WE CURE THE SICK

Back pain-A real nightmare

pterion2910@yahoo.com (pterion2910) — Mon, 20 Feb 2012 13:50:00 +0000

Joint pains pop up out of blue.No one can do even a remote prediction of it.

We may be doing some exercise,or carrying something or may be even waking up from bed.Then you start feeling this pain.A weird back pain.

The nature of pain:
A sharp pain,radiating in nature,no relieving factor and gets aggravated on making further movements.

How it develops?
Back pain develops as a result of sprain of joints.A sprain develops when a tendon of the joint is stretched beyond it's limits resulting in a temporary injury to the joint structures.
Back pain develops when we stretch our joints accidentally while doing exercises,lifting heavy weights etc.

Bammm......you are caged.Totally messed up.You will be finding yourself awake in the bed too.This sharp pain will never let you sleep too.

So what to do?
-take proper rest.
-apply hot fomentation over the affected area.
-apply some topical medicines for joint sprains which will relieve the symptoms.
-If the pain is very severe,go for pain killers like ACECLOFENAC and PARACETAMOL combination which will relieve the pain.But be cautious.You will have to take rest.Otherwise the injury won't be healing well which makes a simple back pain even worse.
-You can also get a quick relief from the back pain by taking an injection of more potent painkillers like ketorolac,pheneramine maleate etc.
-A short course of NSAIDs(non steroidal anti-inflammatory drugs like diclofenac,ibuprofen etc) are also advisable after seeking prior medical consultation.

P.S : TAKE REST...That's the golden rule to fight away BACK PAIN.

Stay strong.

Tips to fight depression

pterion2910@yahoo.com (pterion2910) — Sun, 19 Feb 2012 18:29:00 +0000

DEPRESSION:
This condition is on rise these days.The modern life style,change of moral values,breach of inter personal relationships,loneliness,lack of good friends etc etc....There are a plethora of reasons for depression.

Depression is just like a cycle.Once you are in that phase,unless and until you make a conscious effort,it will be going to get even worse.

So what to do?
Using anti-depressants is definitely a big no.We have to find out drug free methods to get around and survive.
That's the best you can do as it will benefit you in long run.

Here I'm sharing with you a simple trick.
It's easy to preach but difficult to follow unless you have enough determination.

The key idea to be happy is to be at present.You have to glue yourself at present.Never let your mind wander neither in your past,nor in your future.
Live at this moment.

How can I be absorbed at the present?
Yes,there is a simple exercise.Give it a try and you will see the results in a few weeks.

What's that exercise?
The exercise is very simple.Pay attention to your breathing.Pay attention to it and the more you pay attention to it,the more you feel at present.This is an exercise to develop your self awareness.

As you become more and more send aware, you will be no more depressed and sad.

Once again....it's a big no to anti depressants.Those drugs won't benefit you in long run.

P.S Live at the present and stay happy because life happens at this moment.

Golden tips to bust Constipation

pterion2910@yahoo.com (pterion2910) — Thu, 16 Feb 2012 05:37:00 +0000

INTRODUCTIONIf you are a human,you would have gone through this terrible constipation episode a couple of times.

Yea,constipation has been a nightmare for humans since his origin.He has been trying desperate ways to bust it and thus he is almost successful in it.

How we develop constipation?

I will discuss the most common cause.The water content in the stool plays a decisive role in the easy passage of it down the colon.The colonic villi regulate the water content to an optimal level in stools.In some conditions,the function of villi get disturbed and the stool may get hardened as a result due to decreased water content.This results in constipation.
Result:We get the urge to defecate but won't be able to accomplish it.Thus we get constipated.
There are a lot of reasons for constipation.
I just discussed the basic reason.

Treatment

Conservative:
Eat plenty of fibre rich fruits and vegetables like apple,banana,mushroom,cauliflower etc. Drink plenty of water.

Medical treatment

A chemical named bisacodyl which is available as tablets taken once before going to bed.
A syrup named Cremaffin gel

The principle of treatment is to use drugs that soften the stool.If stools are softened,they can voided easier.The above mentioned drugs are good stool softners and laxatives.

Fibre content also softens the stools and that's the reason why fibre rich foods are regularly advised for regularly constipated patients.

Constipation is a condition which attenuates the quality of daily life.But with good logic and knowledge,anyone can get over and live happily.

Acute gastro enteritis

pterion2910@yahoo.com (pterion2910) — Thu, 16 Feb 2012 01:37:00 +0000

It's a medical condition in which patient usually complaints of vomiting,diarrhea,abdominal cramps,fever. Unless and until the patient doesn't develop fever,the use of antibiotics are not indicated. If the patient doesn't have fever,a conservative line of treatment is followed using antiemetics,anti pyretics, added by drugs like lactospore and racecoditril to control diarrhea. The electrolytes loss will be replenished by the use of ORS. If a rapid replenishment is necessary,we will go for i.v infusion if electrolytes. Most of the cases subside by 2-3 days naturally.

Chest pain:discussion starts

pterion2910@yahoo.com (pterion2910) — Mon, 16 Jan 2012 12:44:00 +0000

So from this week,discussion about chest pain starts.

I will be scribbling down my first hand experiences and everything I know about chest pain.

so keep updated.

An idea,which I feel worthy

pterion2910@yahoo.com (pterion2910) — Tue, 10 Jan 2012 12:08:00 +0000

I'm thinking of updating this blog in this fashion.

Each month will be dedicated to a single disease condition.
Accordingly,this month is dedicated to various common heart diseases.

I will try to discuss with you about my clinical experiences and some tips to keep your heart in good health.

So keep in touch and be updated.

Just very basic,common scenarios will be discussed so that it will be comprehensible by even a primary school child.

So that's it.
Hold on.

After more than one year

pterion2910@yahoo.com (pterion2910) — Tue, 10 Jan 2012 12:07:00 +0000

Well,
I couldn't keep up with updating this blog and help you all due to lots of personal matters.

I was burying my head into all those matters like an ostrich. ;)

Now from today I'm starting to update this blog regularly with quality content.

So keep in touch everyone.

Hope I won't be disappointing you all.

Take care.

ANAPHYLAXIS

pterion2910@yahoo.com (pterion2910) — Mon, 17 May 2010 16:19:00 +0000

Imagine this situation…………..
You are on a date, watching a movie or a game………….when your date pops
a handful of nuts into his/her mouth………..
The next thing you know………….he/she breaks out in hives, starts
scratching everywhere, turns red and may start gasping for breaths……….

Though it may seem severe and far fetched, " ANAPHYLAXIS" may occur in
upto 15% of the population (United states data).

Simply put, its an allergy of massive proportions and may terminate fatally.

In non scientific terms, the body's immune system becomes over
protective and identifies a potentially harmless substance like a
peanut as a dangerous invader. The IgE immunoglobulin, a component of
the immune system, activated by the offending nut; attaches to
certain cells in our body. This releases chemicals like histamine.

Once this happens the effects are seen. It so happens that these
special cells (mast cells) are highest in number in the skin, in the
intestinal and respiratory linings……….hence the skin turns red and
swollen, hives appear, diarrhea starts, wheezing, breathing
difficulties set in.
In its most severe form, the blood pressure drops, leading to shock
and if untreated, death.

WHAT CAUSES THIS CONDITION??
Virtually anything; but food allergies to nuts( peanuts, walnuts),
sea food, milk, eggs, soy are the commonest. Others include bee
stings, antibiotics ( penicillins), agents used for anesthesia etc.

You recognize this condition by its rapidity, typical features and
common history of eating any of the foods mentioned above or following
a bee sting.

Since this is an emergency, medical care is a must. However, removal
of the allergen, basic cpr measures, laying the person flat are some
of the intelligent measures one could do.

Administering adrenaline terminates the episode…and in fact people
prone for anaphylaxis could be taught to administer this drug.

Education is of utmost value………and do remember, prevention is better
than cure…….so its always better not to yield to temptation and regret
later……………….( if you are allergic to certain foods that is!! )

--
(hitr@

NEW HUMAN MALARIA SPECIES

pterion2910@yahoo.com (pterion2910) — Thu, 22 Apr 2010 10:25:00 +0000

NEW HUMAN MALARIA SPECIES-Scientists investigating ovale malaria,a form of the disease thought to be caused by a single species of parasite,have confirmed that the parasite is actually two similar but distinct species which do not reproduce with fai other.

GENE THAT REGULATES HAIR GROWTH IDENTIFIED

pterion2910@yahoo.com (pterion2910) — Thu, 22 Apr 2010 10:12:00 +0000

GENE THAT REGULATES HAIR GROWTH IDENTIFIED-Researchers have now discovered that activation of the gene Lhx2 leads to more hair growth.The gene is more active in the growing hair follicles and absent in the non growing hair.

Top five dishes that can keep you healthy!!!

pterion2910@yahoo.com (pterion2910) — Wed, 21 Apr 2010 19:03:00 +0000

Food for heath:- Here are the top five dishes that can keep you healthy so you live to see another day! 1. Cooked fish: Surprised? The 'omega 3 fattyacids', which it has in plenty, will clean up ur system of harmful fats. You can say byebye to heartattack and stroke. But dont even think about frying it! 2. Green leafy veg: Sacred of cancer? Then u'l have to eat ur veg. Their antioxidants will protect u against most of the cancers. Not to mention the precious vitamins and fibers they have in plenty. 3. Wheat: The king of cereals. Good source of energy, protein and fibers. Keeps you sharp and fit at the same time. 4. Fruits: Are you overweight?Then you need an apple a day!Low on calories but rich in vitamins and minerals.Best to have it along with breakfast.
5.Oats:You or your parents diabetic?Then start on oat meals.It fills your tummy without elevating your blood sugar.

NEW ALTERNATIVE FOR OPEN HEART SURGERY

pterion2910@yahoo.com (pterion2910) — Sat, 17 Apr 2010 09:47:00 +0000

NEW ALTERNATIVE FOR OPEN HEART SURGERY-interventional cardiologists have developed a new method to treat patients having defective heart valve.Earlier an open heart surgery was needed to relieve valvular defects.The latest development is the introduction of MITRAL VALVE CLIP.It is introduced into the femoral artery through the groin along with a catheter.Then it is guided into the heart chamber.Clip effectively tightens the valve so that regurgitation is prevented.This novel technique is under trails in various hospitals across the globe.

Read more about TETRALOGY OF FALLOT-A congenital heart disorder.

Test tube babies face increased health hazards

pterion2910@yahoo.com (pterion2910) — Wed, 24 Feb 2010 09:12:00 +0000

The intention of test tube technology was a break through invention in the field of infertility therapy.This technique was introduced in the early 1978s and more than 3 million births have taken place with the aid of this reproductive technique.
But ongoing research in the health of these children points towards the increased risk of developing diabetes mellitus type 2,obesity,hypertension.
Research done on the children born with the aid of assisted reproductive technology give clues that chromosomal modifications namely DNA methylation show variations in those children when compared to the children born naturally.
The underlining cause for the abnormality in methylation is not yet ascertained.Further researches are on pending.

Breast cancer treatment latest breakthrough

pterion2910@yahoo.com (pterion2910) — Wed, 24 Feb 2010 03:48:00 +0000

Breast cancer is one of the major hazards that haunts the human race.Various treatment strategies have been implied towards that cause.
Tamoxifen is one of the most depended drugs that is used to treat women to prevent cancer returning.In a third of patients,tamoxifen fails in its action.Latest researches have picked out a gene FGFR1 responsible for this condition.Scientists are on their way developing a new drug which willturn off this gene FGFR1.
This novel invention will enable clinicians to treat breast cancer in a new dimension effectively in the future.

Music heals stroke

pterion2910@yahoo.com (pterion2910) — Sun, 21 Feb 2010 19:29:00 +0000

'Music heals stroke!' sounds interesting rite?Anyway this is true.Affects of music on stroke patients is getting worldwide attention.
The patients who suffers from stroke may be unable to produce meaningful words if their vocal centre is damaged.If these patients are trained to sing,it is found helping them to form a conversation by assigning a simple melody to each letter in the word.The reason behind this is,the centre concerned with singing is located in a different area of the brain.So if the patient's speech area is destroyed,his singing area will be intact.
This finding is an example of how research has made a leap in the welfare of human race.
Medical practitioners are enthusiastic to the new finding and let us hope it will open up new horizons in the treatment of stroke..

Nap boosts brain power

pterion2910@yahoo.com (pterion2910) — Sun, 21 Feb 2010 19:12:00 +0000

Recently a team of researchers from Berkley university have come up with an interesting finding,from the studies conducted in 39 healthy volunteers that a short nap during day time not only beats tiredness but also boosts the learning power of the brain.This is rather an interesting finding.
According to the researchers,during a short nap the brain moves the fact based memories from the temporary storage in the brain's hippocampus to prefrontal cortex.This process occurs during a transition phase between deep sleep and dreaming sleep.This phase is scientifically called as stage 2 non rapid eye movement sleep.
This process makes the hippocampus afresh to accomodate new information just as like in an email inbox.
But the finding has got its own drawbacks too.It was a trail conducted in a laboratory under optimal conditions.In the real world there will be numerous factors which will hamper the expected results.

Latest breakthrough in cancer treatment

pterion2910@yahoo.com (pterion2910) — Sat, 20 Feb 2010 10:35:00 +0000

A team of scientists from Johns Hopkins Kimmel Cancer Center in Baltimore have developed a new technique for detecting the effectiveness of cancer treatment.

The latest technique is called as personalised analysis of rearranged ends which employs blood tests.
The principal behind the test is the detection of fingerprint DNA which are shed by the tumour cells.If these cells are derected after a successful chemotherapy,surgical removal,radiotherapy,it indicates the recurrence of cancer.This tecnique can be employed to detect the recurrence much before the conventional scans.
The major drawback is the high cost which will hopefully come down affordable to a common man
This tecnique is likely to emerge as a new technique within 5 years.

Wonderland in saliva

pterion2910@yahoo.com (pterion2910) — Fri, 19 Feb 2010 15:39:00 +0000

Recently a team of researchers discovered that there are a wide variety of bacteriae residing in our saliva.They found 101 known bacterial genera,36 of them newly seen in mouth and about 64 novel types.People in each location shared about 60% of the bacteriae in common and people from different places shared about 50% of bacteriae in common.

Pericardial tamponade

pterion2910@yahoo.com (pterion2910) — Thu, 18 Feb 2010 18:38:00 +0000

Fluid or blood gets collected in the pericardial sac.This condition effects the normal functioning of the heart.
The patient complains of breathlessness,chest pain,syncope.
The signs of pericardial tamponade are pulsus paradoxus,raised JVP on inspiration,third heart sounds.
The investigation done are ecg,echocardiography.ECG may show changing cardiac axis,flattening of waves.
The treatment is mainly aimed at clearing the fluid collection.

TETRALOGY OF FALLOT

pterion2910@yahoo.com (pterion2910) — Sat, 02 Jan 2010 14:09:00 +0000

It is a congenital disorder.It occurs as a result of developmental anomaly.The heart wont be able to function normally due to lack of it’s proper functional structures.

Tetralogy of FALLOT is characterized by obstruction to the right ventricular outflow,hypertrophy of right ventricle,ventricular septal defect and dextroposition of aorta with septal override.

CLINICAL MANIFESTATIONS:-

It depends on the degree to which right ventricle is obstructed,time of onset of symptoms and degree of cyanosis.Cyanosis(bluish colour on lips,oral cavity,face) may be present or absent at birth.It precipitates usually by one year.The other clinical manifestations are clubbing,dyspnea(difficulty to breath)on exertion,squatting at times of attack.Cyanotic attacks precipitate as the child becomes active in his later stages of life and lasts for minutes to hours.The growth of the child will be delayed.The associated symptoms are convulsions,restlessness,hyperpenic,gasping respiration,hypoxia and acidosis.It lasts for minutes to hours.

On examination the heart beat will be normal.On x ray examination a concavity can be seen on the left heart border and elevation of heart border.

Major Complications are:-

Cyanotic spells,cerebral thrombosis,brain abcess,infection of the heart wall with bacteria,Congestive cardiac failure.

TREATMENT:-

Treatment is done by a systematic approach.Severe obstruction to the outflow of right ventricle is treated to increase pulmonary blood flow by keeping pulmonary duct by administration of PGE1 and this is a temporary measure till surgery.In less severe cases,medical management is by prevention and prompt treatment of dehydration.oral propanolol administration.

CYANOTIC SPELL is managed by eeiping the patient in a knee-chest positon,administering oxygen and glucose,morphine .2mg/kg,propanolol I.V 0.1mg/kg,correction of acidosis.

Complications like brain absess is treated by administration of antibiotics for 6 weeks,polycytemia by adequate hydration,phlebotomy and volume replacement,bacterial endocarditis by administration of antibiotics for 6 weeks.

SURGICAL MANAGEMENT:-

1.PALLIATIVE PROCEDURE:-decrease hypoxia,improves growth,augments pulmonary artery growth and increae pulmonary artery blood flow.

2.CORRECTIVE SURGERY:-Often aimed at curing.The patient can lead a near normal life.It is performed in early infancy.

MANAGEMENT OF DIABETES

pterion2910@yahoo.com (pterion2910) — Tue, 29 Dec 2009 11:47:00 +0000

It is a chronic metablic disorder charactersied by hyperglycemia with or withour glucosuria resulting from an absolute or relative deficiency of insulin.

The major clinical features of diabetes are:-Non healing ulcers,unexplained weight loss,recurrent respiratory or urinary tract infections,onset of cataract before 50 years,loss of sensations in the periphery,impotence in young males,history of overweight babies and recurrent fetal loss in women,recurrent infections like moniliasis,balanoposthitis and vulvitis,premature onset of stroke,heart disease and valvular occlusions,any vague ill health.

Diabetic patient is adviced to keep a check on his/her lifestyle,take oral anti-diabetic agents and insulin if indicated.

DIET AND LIFESTYLE:-It is the starting point and mainstay treatment in 1 and 2 type diabetes mellitus.It is also helpful in reducing weight in obese patients,to improve glycemic control and to reduce chronic vascular diseases like hyperlipedimia and hypertension.

CALORIE REQUIREMENT:-It is the basic requirement of the body which is about 20-25kcal/kg of desirable body weight.Additional energy required for sedentary persons is 30kcal/kg,for moderate working persons about 40kcal/kg and for people with strenuous lifestyle about 50kcal/kg.We will get 45-60% of total calories from carbohydrates,<35%from fats and 10-15% from proteins.

CARBOHYDRATES:-The major strategies to be followed in carbohydrate uptake are

1.maintain a regular intake of carbohydrate in meals throughout the day.

2.Avoidiing refined carbohydrates

3.Restriction of total intake of carbohydrates.

5.Taking food with low glycemic index.eg:-whole grain food,legumes,fruits,nuts,barley,oats.They cause only a slow gradual rise in blood glucose.

FAT:-Take saturated fat < 10%,monounsaturated fat 10-20%.eg:-- oils made from olive , groundnut .They help to reduce total & LDL cholesterol without reduction in HDL.Polyunsaturated fat <10% helps to reduce total, LDL & HDL cholesterol.w3 fatty acids can be taken once or twice weakly.eg:-mackerals, sardines.

WEIGHT MANAGEMENT:-Reducing energy intake,increasing energy expenditure through physical activity and regular exercise in the form of walking,swimming,cycling for approximately 30 minutes daily improves insulin sensitivity,lipid profile and lowers B.P.Alchohol intake in moderate amounts along with a meal is advisable.Quitting smoking,salt restriction to 6gmm/d-3gm/d in hypertensives is advisable.The patients must intake low calorie,sugar free drinks and foods.Avoid biscuits,cake and take nuts and fruits instead.Eat regular meals avoiding fried and sugary food.Eating plenty of vegetables,whole fruits and limit consumption of animal products like red meat,eggs,liver,high fat diary products.Replace those foods with lean meat,fish,poultry(without skin),low fat diary products.Patients must not overeat in any occasions.

TREATMENT:-Tretement by terapy with insulin secretogogues like suphonylureas,meglitinides and Insulin sensitizers like metformin,thiazolidinediones.

Liver decreases glucose output.Drugs like metformin,thiazolidinediones also do the same action.Pancreas increases insulin secretion and suplhonylureas and meglitinides are used to aid pancreas in insulin secretion.Peripheral glucose uptake is increased by metformin.Alpha gucosidase inhibitors are used to delay glucose absorption.Thaizolidinediones help in increasing insulin sensitivity.

SULPHONYLUREAS:-They are used to treat non-obese patients when lifestyle modification alone doesn’t work.The major limitations are hypoglycemia and weight gain.

METFORMIN:-They are used to treat diabetes in diabetic patients.Their action is synergestic with sulphonylureas and insulin.The major limitations are impaired hepatic/renal function,alcoholic shock and hypoxia.

THAIZOLIDINEDIONES:-Used to treat patients with severe insulin resisitance(abdominal abesity).The major limitations are liver dysfunction,salt and water retention and these drugs are avoided in cardiac failure.

INCRETINS:-Oral glucose ingestion induces the release of GLP-1 which is a gut hormone.It amplify glucose induced insulin release.It suppresses glucagon secretion and improve PP hyperglycemia.It also delays gastric emptying.EXENATIDE is a GLP-1 receptor agonist.S.C.injection twice a day 60 mins before breakfast and dinner is iadvised for type 2 DM patients.Adding Sulphonylureas or metformin further reduces B.glucose.The effects of this drug are weight loss,nausea and hypoglycemia.

PRAMLINTIDE:-Synthetic analogue of islet amyloid polypeptide.It delays gastric emptying,suppress glucagon secretion and decrease appetite.Subcutaneous injection immediately befor meal is done for type 1 and insulin treated type type 2 Diabetes mellitus patients.The effects of this drug are initial weight loss,nausea and hypoglycemia.

INSULIN:-It is advised for patients with type1 Diabetes mellitus,pregnancy induced diabetes,OHA failure,A/C disease atate and surgery.

TYPES OF INSULIN are :-

1.Rapid acting(lispro,aspart)

2.short acting(soluble/regular)

3.Intermediate acting(Lente insulin)

4.Long acting(ultralente)

5.Long acting insulin analogues(glargine,detemir)

ROUTES OF INSULIN DELIVERY:-Insulin is deliverd by means of a syringe/pen.It is delivered subcutaneously to anterior abdominal wall,upper arms,upper thigh,buttocks.

The rate of absorption of insulin depends upon the site,depth,volume,warmth,local message and exercise.Other routes of drug delivery are intra muscular,Intra venous,peritoneal,intrapulmonary.it is also deliverd through continuous S.C or I.V infusion.SIDE EFFECTS of insulin are-hypoglycemia,weight gain,peripheral oedema,insulin antibodies,lipodystrophy,local allergy and phenomena like somogyi,DAWN phenomenon.

The major golas of therapy are maintain glucose level at a range of 90-130,peak post pandrial plasma glucose at <180 and HbA1C<7.

The patient can keep himself completely free from the complications and panic of diabetes by follwing the below mentioned steps.

1.Check HbA1C level 2-4 times/year.

2.Eye check up annually.

3.Foot examination 1-2 times/year by a physician,and daily by the patient.

4.B.P check up quarterly.

5.Lipid profile annually.

6.Educating the patient by giving proper guidance.

FIBROMYALGIA

pterion2910@yahoo.com (pterion2910) — Tue, 29 Dec 2009 11:43:00 +0000

It is a syndrome of widespread chronic muscular pain and tender joints without any definable musculoskeletal pathology.Patient may complain with a pain either axial pain with severe pain in the axial spine and in atleast two contralateral sides or a chronic pain for atleast 3 months duration with tender points(patient may have physical humps which are in the size of a grain upto the size of an apple) of more than 11 out of 18 total tender points.Associated symptoms are fatigue,disturbed sleep,depression,anxiety.There are other associations with this disease like irritable bowel syndrome and chronic fatigue.

The etiology of this disease is unknown.It is defined in psychiatry as an abnormal sensitivity to pain.Cognitive therapy and therapy with analgesics like diclofenac sodium are often advised.

There is no specific treatment for this condition.The treatment will not be beneficial for the patient.The patient need not find any improvement in his condition.The patient may be counseled instead,advising him to live with it and avoiding unnecessary further drug treatment and investigations.

ENTERIC FEVER

pterion2910@yahoo.com (pterion2910) — Sun, 27 Dec 2009 11:00:00 +0000

ENTERIC FEVER

EPIDEMIOLOGY:-

It is an endemic disease caused by salmonella enterica.Transmitted by ingestion of contaminated food water or milk.Natural reservoir of the microorganism is humans.It transmits over congenitally and by intrapartum means.

Convalescent carriers-excrete salmonella for 3 months after the illness.Period of communicability is as long as bacteria is present in the exctreta.The disease spreads rapidly in hot summer months,over crowding,breakdown in safe water supply and sewage disposal.

PATHOGENESIS:-

Risk increases with increase in inoculum size,stomatch acidity,possession of Vi antigen.The microorganism invade peyers patches,then get transported to intestinal lymph nodes,multiply inside monocytes and gets carries to mesenteric lymph nodes.Macrophages then engulf bacteria and gets carried away alng with it to blood stream through thoracic duct which eventually causes primary bacteremia.Results in onset of fever.The microorganism spread to liver,spleen and bone moarrow causing more complications.It multiplies in liver and spleen and release antigens causing secondary bacteremia.

CLINICAL MANIFESTATIONS:-

Incubation period is 7-14days.Its less common under 2 years.It has got a gradual onset.Fever is of step ladder pattern and it is continuous generally.Patient suffers rapid increase in fver,headache and vomiting.Constipation,diarrhea and abdominal pain may also occur.Tongue will get a white coat at the center and clear at margins.Patient may have bradycardia.Typhoid rash appears on 6th day.Appears in crops called as rose spots for a few hours and fade on pressure.On second and 3rd week abdomen gets distended with a tympanic resonance.Splenomegaly of about 1-2 cm.The patient will be in a typhoid state which is characterized by dull sensorum,apathy,stupor,muttering delirium,pick at clothes.For school aged children and adolescents,initial symptoms are fever,malaise,anorexia,myalgia,headache and abdominal pain develop over 2-3days.Dirrhoea have a pea soup consisitency.Constipation becomes a prominent symptom later.Cough and epistaxis are also symptomatic.

In 2nd week of illness major symptoms are-high fever,fatigue,cough,abdominal symptoms and severe lethargy.PHYSICAL FINDINGS-a relative bradycardia disproportionate to fever.In 50% subjects,macular or maculopapular rash measuring 1-5mm appears.Rose spots appear on 7th-10th day.The lesions are slightly raised and blanch on pressure.10-15 lesions appear on the lower chest and abdomen and lats for 2-3 days.They lave a brown discolouration.

IN INFANTS-this disease is not so common.Mild fever and malaise with diarrhoea accompaniying are the symptoms.

All fever more than 7 days,low heart rate,blood tinged fecal matter all points to this disease.

THERAPY DEPENDS UPON-age,health sattus,serotype,and complications.Mortality if untreated is 10%.The disease recurs in 10-20% subjects.Typhoid is treated by using antibilocs,analgesics.

Epistaxis

pterion2910@yahoo.com (pterion2910) — Thu, 03 Sep 2009 15:32:00 +0000

Epistaxis:

Epistaxis is defined as bleeding from the nose due to any cause.

can be,local or systemic.

Through :anterior nares and posterior nares

Origin of blood from:

Nose
Nasopharynx
PNS
Antrior cranial fossa

VASCULAR ANATOMY:

Nose is supplied by both external & internal carotid systems.

External carotid system comprises of:

Sphenopalatine br of Maxillary A
Gr.Palatine br of Maxillary A
Superior labial br of Facial A
Internal carotid system (Ophthalmic A) comprises of:
Ant ethmoidal Artery
Post ethmoidal Artery

LITTLE's AREA

Situated in the ant inf part of nasal septum

Kiesselbach’s plexus comprised by:

•Ant ethmoidal

• Septal br of Sup labial

• Gr.Palatine

•Septal br of SPA

LITTLE's Area

Exposed to drying inspiratory air currents and digital trauma

Commonest site of epistaxis in children and young adults

Leads to arterial bleeding.

RETROCOLUMELLAR VEIN:

A vein running down just behind the columella crossing the floor and joining the venous plexus the lateral wall of nose .May bleed in young people

WOODRUFF's PLEXUS:

Venous plexus on the lateral wall of the inf. meatus posteriorly.Also called naso-nasopharyngeal plexus .Site of epistaxis in elderly

SPHENOPALATINE ARTERY:-

Artery of epistaxis .Terminal br of int maxillary Artery.Enters nose by traversing the sphenopalatine foramen.

SITE OF EPISTAXIS:

Little’s area ,Woodruff’s area ,Above middle turbinate (ant & post eth.A).Below middle turbinate (br of SPA),Diffuse bleeding,Nasopharynx,Roof of nasal cavity ,Post. Part of nasal septum (Brown’s area) .

PATHOPHYSIOLOGY:

Various factors are involved.Vessel wall damage by trauma ,Sudden rise of pressure(violent exp effort) in a weak vessel wall rupture,Inherent weakness of capillary wall,Infection,inflammation,fragility of capillary wall,bleeding,Vitamin deficiencies (K,C) cause weakness of capillary wall ,clotting factor deficiency

Impaired coagulation eg:epistaxis as in coag disorders, aspirin

AETILOGY:

Age: Children: nosepicking, FB, adenoids, diphtheria , adolescent: JNA, trauma, rhinosinusitis ,adults: infection, injuries,lderly: HT, neoplasm, sex: no sex prediliction.

It can be due to Local,systemic and idiopathic factors.

LOCAL:

Most common
Can be
Congenital - multiple telangiectasiasis(Osler Rendu Weber syndrome)
Traumatic
Foreign body
Inflammation ,neoplasm,miscellaneous..

LOCAL TRAUMATIC:-Digital trauma

Nasal #
# ant cranial fossa
Surgical trauma
Chemical trauma…eg..arsenic
Traumatic septal perforation
Forceful blowing of nose and sneezing
local foriegn body:-
Maggots
Rhinolith
Neglected FB

LOCAL INFLAMMATION:Acute non specific rhinosinusitis

Acute specific—nasal diphtheria
Chronic non specific
Atrophic rhinitis
Rhinitis sicca
Rhinitis caseosa
Chronic rhinitis

Chronic specific :

Rhinosporidosis
TB, Lupus
Syphilis
Leprosy
Rhinoscleroma

LOCAL NEOPLASMS:-

Benign growth, bleeding polyps of septum, angiofibroma, inverted papilloma

Malignant growths of the nose, PNS and nasopharynx

LOCAL-miscellaneous:-

Vicarious menstruation
Barotrauma
Deviated nasal septum

SYSTEMIC:-

Congenital- hemophilia and other disorders of coagulation
Infective

Disorders of blood and blood vessels
Systemic diseases
Drugs
Mediastinal compression
miscellaneous

SYSTEMIC-Infective:-

Acute exanthematous fevers—measles, varicella, influenza
Malaria
Typhoid
Kala-azar
Pertussis
Rheumatic fever
Dengue fever
Infectious mononucleosis

Blood and blood vessels:-

Purpuras
Leukemias
Haemophilias
Aplastic & pernicious anaemias
Vit K def
DIC

SYSTEMC DISEASES:-

Hypertension
Atherosclerosis
Mitral stenosis
Cirrhosis
Chronic nephritis

DrUGS:-

Anticoagulants
Aspirin
Phenytoin

SYSTEMIC:-

Mediastinal compression by tumours of the lower neck and mediastinal growths

Miscellaneous:

Prolonged exertion
Pregnancy
Puberty

Management:-

Surgical emergency
Treatment consists of
Assess gen condition of patient and resuscitate if necessary
Local measures to stop haemorrhage
Treatment of the specific cause of bleeding

General measures:-

Record vital signs
Hb, PCV
history-amount of bleeding, ppt cause, medical illness, drugs, family history
Fluid replacement
Blood transfusion
Oxygen masks
Bleeding profile, X-rays, CT scans if required

Management:-

Control of hypertension
Correction of coagulopathies/ thrombocyto penia
FFP or whole blood/reversal of anticoagulant/platelets
Topical decongestants/vasocontrictors
Cautery (AgNo3 vs. TCA vs. Bipolar)
Nasal packing (effective 80-90% of time)
Greater palatine foramen block.
Humidity/emolients
Discontinue offending meds
Nasal saline sprays
Avoidance of nose picking/blowing
Sneeze with mouth open
Avoid straining/bedrest .

LOCAL MEASURES:-

Temporary pressure over alae—pinch nose with pt upright
Ice cubes over nose—vasoconstriction
Trotters method: NOT DONE NOW
Pt sit on a chair leaning forward with open mouth—bleed till hypotensive. Risk of coronary thrombosis .

CAUTERIZATION:-

Nasal endoscopy after local spray to locate bleeding point.
Cauterization of the bleeding point
Chemical cautery :
50% trichloroacetic acid
10% silver nitrate
Electric cautery
Cryo cautery

NASAL PACKS:-

Anterior nasal packs
Traditional
Recent modifications
Posterior nasal packs
Traditional
Recent modifications
Ant/Post nasal packing .

Complications of nasal packing:-

Early:pain,vasovagal attack,injury to soft palate,columella,nares,mucosa,choana.

Intermediate :

Hypoxia & hypoventilation
Sleep
Apnoea
Arrythmias and cardiac arrest
ET dysfunction

Late :

Secondary haemorrhage
Septal necrosis and perforation
Toxic shock syndrome
Synechiae
Atrophic rhinitis

Surgical treatment:-

Last resort in epistaxis control
ECA ligation as 90% mucosa is supplied by it
Arteries that can be ligated are:
Internal maxillary A: transantral/ transoral approach
ECA: cervical incision
Sphenopalatine A: transantral/ endoscopic
Ant and Post ethmoid A: Lynch incision

EMBOLIZATION:-

For severe post epistaxis—IMA embolized

Using gelfoam, oil, balloon, poly vinyl alcohol particle

Side effect: CVA

Nasal balloon:-

For posterior epistaxis
Foley’s catheter is used
Catheter with 2 balloons--- one in nasopharynx and other in the nasal

Allergic rhinitis

pterion2910@yahoo.com (pterion2910) — Thu, 03 Sep 2009 15:29:00 +0000

Definition
- an inflammation of the mucous membrane lining the nose (usually associated with nasal discharge sneezing, congestion and irritation in the nose, eyes, throat and ears.)

Classification of rhinitis
A. Allergic
Seasonal
Perennial
Occupational

B. Non allergic
Infection
Intrinsic rhinitis
Others.

Allergic Rhinitis-definition:-
Allergic rhinitis is clinically defined as a symptomatic disorder of the nose induced by an IgE-mediated inflammation after allergen exposure of the membranes lining the nose

ATOPY
Tendency to develop an exagerrated antibody response( IgE) to common aero allergens.
Allergy is its clinical expression.
Genetically inherited.
Elevated IgE OR Exagerrated skin prick test

SEASONAL RHINITIS
Allergy to grass pollen,fungal spores
Nasal mucosa may be primed .
A pollen count of more than50/l provokes usually.
More in the evening when pollens settle down.

Evening time is when the pollenssettle down on the ground.

PERENNIAL ALLERGIC RHINITIS
Caused by the digestive enzymes of house dust mite (Dermatophagoides pteronysinnus and D.farinae.
In pillows carpet bedclothes ,curtains ,soft furnishings.
Also cat salivary protien.

Dust Mites (Der p, Der f)
Eight legged arachnids (related to spiders, chiggers and ticks)
Thrive in warm moist micro-environments (inside pillows, cushions, mattresses)
Feed on human and animal dander (dead skin flakes)
Focus on the bedroom
Pillow and mattress covers
Wash bedding in hot water
Damp dust
Cost effective tips
(cheese cloth)

OCCUPATIONAL ALLERGENS
Flour (bakers,grain workers)
Lab animals
Washing powders
Wood dust
Latex-important in surgeons,nurses and other health workers.
Furry and Feathered Friends (Can d1, Fel d1, Mus m)
Dander: proteins in dead skin, urine and saliva
Cats (most common)
Dogs
Birds
Rodents

FOOD AND DRUG INDUCEDRHINITIS
Ig E mediated
Symptoms in mouth tongue and digestive tract.
Sensitivity to preservatives like sulphites,benzoates and tartrazine.
Saint’s or Samter’s triad-Aspirin induced rhinitis,nasal polyposis and late onset asthma.

Allergic rhinits-Aspirin triad:-
Nasal Polyposis
Allergic Sinusitis
Asthma

Natural history of allergic rhinitis:-
onset is common in childhood,adolescence and early adulthood.Symptoms often wane in older adults,but may develop or persist at any age.No apparent gender selectivity orpredisposition for developing allergic rhinitis.May contribute to other conditions such as sleep disorders,fatigue,learning problems.

MEDIATORS OF ALLERGY
From granules and cellmembrane of basophils and mast cells.
Histamine-itch,sneezing and mucous secretion
LeukotrieneC4-Mucous secretion
LKB4 and PAF-Eosinophil,Neutrophil chemoattractant

How are the symptoms caused?
Irritation of freenerve endings---- Itching and sneezing
Increasedmucus production ------ Rhinorrhoea
Vasodilation -------- Congestion
Increasedvascular permeability---- Oedema

Diagnosis of AR
History
Physical / Nasal Examination
Laboratory investigations
-Routine blood;look for eosinophilia
- Skin Prick Test
- RAST
-Nasal lavage for eosinophils

CLINICAL MANIFESTATIONS:-
Repetitive sneezing,watery rhinorrhea,nasal pruritus,nasal congestion
others:-eye symptoms,ear symp,postnasal drainage.

Physical examination:-
nAllergic shiner
nDennie Morgan line(prominent creases below inferior eyelid)
nAllergic crease
nAllergic salute
nNasal mucosa may appear normal or pale bluish, swollen with watery secretions but only if patient is symptomatic
nExclude structural problems (polyps, deflected nasal septum)
Others:
nasal voice, constant mouth breathing, frequent snoring, coughing, repetitive sneezing, chronic open gape of the mouth, weakness, malaise, irritability

Allergic testing-Prick test:-
Patients have to be off of all antihistamines for 4 days. Off of non-sedative antihistamines for up to 6 weeks.
Cannot be on Beta Blockers.

Skin prick testing
It is usually carried out on the inner forearm,but if the patient has bad eczemaon the test can be performed on the back
Ideally the allergens to be selected should be in accordance with the patient’s history
As few as 3 or 4 or up to about 25 allergens can be tested
The arm is coded with a marker pen for the allergens to be tested
A drop of the allergen (extract) solution is placed by each code.

Radio allergosorbent test:-the blood measures of allergy antibody or IgE,produced when your blood is mixed with a series of allegens in a laboratory.

Management of AR:-
Allergen Avoidance
Pharmacotherapy
Immunotherapy

Animal Control Measures:-
The ideal solution:
Remove pets from house
If not possible:
Keep pet out of bedroom
Use HEPA air filtering system
Remove carpet and other reservoirs for allergens in the bedroom
Encasing on mattress, box springs, and pillow
Wash pet weekly.

Outdoor Triggers:-
Pollens: particles released from trees, weeds and grasses
Highest levels at midday (10-2pm)
Use air conditioning, not fans
Visit an air-conditioned mall or movie theater
Not many options (avoidance)

Pharmacotherapy:-
Medications used to treat allergic rhinits:
Antihistamines
Decongestants
AH-D combinations
Corticosteroids
Mast Cell stabilizers
Anticholinergics
Antileukotrienes

Anti-Histamines:-
Act by preventing histamine from binding to the H1-receptors
Primarily helpful in controlling Sneezing, itching & rhinorrhoea; ineffective in releiving nasal blockage
1st generation anti-histamines
- chlorpheniramine
- diphenylhydramine
2nd generation anti-histamines
- cetrizine
- azelastine
- fexofenadine
- loratadine

Intranasal corticosteroid therapy:-
Potent topical activity
Administration of low doses directly at site of action
Considerable efficacy at low doses
High topical: systemic activity ratios
Rapid first-pass hepatic metabolism of any systemically absorbed drug, to compounds with negligible activity
Markedly greater inhibition of EAR than with oral steroids

Immunotherapy:-
Allergy shots (immunotherapy) for allergic rhinitis Treatment Overview
When you get allergy shots (immunotherapy), your allergist or doctor injects small doses of substances that you are allergic to (allergens) under your skin. This helps your body "get used to" the allergen, which can result in fewer or less severe symptoms of allergic rhinitis.
Your allergist will use an extract of grass, weed, or tree pollen; dust mites; molds; or animal dander for allergy shots. You must first have skin testing to find out which allergen you are allergic to.

The "Ideal" Drug For Allergic Rhinitis Should Have The Following Features:
Inhibit both early and late phases
Be an H1 blocker
Counter effects of other mediators
Fast-acting, to control the early phase
Dosing-od or bd for compliance
No side effects
Manage all symptoms
Intranasal administration

The "Ideal" Drugs Are……
"Corticosteroids are undoubtedly the pharmacotherapeutic agents with the broadest application for the treatment of many types of rhinitis"