning fork or a monofilament device. Diabetic neuropathy is a leading cause of lower extremity ulcers in individuals with diabetes, which frequently lead to amputation of the feet or legs.

Ø The health care professional should check the feet and lower legs of the patient at every visit for cuts, scrapes, blisters, or other lesions that could become infected. Adults with diabetes should check the soles of their feet and their legs daily with a hand-held mirror, either by themselves or with the assistance of a relative or caretaker.

Ø The patient should be screened regularly for conditions that may contribute to heart disease, such as high blood pressure and high cholesterol

Diabetes Medical Treatment

The treatment of diabetes is highly individualized, depending on the type of diabetes, whether the patient has other active medical problems, whether the patient has complications of diabetes, and age and general health of the patient at time of diagnosis.

Ø A health care professional will set goals for lifestyle changes, blood sugar control, and treatment.

Ø Together, the patient and the health care professional will formulate a plan to help meet those goals.

Type 1 diabetes:

Treatment of diabetes almost always involves the daily

Ø injection of insulin,

usually a combination of short-acting insulin (for example, lispro [Humalog] or aspart [NovoLog]) and a longer acting insulin (for example, NPH, Lente, glargine [Lantus], detemir [Levemir]).

Insulin must be given as an injection just under the skin. If taken by mouth, insulin would be destroyed in the stomach before it could get into the blood where it is needed.

Most people with type 1 diabetes give these injections to themselves. Even if someone else usually gives the patient injections, it is important that the patient knows how to do it in case the other person is unavailable.

A trained professional will show the patient how to store and inject the insulin.

Insulin dose

is usually given in two or three injections per day, generally around mealtimes. Dose should be given according to glucose levels

Longer acting insulin are typically administered one or two times per day.

Some people have their insulin administered by continuous infusion pumps to provide adequate blood glucose control. Supplemental mealtime insulin is programmed into the pump by the individual as recommended by his or her health care professionals.

Point to ponder:

t is very important to eat after the taking insulin, as the insulin will lower blood sugar regardless of whether the person has eaten. If insulin is taken without eating, the result may be hypoglycemia. This is called an insulin reaction.

There is an adjustment period while the patient learns how insulin affects them, and how to time meals and exercise with insulin injections to keep blood sugar levels as even as possible.

Keeping accurate records of blood sugar levels and insulin dosages is crucial for the patient's diabetes management.

Eating a consistent, healthy diet appropriate for the patient's size and weight is essential in controlling blood sugar level.

Type 2 diabetes:

Depending on how elevated the patient's blood sugar and glycosylated hemoglobin (HbA1c) are at the time of diagnosis, they may be given a chance to lower blood sugar levels through lifestyle changes, without medication.

The best way to do this is to lose weight if the patient is obese, and begin an exercise program.

This will generally be tried for 3 to 6 months, then blood sugar and glycosylated hemoglobin will be rechecked. If they remain high, the patient will be started on an oral medication, usually

Ø a sulfonylurea

Ø biguanide (metformin [Glucophage]),

to help control blood sugar levels.

Even if the patient is on medication, it is still important to

Ø eat a healthy diet,

Ø lose weight if they are overweight,

Ø engage in moderate physical activity as often as possible.

right dose of the right medication

The health care professional will initially monitor the patient's progress on medication very carefully. It is important to receive just the right dose of the right medication, to regulate blood sugar levels in the recommended range with the fewest side effects.

The doctor may decide to combine two types of medications to achieve blood sugar levels control.

Gradually, even people with type 2 diabetes may require insulin injections to control their blood sugar levels.

It is becoming more common for people with type 2 diabetes to

Ø take a combination of oral medication

Ø insulin injections to control blood sugar levels.

Diabetes Medications

Many different types of medications are available to help lower blood sugar levels in people with type 2 diabetes. Each type works in a different way. It is very common to combine two or more types to get the best effect with fewest side effects.

Ø Sulfonylureas:

These drugs stimulate the pancreas to make more insulin.

Ø Biguanides:

These agents decrease the amount of glucose produced by the liver.

Ø Alpha-glycosidase inhibitors:

These agents slow absorption of the starches a person eats. This slows down glucose production.

Ø Thiazolidinediones:

These agents increase sensitivity to insulin.

Ø Meglitinides:

These agents stimulate the pancreas to make more insulin.

Ø D-phenylalanine derivatives:

These agents stimulate the pancreas to produce more insulin more quickly.

Ø Amylin synthetic derivatives

Amylin is a naturally occurring hormone secreted by the pancreas along with insulin. An amylin derivative, such as pramlintide (Symlin), is indicated when blood sugar control is not achieved despite optimal insulin therapy. Pramlintide is administered as a subcutaneous injection along with insulin and helps achieve lower blood sugar levels after meals, helps reduce fluctuation of blood sugar levels throughout the day, and improves hemoglobin A1C levels.

Incretin mimetics:

Incretion mimetic promotes insulin secretion by the pancreas and mimics other blood sugar level lowering actions that naturally occur in the body. Eventide (Beta) was the first incretin mimetic agent approved in the United States. It is indicated for diabetes mellitus type 2 in addition to metformin or a sulfonylurea when these agents have not attained blood sugar level control alone.

Insulin:

Synthetic human insulin is now the only type of insulin available in the United States; it is less likely to cause allergic reactions than animal-derived varieties of insulin used in the past. The type of insulin chosen to customize treatment for an individual is based on the goal of providing optimal blood sugar control. Different types of insulin are available and categorized according to their times of action onset and duration. Commercially prepared mixtures of insulin may also be used to provide constant (basal) control and immediate control.

o Examples of rapid-acting insulin

Ø Regular insulin (Humulin R, Novolin R)

Ø Insulin lispro (Homolog)

Ø Insulin aspart (Novo log)

Ø Insulin glulisine (Apidra)

Prompt insulin zinc (Semilente, slightly slower acting)

o Examples of intermediate-acting insulin

Ø Isophane insulin, neutral protamine Haledon (NPH) (Humulin N, Novolin N)

Ø Insulin zinc (Lente)

o Examples of long-acting insulin

Extended insulin zinc insulin (Ultralente)

Insulin glargine (Lantus)

Insulin detemir (Levemir

Nutritional medicines:

Ø Zinc - Zinc has proven to aid in the formation of new skin and soft tissue cells and is particularly helpful in poor healing diabetic ulcers. Zinc also is critical to the synthesis, secretion and utilization of insulin. 70mg three times a day with meals is the recommended dosage.

Ø Fenugreek - Fenugreek seeds have shown to be helpful in improving glucose tolerance. Consult your local health food store for dosage recommendations.

Ø Bitter Melon - Recommended dosage of Bitter Melon is 125mg/day which has shown the ability to lower blood sugar levels.

Ø Vanadium - Studies have shown that cells become more receptive to insulin with a 100 to 150mg/day dose of Vanadium. Vanadium can have a dramatic effect on lowering blood sugar levels acting like an oral insulin.

Ø Gymna Sylvestre - This plant is native to the rain forests of India and has been used in Asian cultures for years as a means of lowering blood sugar levels.

Ø Chromium Polyniacinate - Chromium taken in dosages of 400 to 600 micrograms each day has shown effective reduction in blood sugars by improving insulin efficiency.

Ø L-Carnitine - Taken on an empty stomach, 500mg of L-Carnitine decreases ketones.

Ø Ascorbic Acid - Vitamin C (ascorbic acid) is a well known building block of collagen. Collagen is a precursor to healthy granulation of skin and necessary for proper wound care. Vitamin C may also effect glycosylation.

Ø Vitamin B Complex - B complex vitamins, especially B1 (thiamine) and B6 (pyridoxine) have been shown to aid in the symptoms of diabetic neuropathy.

Ø Alph Lipoic Acid (ALA) - Alpha Lipoic Acid has been shown to act as a potent antioxidant aiding in the care of symptoms of diabetic neuropathy. ALA helps to repair the damage to peripheral nerve caused by oxygen and nitrogen free radicals. ALA is both water and fat soluble and therefore able to have an impact in many organ systems including the kidneys, liver, muscle and bone. The most effective aspect of ALA is its' ability to mediate damage to peripheral nerve tissue. ALA has also shown evidence that it aids in metabolizing glucose more effectively. The recommended dosage of ALA is 100 to 400mg/ day.

Diabetes Follow-up:

Treatment:

Follow the health care professional's treatment recommendations.

Keep records of blood sugar levels as often as recommended by the health care professional and the diabetes care team, including the times the levels were checked, when and how much insulin or medication was taken, when and what was eaten, and when and for how long the patient exercised.

Call the health care professional if the patient has any problems with their treatment or symptoms that suggest poor glucose control.

Education:

Ø The more educated the patient and their family are about the disease, the better they are likely to do.

Ø If the patient takes insulin, they should see the health care professional about every 3 months or more often.

Ø For other people with diabetes, every 3 to 6 months is generally adequate, unless they are having complications.

Ø Recognize low blood sugar levels and know how to treat them

Ø The patient and their family should be taught how to recognize the signs and symptoms of low blood sugar levels. The patient should have a clear plan for treating low blood sugar levels.

Mild symptoms include confusion

Ø sweating. Moreover,

these symptoms can progress to

Ø lethargy,

Ø agitation (sometimes with violent, jerking motions),

Ø even seizures..

Diabetes Prevention:

It is not yet known how to prevent type 1 diabetes. Type 2 diabetes, however, can be prevented in some cases.

Ø Control weight to normal or near-normal levels by eating a healthy low-fat, high-fiber diet.

Ø Regular exercise is crucial to the prevention of type 2 diabetes.

Ø Keep alcohol consumption low.

Ø Quit smoking.

Ø If a person has high blood fat levels (such as high cholesterol) or high blood pressure, take all medications as directed.

Ø Lifestyle modifications and/or certain medications can be used in people with prediabetes to prevent progression to diabetes. Prediabetes can be diagnosed by checking fasting glucose and 2 hours after ingesting up to 75 grams of glucose (dosing is based on the weight of the patient).

Ø If you or someone you know already has diabetes, the focus should be on preventing the complications, which can cause serious disabilities such as blindness, kidney failure requiring dialysis, amputation, or even death.

Ø Tight glucose control: The single best thing a person with diabetes can do is to keep their blood sugar level within the suggested range every day. The only way to do this is through a combination of regular blood sugar checks; a balanced diet low in simple sugars and fat, and high in complex carbohydrates and fiber; a high degree of personal motivation; and appropriate medical treatment. Consult a nutritionist or check with a doctor with questions in regard to diet.

Ø Quit smoking

Ø Maintain a healthy weight

Ø Increase physical activity levels. Aim for moderately vigorous physical activity for at least 30 minutes every day.

Ø Drink an adequate amount of water and avoid consuming too much salt.

Ø The skin should be taken care of; keep it supple and hydrated to avoid sores and cracks that can become severely infected.

Ø Brush and floss the teeth every day. See a dentist regularly to prevent gum disease.

Ø The feet should be washed and examined daily, looking for small cuts, sores, or blisters that may cause problems later. The toenails should be filed rather than cut to avoid damaging the surrounding skin. A specialist in foot care (podiatrist) may be necessary to help care for the feet

Diabetes Prognosis:

Diabetes is a leading cause of death in all industrialized nations.. Prognosis depends on the type of diabetes, degree of blood sugar control, and development of complications.

Type 1 diabetes:

About 15% of people with type 1 diabetes die before age 40 years, which is about 20 times the rate of that age group in the general population.

The most common causes of death in type 1 diabetes are

Ø diabetic ketoacidosis,

Ø kidney failure,

Ø heart disease.

The good news is that prognosis can be improved with good blood sugar control. Maintaining tight blood sugar control has been proven to prevent, slow the progression of, and even improve established complications of type 1 diabetes.

Type 2 diabetes

The life-expectancy of people who are diagnosed with type 2 diabetes in their 40s decreases by 5-10 years because of the disease.

Heart disease is the leading cause of death for people with type 2 diabetes.

Excellent glycemic control, tight blood pressure control, and keeping the "bad" cholesterol (LDL) level at the recommended level of <100 mg/dL (or lower, particularly if other risk factors for cardiovascular disease are present) and the "good" (HDL) cholesterol as high as possible. Use of aspirin when indicated can prevent, slow the progression of, and improve established complications in diabetes

The Foot and Diabetes
Many of the complications of DM effect the foot. As previously mentioned, the impact of DM on health, and in particular the foot, is immense. Subsequently, diabetic foot care is a critical part of overall diabetic care.

The combined effects of diabetic peripheral neuropathy and impaired circulation create a challenge for all diabetics. Many of the irritations of the skin that we would take for granted cannot be felt by a diabetic due to their peripheral neuropathy. Many diabetics fail to notice these problems until significant damage has occurred. The first symptoms for many diabetic patients is when they find blood or drainage on a sock that is the result of a blister or ulceration.

Wound healing is also impaired in diabetic patients. In addition to the loss of normal blood flow to the foot, normal wound healing is compromised. The normal cellular and chemical responses of the body are unable to address diabetic wounds. Ulcers of the foot are a common complication in diabetic patients. Ulcers create a portal for infection which can effect both the soft tissue of the foot and the underlying bone.

New methods of wound care are always appreciated, but some of the tried and true methods still prevail as the most important. Debridement of diabetic foot wounds and counseling in effective footwear is a must. In addition to basic wound care, many adjunctive therapies have become popular over recent years including

Ø hyperbaric oxygen,

Ø growth factors,

Ø bioengineered tissue equivalents

Ø electrical stimulation.

Another complication of advanced diabetes is a gradual shut-down of the autonomic nervous system. The autonomic nervous system regulates bodily functions such as salivation, bowel motility and perspiration. With advanced diabetes, the autonomic nervous system and its' ability to regulate perspiration of the foot is impaired. As a result, the skin of diabetics becomes brittle and dry. If left untreated, the dryness may progress to fissures of the skin that crack and become infected. Therefore, use of a skin softener on a daily basis is extremely important.

Diabetic foot infections are obviously a challenge to treat. The complexity of impaired wound healing, peripheral neuropathy, poor circulation and dysfunction of the nervous system is a challenge for all physicians.

By far the most important method of caring for foot ulcers and infections is

Ø prevention

Ø careful regulation of blood sugar levels.

The tools of prevention are

Ø education

Ø awareness.

The following are tips for daily diabetic foot care.

1. Visually inspect the foot when the socks go on and when the socks come off.

With a slow progressive loss of sensation due to peripheral neuropathy, the eyes become the next most effective tool to assess the status of the skin on a regular basis. Use a adjustable magnified mirror specifically designed for diabetic foot inspections on a daily basis.

2. Frequent changes of shoes and socks (2-3 times/day). If you have a pressure point in a particular pair of shoes that could effect the skin, change the shoes. There's no simpler way to be kind to the feet. For over sized or swollen legs, be sure to wear a sock designed for swelling.

3. skin crea on a daily basis to the feet. Whether it's an over-the-counter or prescription skin softener, do it every day. Dryness and cracked skin is a major source of diabetic foot infections.

4. Wash and dry between the toes on a daily basis. The best location for bacteria to congregate on the foot is in between the toes. If you can't reach them, have someone else do it for you on a regular basis. The daily use of soap, water and a wash cloth to debride between the toes is very important. 5. Treat fungal infections.

Many fungal infection look like dry skin and can promote soft tissue infection. If you have a dry skin problem that does not respond to skin softeners, seek the help of a qualified podiatrist. Home care can include the use of an antifungal shoe spray, antifungal soap and topical antifungal cream.

6. Make sure your shoes are your friends.

It's well worth the time, effort and money to be sure that your shoes are not going to cause harm. Blisters and calluses in advanced diabetes can result in significant complications. Don't cheat yourself by buying inexpensive shoes. Seek the help of a certified Pedorthist. 7. When questions arise, don't wait. Act. Seek the help of your family physician or podiatrist.

Hypertension

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Hypertension: abnormal alteration in systolic and diastolic Blood Pressure beyond the normal values i.e 120/80mmhg.
or:
hypertension means high pressure (tension) in the arteries.

A disease neither caused by any bacteria or virus nor it transfers

BP Categorization	Systolic BP mmHg	Diastolic BP mmHg	Life style modification
Normal	<120	<80	Encourage
Prehypertension	120-130	80-89	Yes
Stage 1	140-159	90-99	Yes
Stage 2	>160	>100	yes

It occurs in 5% patients.tere are different stages of hypertension given below in table:person to another except the inheritance. but occurs due to certain factors like: diet ,environment, stress, high cholesterol, excess salts ,lack of exercise , cigarette smoking, alcohol intake . Increase in blood pressure due to these reasons can be called as primary/essential hypertension 95% of patients suffers this type. While increase in blood pressure due to It can be caused due to renal diseases genetic syndromes or hyperaldosteronism is called as secondary or non essential hypertension .
Diet

Diet for BP patients:

JUICES

VEGETABLE

DIET LOW IN SATURATED FAT

LOW FAT

DAIRY FOODS

hypertensive patients should be careful regarding the diet they are using as diet imparts effect on blood pressure. Cholesterol increases blood pressure so diet free or less in cholesterol is recommended for maintaining the blood.salt in your body causes the absorption of wHater ultimately leading to the increase in blood volume and blood pressure leading to the worsening of hypertensive situation.
hypertensive emergencies
Table shows Drug use to deal hypertensive emergencies

Class of drug	Generic name	Brand name
Nitrates	Nitroglycerine	nitromint
Vasodilators	Hydralazine	Hydralazine
CCBs	Amlodipine	Amlocard
ACE	captopril	Capotin
diuretic	furosamide	Generic
Vasodilator	nitroprusside	Generic
vasodilators	fenoldopam	Generic
ARBs	losartan	Co-ezyday

It requires keeping patient in ICU and continuously checking patient’s BP .paranteral antihypertensive medicine are use to lower BP as soon as BP is lowered oral medication should be started because this allows smoother and long term management of hypertension .more over rapid normalization of bp may lead to hypoperfusion & brain injury

High blood pressure leads to·

High blood pressure is called "the silent killer"because it often cause no symptoms for
many years even decades,until it finally damages certain critical organs
Poorly controlled high blood pressure ultimately can cause damage to
blood vessel in the eye
thickening of heart muscles and

heart attack
hardening of ateries (arterioclerosis)
kidney failure
strokes

How do I control my high blood pressure?

              Check your blood pressure.
              Take your high blood pressure medicine every day if needed.
              Exercise often.
              Eat foods low in salt.
              Lose weight or keep weight at a healthy level.
              Do not smoke.
             Limit alcohol.
             Talk to your doctor regularly about your pressure
   Have a higher risk of high blood pressure if you:

             Are African American
             Are obese
             Are often stressed or anxious
           Drink too much alcohol (more than one drink per day         for women and more than two drinks per day for          men)
             Eat too much salt in diet
            Have a family history of high blood pressure
            Have diabetes
            Smoke

   CONTRIBUTING FACTORS

Many factors can affect blood pressure, including:

                How much water and salt you have in your body
          The condition of your kidneys, nervous system, or blood vessels
          The levels of different body hormones

   SYMPTOMS
      Most of the time, there are no symptoms. For most patients, high blood pressure is found when they visit their health care provider or have it checked elsewhere.
        If you have a severe :
          headache
nausea
          vomiting
          bad headache
          confusion
          changes in your vision
          nosebleeds you may have a severe and dangerous form of high blood pressure

ABOUT SOCIETY

2012-05-19T22:16:00.001+05:00

we are encourged to benefit the people through our knowledge regarding human body chemistry and functioning.therefore we established a society called "HEALTH CARE & BLOOD TESTING SOCIETY"....
To serve the humanity and comunity by alarming the people regarding disease progress,its hazards,its ultimate results for the purpose of safety and surviver of good health.we take the specimen of blood for testing blood.Blood testing procedure is performed to detect and daignose the presence of bacteria or viral infections in blood.So,we, for the poeple comfort and convenience made our society a mobile network of blood testing system .A very noble motive of our society is to provied the blood test facility at their areas and institutes like an angle at the door .particularly we visit educational institutes where children and youth community has its maximum strenth ,with the aim of building children and youth commuty of society with the bricks of testified health ,determining their health conditions by testing their blood with modified modern tecniques .