Disease type

Abdominal pain

Introduction

Abdominal pain can be felt anywhere between chest and groin. Pain could be mild, moderate or severe. It may be dull or acute. Almost everyone has experienced pain at one time or another. Most of the time pain in stomach is not a serious cause of concern but severe abdominal pain is a cause of concern. If pain starts suddenly and un expectedly, it should be regarded as an emergency.

Symptoms

Pain in abdomen can be of various intensities and nature. It can be:

Sharp, stabbing cramp like pain

Brief pain that may come or go

Pain associated with vomiting

Causes

Various conditions are associated with abdominal pain . Causes of abdominal pain include:

Constipation

Irritable bowel syndromes

Food allergies

Food poisoning

Menstrual pain

Sudden, severe abdominal pain:

Abdominal infection

Appendicitis

A perforated peptic ulcer

Galls tones

Kidney stones

Diverticulitis : Inflammation of small pouches that are part of the bowel

Other common causes in adults are:

Irritable bowel syndrome

Crohn's disease

Urinary tract infection

Long term Peptic ulcer

Constipation

Heartburn and acid reflux

Common Causes in children

Constipation

Urinary tract Infection

Anxiety

Heartburn and acid reflux

Diagnosis

Generally abdominal pain goes with the time but if the pain does not subside one should seek medical help:

Abdominal discomfort that lasts 1 week or longer

Abdominal pain that does not improve in 24 - 48 hours, or becomes more severe and frequent and occurs with nausea and vomiting

Bloating that persists for more than 2 days

Burning sensation when you urinate or frequent urination

Diarrhea for more than 5 days

Fever (over 100°F for adults or 100.4°F for children) with pain

Prolonged poor appetite

Prolonged vaginal bleeding

Unexplained weight loss

Management

Generally, treatment for abdominal pain depends upon its causes.

Treatment vary from medications for inflammation of Gastroesophageal reflux disease (GERD) or Ulcers

Use antibiotics in case of infections

Modify your eating habits

In some conditions it may require surgical treatment like in appendicitisor hernia (inguinal and umbilical)

Seek your doctors advice before going in for any treatment.

Acquired Immuno Deficiency syndrome

(AIDS / Hiv)

Introduction

AIDS is caused by human immunodeficiency virus (HIV). HIV kills or damages the body's immune system cells.

There are two types of HIV. Type I and Type II. Type I is more common in India.

AIDS is generally caused by unprotected sex with an infected partner. It may also spread through the use of infected syringes of HIV infected people and blood transfusions.

The first signs of AIDS is influenza (flu) like symptoms or may be swollen glands but at times symptoms might not appear. Symptoms may appear after two or three months. Generally, blood test is done to confirm the diagnosis. There is no cure, but there are many medicines to fight/ control HIV infection.

Symptoms

There are 3 main stages of AIDS:

Acute symptoms, clinical latency and severe symptoms

Acute symptoms: The majority of people infected by HIV develop a Influenza (flu) like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible symptoms include:

Headache

Fever

Sore throat

Muscle soreness

Rash

Mouth or genital ulcers

Swollen lymph glands, mainly on the neck

Joint pain

Diarrhea

Night sweats

Clinical Latency:

There is persistent swelling of lymph nodes during clinical latent HIV. Else, there are no specific signs and symptoms. However, body remains infected with the virus.

Severe Symptoms:

Headaches

Blurred and distorted vision

Cough and shortness of breath

Persistent white spots or unusual lesions on your tongue or in your mouth

Soaking night sweats

Shaking chills or fever higher than 100 F (38 C) for several weeks

Chronic diarrhea

Persistent, unexplained fatigue

Weight loss

Skin rashes

Causes

A person becomes infected with HIV/AIDS by several ways:

Blood transfusions: In some cases, the virus may be transmitted through blood transfusions.

Sharing infected needles: HIV can be transmitted through needles and syringes contaminated with infected blood.

Sexual Contact: The most frequent mode of transmission of HIV is through sexual contact with an infected person.

From mother to child: A pregnant woman infected with HIV virus can transmit the virus to her fetus through their shared blood circulation, or an infected nursing mother can transmit it to her baby through her breast milk.

Diagnosis

HIV test is done to detect human immunodeficiency virus in saliva, serum or urine. The UNAIDS/WHO policy statement on HIV Testing states that conditions under which people undergo HIV testing must be anchored in a human rights approach that pays due respect to ethical principles . According to these principles, the conduct of HIV testing of individuals must be:

Confidentiality: The entire process of testing and results are kept confidential to give boost to individuals, couples, and families to learn about their HIV status in the convenience and privacy of their home environment. Home-Based HIV Testing and Counseling (HBHTC) allows rapid HIV tests that are most often used, so results are available for the client between 15 and 30 minutes.

Accompanied by counseling (for those who test positive).

Conducted with the informed consent of the person being tested. Diagnosis of HIV/AIDS, several types of tests can help physician to determine what stage of the disease. These tests include:

Window period: There is a period of time between HIV infection and the appearance of anti-HIV antibodies that can be measured which is called "window period". Antibody tests may give false negative (no antibodies are detected despite the presence of HIV) results during the window period, an interval of three weeks to six months between the time of HIV infection and the production of measurable antibodies to HIV sero conversion.

CD4 count: CD4 cells are a type of white blood cell that's specifically targeted and destroyed by HIV. A healthy person's CD4 count can vary from 500 to more than 1,000. Even if a person has no symptoms, HIV infection progresses to AIDS when his or her CD4 count becomes less than 200.

Rapid or point-of-care tests: The rapid test is an immunoassay used for screening, and it produces quick results, in 20 minutes or less. Rapid tests use blood or oral fluid to look for antibodies to HIV. If an immunoassay (lab test or rapid test) is conducted during the window period (i.e., the period after exposure but before the test can find antibodies), the test may not find antibodies and may give a false negative result. All immunoassays that are positive need a follow up test to confirm the result.

ELISA (enzyme-linked immunosorbent assay): ELISA is set of blood tests used to diagnose HIV infection. ELISA test is performed by inserting a needle to draw blood. A positive result on the ELISA screening test does not necessarily mean that the person has HIV infection. Certain conditions may lead to a false positive result, such as Lyme disease, syphilis, and lupus.

RNA tests detect the virus directly (instead of the antibodies to HIV) and thus can detect HIV at about 10 days after infection as soon as it appears in the bloodstream, before antibodies develop. These tests cost more than antibody tests and are generally not used as a screening test, although your doctor may order one as a follow-up test, after a positive antibody test, or as part of a clinical workup.

Western Blot: A positive ELISA test is always followed by a Western blot test which confirm the HIV infection.

*NHP provides indicative information for better understanding of health. For any treatment and diagnosis purpose you should consult your physician.

Management

Definitive cure for AIDS is yet to be disocvered. However, some medicines, given at certain stages of the disease, depending upon the CD4 count in the blood of the patient, can prolong the life of HIV positive persons.

Reverse transcriptase (RT) inhibitors - It interferes with a critical step during the HIV life cycle and keep the virus from making copies of itself.

Protease inhibitors - It interferes with a protein that HIV uses to make infectious viral particles.

Fusion inhibitors - It blocks the virus from entering the body's cells.

Integrase inhibitors - It blocks an enzyme HIV needs to make copies of itself.

Multidrug combinations - It combines two or more different types of drugs into one. These medicines help people with HIV, but they are not perfect. They do not cure HIV/AIDS. People with HIV infection still have the virus in their bodies. They can still spread HIV to others through unprotected sex and needle sharing, even when they are taking their medicines.

*NHP provides indicative information for better understanding of health. For any treatment and diagnosis purpose you should consult your physician.

Prevention

Avoiding AIDS is as easy as ABC;

A= Abstain

B= Be faithful

C= Condomise

HIV prevention refers to practices done to prevent the spread of HIV/AIDS. HIV prevention practices may be done by individuals to protect their own health:

Spreading awareness among masses.

Protected sexual contact through the use of condoms reduces the risk of HIV/AIDS

Providing awareness among the population about their HIV status especially in high risks population, High risks population involves sex workers and their partners, Intravenous drug users, truck drivers, labor migrants, refugees and prisoners.

Safe injections: Using auto disposal syringes helps to prevent HIV infections.

Male circumcision: It is the surgical removal of the foreskin (prepuce) from the human penis.

Safe blood transfusion procured only from authorized and accredited blood banks.

Counseling of HIV positive pregnant mother on the issue of how to prevent parent to child transmission (PPTCT).

Alcohol Abuse & Alcoholism

Introduction

Alcoholism is a condition when a person have signs of physical addiction to alcohol and continues to drink , despite problems with physical and psychological health. Alcohol abuse is when person's drinking habits leads to problems, but not physical addiction.

These problems can lead to a number of harmful physical, psychological and socioeconomic effects such as alcohol poisoning, cirrhosis of the liver, inability to work and socialize and destructive behaviors(violence and vandalism).

Alcoholism is not a gender related disease.

Symptoms

People who have alcoholism or alcohol abuse often:

• Continue to drink, even after knowing the ill effects of drinking

• Drink alone

• Become hostile when asked about drinking

• Unable to control drinking

• Make excuses to drink

• Miss work or school, or have a decrease in performance because of drinking

• Stop taking part in activities because of alcohol

• Need to consume alcohol on most days to get through the day

• Become violent if somebody tries to stop them to drink

In addition, physical problems also develops. Alcoholics suffer from disturbing memory lapses called blackouts. Alcoholics eat poorly because their irritated liver and inflamed digestive systems leads to heart burns and nausea.

The warning signs are "slurred speech, alcohol odour".

"Dry drunk syndrome" is a syndrome characterized by short temper, irritability and restlessness.

Diagnosis

The medical professional will perform a physical examination and ask questions about person's medical and family history, including use of alcohol.

Tests to rule out, if a person is alcoholic or not:

• Blood alcohol level

• Complete blood count

• Liver function test

• Magnesium blood test

Management

Treating alcoholism depends on how much a person drinks. Further treatment options are:

• Detoxification - It involves a nurse or doctor supporting the person to safely give up drinking. It can be done by helping the person to slowly reduce the alcohol intake over time or by medications. Thus reducing the withdrawal symptoms

• Counseling - It includes self-help groups and talking therapies, such as cognitive behavioral therapy (CBT)

• Medication - There are two main types of medicines to facilitate a person to stop drinking. The first is to help reduce withdrawal symptoms and is generally given in tapering doses over a short period of time.

The most common medicine that’s used in this way is called chlodiazapoxide (Librium). The another medication to reduce any urge that one may have to drink. The most common medications used for this are acamprosate and naltrexone; these medicines are given at a fixed dose and you'll usually be on them for 6-12 months.

Alopecia (hair loss )

Introduction

Partial or complete loss of hair is called alopecia. Hair loss usually develops gradually and may be patchy or diffuse (all over). One loses up to 100 hair from the scalp everyday.

Baldness is not usually caused by disease. It is also related to aging, heredity or changes in the hormones. There can be male pattern baldness or female pattern baldness.

Causes

There are many reasons for hair loss. It include following reasons:

Hair Disorders

Hereditary thinning or baldness: It is also called androgenetic alopecia. It is regarded as the most common cause of hair loss. Hereditary hair loss in men is seen as a receding hairline as well as hair loss on top of the scalp. Women, on the other hand, tends to have their hairline and have visible thinning of hair over the front and top of the scalp.

Alopecia areata. It is an autoimmune disease that causes hair loss on the scalp and elsewhere on the body. It develops in people of all ages and hair is lost in patches

Cicatricial (scarring) alopecia: It can develop in otherwise healthy men and women, cicatricial alopecia is a rare condition that destroys hair follicles. Scar tissue forms where the follicles once were and re-growth is not possible. Treatment attempts to stop the inflammation that destroys the hair follicles.

Disease

Underlying medical condition:Decreasing hair loss is regarded as warning sign for about 30 diseases, hair loss often can be stopped or reversed with treatment for the underlying disease. Medical conditions that leads to hair loss are thyroid disease and anemia caused by an iron deficiency.

Some cancer treatments: Radiation therapy and some chemotherapeutic medications can also cause hair loss. While hair loss is usually temporary, it can be the most distressing part of therapy.

Ringworm of the scalp. Hair loss can also be caused due to fungal infection, which is most common in children, can cause balding and scaling on the scalp.

Trichotillomania. It is a disorder that causes people to repeatedly pull out their own hair. Aside from a constant urge to pull out the hair on the scalp, sufferers often say they feel compelled to pull out their eyelashes, nose hairs, eyebrows, and other hairs on their bodies.

Stress and Hormones

Stress: Hair loss can also occur if a person is mentally or physically stressed, or after a major surgery, high fever, severe infection, or even the flu.

Hormones fluctuations: Any change in hormonal levels can cause hair loss especially in women. Hair loss is common during menopause and after childbirth due to falling estrogen levels. When hair loss is caused by falling estrogen levels, the loss is usually temporary. Hair can be re grown .

Diet

Weight loss: People having weight issues can also have hair loss issues. . This hair loss is common, and hair growth does return to normal with proper diet and weight.

Vitamin A excess: Intake of too much vitamin A through vitamin supplements or medications can also lead to hair loss.

Protein intake too low: Hair loss can also occur when the body is not getting enough protein, it conserves the protein it does get by shifting hair growth into the resting phase. Within 2 to 3 months, the person usually sees visible hair loss. This can be reversed and prevented by eating enough protein.

Iron intake too low. Consuming too little iron can lead to hair loss. Good vegetarian sources of iron are iron-fortified cereals, soybeans, pumpkin seeds, white beans, lentils, and spinach. Clams, oysters, and organ meats top the list of good animal sources of iron.

Eating disorder. An eating disorder such as anorexia or bulimia is the other cause of hair loss.

Medication

Medications that can cause hair loss include:

Blood thinners

High-dose vitamin A

Medicines for arthritis, depression, gout, heart problems, and high blood pressure

Birth control pills: Some women taking or discontinuing birth control pills experience hair loss. This usually occurs in women with an inherited tendency toward hair thinning

Hair Care Practices

Hair cosmetics: Frequent coloring of hair can cause the hair to break. Regular or improper use of dyes, gels, relaxers, and sprays also can cause hair breakage. Dermatologists recommend limiting use of these hair cosmetics to reduce hair breakage.

Blow dryers, flat irons, and similar devices. Regular use of a blow dryer tends to damage hair. The high heat from a blow dryer can boil the water in the hair shaft leaving the hair brittle and prone to breakage. Allowing the hair to air dry and styling it only when dry will lessen this risk. Dermatologists also recommend limiting the use of flat irons, which straighten hair by using high heat, and other devices such as curling irons.

Hairpins, clips, and rubber bands: If hair are held tightly with hairpins, clips, and rubber bands can break hair. To minimize hair breakage, one should use loosely fitting clips and wear them in different areas of the scalp so that hair breakage is not localized in a specific area.

Too much or vigorous grooming:Regular shampooing, combing, or brushing (100 strokes or more a day) or doing any of these too vigorously can cause hair breakage. When hair breakage occurs, the hair appears shaggy or too thin.

Diagnosis

Dermatologists can diagnose hair loss by asking questions about medical history, family history. A dermatologist may also carefully look at the scalp to know the condition of scalp.

Management

Treatment of hair loss depends upon the cause of disease.

Treatment available without a prescription

Minoxidil: This medicine is applied to the scalp. It can stop hair from getting thinner and also stimulate hair growth on the top of the scalp. It is the only hair re-growth product approved for men and women. A dermatologist generally combine minoxidil with another treatment.

Laser devices: Brushes, combs, and other hand-held devices that emit laser light also stimulate hair growth. These devices might make hair look more youthful in some people. Because the FDA classifies these products as medical devices, the products do not undergo the rigorous testing that medicines undergo. The long-term effectiveness and safety for these devices are not known.

Prescription medicine

Finasteride: The FDA approved this medicine to treat men with hair loss. It comes in pill form and helps slow hair loss in most (about 88%) men. It helps stimulate hair re-growth in many (about 66%) men. Finasteride works by stopping the body from making a male hormone, dihydrotestosterone (DHT).

Corticosteroid: If your hair loss is caused by inflammation in your body, a dermatologist may inject a medicine called a corticosteroid into your scalp. This can help stop the inflammation that happens when a person has alopecia areata. A corticosteroid is different from an anabolic steroid.

Procedures

The type of procedure that a dermatologist recommends will depend on how much hair you have lost. To achieve the best results, a dermatologist may use one or more of the following procedures:

Hair transplantation: Skin on the scalp that has good hair growth is removed and transplanted to areas of the scalp that need hair.

Scalp reduction: Bald scalp is surgically removed and hair-bearing scalp is brought closer together to reduce balding. Scalp reduction surgery can be performed alone or in conjunction with a hair transplant.

Scalp expansion: Devices are inserted under the scalp for about 3 to 4 weeks to stretch the skin. This procedure may be performed before a scalp reduction to make the scalp more lax. It also can be performed solely to stretch hair-bearing areas, which reduces balding.

Scalp flaps: A hair-bearing segment of scalp is surgically moved and placed where hair is needed.

Alzheimer's Disease 

Introduction

Dementia is a disorder characterized by serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal ageing. Alzheimer's Disease is the most common form of dementia. It is more common in older individuals.

Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills and eventually the ability to carry out the simplest tasks of daily living. Although scientists are learning more every day, right now, they still do not know what causes Alzheimer’s disease. Thus it is an Idiopathic disease.

DSM 5 has changed the terminology of Alzheimer’s Disease as “Major or Mild Neurocognitive Disorder Due to Alzheimer’s Disease”

Symptoms

Forgetfulness

Language difficulties including difficulty in remembering names

Difficulty in planning and problem solving

Difficulty in doing previously familiar tasks

Difficulty in concentration

Difficulty in spatial relationships like remembering roads and routes to a particular destination

Difficulty in social behavior

STAGES

Pre-dementia or Mild Cognitive Impairment (MCI)or Mild Neurocognitive Disorder Due to Alzheimer’s Disease: Characterized by level of cognitive decline that requires compensatory strategies and accommodations to help maintain independence and perform activities of daily living.

Mild Alzheimer’s dementia or Major Mild Neurocognitive Disorder Due to Alzheimer’s Disease- mild: Characterized by symptoms which mildly impair activities of daily living such that patient needs supervision over complex tasks like managing finances etc.

Moderate Alzheimer’s dementia or Major Neurocognitive Disorder Due to Alzheimer’s Disease- Moderate: Characterized by symptoms which moderately impair activities of daily living such that patient needs assistance for some of the activities.

Severe Alzheimer’s dementia or Major Neurocognitive Disorder Due to Alzheimer’s Disease- severe: Characterized by symptoms which severely impair activities of daily living such that patient is completely dependent on others for basic needs.

Patients with severe dementia may lose the ability to walk, talk, and care for themselves and need to rely on caregivers to handle even their most basic needs, including eating, washing, and going to the bathroom. They may also have difficulty in communication including telling names of things or finding appropriate words to express themselves.

Causes

Scientists have not yet understood the exact cause of Alzheimer's disease. It is postulated to have multifactorial etiology like:

Genetic: The Apolipoprotein E (ApoE) gene is implicated in Alzheimer’s Disease. This gene has several forms. One of them, ApoE ε4, seems to increase a person’s risk of getting the disease. However, carrying the ApoE ε4 form of the gene does not necessarily mean that a person will develop Alzheimer’s disease, and people carrying no ApoE ε4 can also develop the disease. Most experts believe that additional genes like Presenilin 1, mutation on chromosome 14, APP (Amyloid Precursor Protein) mutation on chromosome 21 and Presenilin 2 mutation on chromosome 1 may influence the development of late-onset Alzheimer’s. Scientists around the world are searching for other genes that may increase a person’s risk for developing Alzheimer’s disease.

Environmental/ Lifestyle factors: Diseases like heart disease, stroke, high blood pressure, diabetes, obesity, hyperlipidemia etc. have also shown to be linked with the Alzheimer's disease.

Diagnosis

Early, accurate diagnosis is crucial for several reasons. It can tell people whether their symptoms are due to Alzheimer’s disease or another cause, such as stroke, tumor, Parkinson’s disease, sleep disturbances, side effects of medications, or other conditions that may be treatable and possibly reversible.

It also helps families plan for their future, make living arrangements and develop support networks. In addition, an early diagnosis can provide greater opportunities for people to get involved in clinical trials.

Although definitive diagnosis of Alzheimer's can be made only after death, yet the doctors can usually diagnose the disease with the help of:

Past medical history and current health status

Changes in the behavior and personality of the patient

Conducting cognitive tests involving memory, problem solving, language, etc

Standard medical tests such as blood and urine tests in order to rule out other causes

Brain scans including CT/MRI scans

Management

There is no cure for Alzheimer's disease; though symptomatic relief can be provided. Current treatments can be divided into Medicinal, Psychosocial and Care giving.

Medical:

Cholinesterase Inhibitors - Acetylcholine is a chemical that keeps the nerve signals charged and helps the messaging system within the brain cells. Various medications to treat Alzheimer's are:

Donepezil

Rivastigmine

Galantamine

These are used to treat mild to moderate Alzheimer's disease

NMDA Receptor blocker

Memantine can be used for moderate to severe Alzheimer's disease as well.

Psychosocial:

Psychosocial interventions are used as an adjunct to medicinal treatment and can be classified as supportive, cognitive and behavioral approaches.

Care giving:

Since patient with Alzheimer's has no cure, it gradually renders people incapable of tending for their own needs, thus care giving essentially is the treatment and must be managed carefully over the course of the disease.

Prevention

There is no definitive evidence to support that any particular measure which is effective in preventing. However, there are certain steps that could be taken which may help to delay the onset of dementia. Staying mentally healthy by:

Reading

Writing for pleasure

Playing musical instruments

Taking part in adult education courses

Playing games

Swimming

Group sports, such as bowling

Walking

And other recreational activities

Appendicitis

Introduction

Appendicitis is the swelling (inflammation) of the appendix. The appendix is a small, tube like organ attached to the large intestine. The condition is due to blockage inside the appendix. The blockage leads to increased pressure and inflammation. Appendicitis can occur at any age but it is more common during childhood and adolescence.

Symptoms

The main symptom is the pain in abdomen. It is dull initially but gets worse over time.

Other symptoms include:

• Swelling in the abdomen

• Loss of appetite

• Nausea and vomiting

• Constipation or diarrhea

• Inability to pass gas

• Low fever

Causes

The exact reason for acute appendicitis is still unclear. Although it is associated with the blockage inside the appendix. This blockage can be due to small pieces of faeces, a foreign object and many more.

Diagnosis

Diagnosis may include thorough physical examination and careful consideration of the symptoms. If the diagnosis is not clear, then laboratory tests and ultrasound or CT scans may be performed.

Management

Treatment generally include surgical removal of appendix. This procedure is known as an appendicectomy or appendectomy. The appendix is removed using laparoscopic (keyhole) surgery. In this procedure, surgeon uses a slender instrument (laparoscope), which is inserted through tiny incisions (cuts) in the abdomen. This eliminates the need for an abdominal incision.

Arthritis

Introduction

Arthritis is disease of joints (inflammation of joints). There are many types of arthritis.

Types of Arthritis are:

Osteoarthritis: It is often related to aging or to an injury.

Rheumatoid arthritis: It is the most common form of arthritis.

Juvenile rheumatoid arthritis: It is a form of the disease that occurs in children.

Infectious arthritis: It is an infection that has spread from another part of the body to the joint.

Gout: It is Inflammation of joints.

The major complaint of individual is pain in joints which is localized and is often consistent. The pain from arthritis is due to inflammation that occurs around the joint, damage to the joint from disease daily wear and tear of joint, muscle strains caused by forceful movements against stiff painful joints and fatigue.

Symptoms

The commonest symptoms involve joints. Joint pain and stiffness is common feature along with swelling of joints.

Arthritic disorders like lupus and rheumatoid can also affect other organs in the body with a variety of symptoms.

Difficulty to walk

Malaise and a feeling of tiredness

Weight loss

Poor sleep

Muscle aches and pains

Tenderness

Difficulty moving the joint

Causes

When inflammation occurs, chemicals from the body are released into the blood or affected tissues. This release of chemicals increases the blood flow to the area of injury or infection and may result in redness and warmth. Some of the chemicals cause a leak of fluid into the tissues, resulting in swelling. This process may stimulate nerves and cause pain.

Diagnosis

Physical Examination: Physician will check for limited range of motion in the joint, the feeling of fluid around joints, or warm or red joints.

Blood test: This is generally done for rheumatoid arthritis.

Rheumatoid factor (RF): It is checked for rheumatoid arthritis. However, RF can also be found in people without RA or with other autoimmune disorders. In general, if no rheumatoid factor is present in someone with RA, the course of the disease is less severe.

Levels of ESR (erythrocyte sedimentation rate) and C-reactive protein (CRP) levels: These are also increased. Both CRP and ESR levels are used to check disease activity and also to monitor how well someone is responding to treatment.

Imaging scans: Like X-ray, CT scans and MRI are commonly used to get the image of bones and cartilage so that doctor can better determine if it is arthritis or not.

Management

Physical exercise: During pain exercise seems to be the last option but muscle strengthening and stretching exercises have proved to be very helpful.

To relieve pain: Pain relievers like NSAIDs (non-steroidal anti inflammatory drugs). NSAIDs generally interfere with chemicals called prostaglandins in the body, which trigger pain, inflammation, and fever. They are very helpful in relieving pain in all forms of arthritis.

Surgery: Joint replacement surgery is often performed for those who are not able to walk or has lots of difficulty in walking.

Disease-modifying anti rheumatic drugs (DMARDs): Often used to treat rheumatoid arthritis, DMARDs slow or stop immune system that attack joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil).

Intra-articular injection: It is a procedure used in the treatment of inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendinitis, bursitis and occasionally osteoarthritis. A hypodermic needle is injected into the affected joint where it delivers a dose of any one of many anti-inflammatory agents, the most common of which are corticosteroids.

Asthma

Introduction

Asthma is a chronic disease characterized by recurrent attacks of breathlessness and wheezing. During an asthma attack, the lining of the bronchial tubes (airways) swells, causing the airways to narrow, turn more sensitive to irritants in the environment, and thus reducing the flow of air into and out of the lungs. The causes of asthma are not completely understood.

However, risk factors for developing asthma include inhaling asthma “triggers”, such as allergens (some common to all and some individualized), tobacco smoke and chemical irritants. Several patients with asthma may also have allergic rhinitis which is characterized by sneezing and “runny” nose. It can start at any age. About half of all people with asthma tend to have their first symptoms by the age of ten years, and many children with asthma have had their first asthma attack before the age of six. Asthma cannot be cured, but appropriate management can control the disorder and enable people to enjoy a good quality of life.

Symptoms

Asthma symptoms can vary in severity with time, can come and go, there may be good and bad periods. Asthma is characterized by:

Recurrent episodes of wheezing

Shortness of breath

Chest tightness

Coughing-sometimes cough may be the only symptom of asthma

Sputum may be produced from the lung due to coughing, small in volume and often in the form of threads and plugs. Symptoms are generally worse at night and in the early morning or in response to allergens.

When uncontrolled, there may be acute asthma attacks often occurring after viral infections (flu, cold), allergen/irritant exposure (pets, pollen, dust, atmospheric pollution, tobacco smoke), exercise, weather changes, medications (aspirin). Danger signs of an acute asthma attack are symptoms not improving after airway-opener inhaler medication, and difficulty in talking due to breathlessness, peak flow-meter readings ranging below 50% of normal value, and require urgent medical attention.

A number of other health conditions are found associated with asthma including:

Gastro-esophageal reflux disease (GERD)

Rhinosinusitis

Obstructive sleep apnea

Causes

The exact cause of asthma is yet not known. But there are certain risk factors that are associated with asthma. It is probably caused by interplay of hereditary and environmental factors.

Some of the factors include:

An inherited tendency to develop allergies, called atopy (AT-o-pe). Children with eczema or food allergy are more likely than other children to develop asthma.

Parents who have asthma (heredity).

Allergens from dust, animal fur, cockroaches, mold, and pollens from trees, grasses, and flowers etc.

Irritants such as cigarette smoke, air pollution, chemicals or dust in the workplace and sprays (such as hair spray).

Medicines such as aspirin or other non steroidal anti-inflammatory drugs and nonselective beta-blockers.

Sulfites in foods and drinks

Viral upper respiratory infections, such as colds

Physical activity, including exercise

Contact with some airborne allergens or exposure to some viral infections in infancy or in early childhood when the immune system is developing.

Diagnosis

Medical History: Doctor may also ask:

About one's medical history, including information about allergies, asthma, or other medical conditions.

If one had heartburn or a sour taste in the mouth. These may be signs of gastro esophageal reflux disease (GERD).

If one had cold or an episode of flu-like symptoms.

If one smokes or spends time around others who smoke.

Physical Examination & Investigations: To check for signs of problems related to cough; your doctor will use a stethoscope to listen to your lungs. He or she will listen for wheezing (a whistling or squeaky sound when you breathe) or other abnormal sounds. Other tests may include:

Chest x ray takes a picture of heart and lungs. This test can help diagnose conditions such as pneumonia and lung cancer.

Lung function tests: These are detailed tests that can measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. Lung function tests can help diagnose asthma and other conditions.

Peak-flow-meter is a simple hand-held instrument that can be used by you to measure one aspect of lung function and monitor your asthma control. It helps in deciding if someone has asthma, determine how bad an asthma attack as well as assess the degree of asthma control. Your doctor can guide you in its use at home, so that you can be cautious about how to increase asthma medication and when seek urgent medical help.

An X- ray of the sinuses: This test can help diagnose a sinus infection.

butamol and terbutaline. They are utilized in stopping asthma attacks.

“Controller medication” (Preventer) inhaler: It works to reduce the amount of inflammation and ‘twitchiness’ in the airways and prevent asthma attacks occurring. Examples of preventer inhalers are beclomethasone, budesonide, fluticasone and mometasone; often combination of these drugs with long-acting bronchodilators like salmeterol and formoterol are used as preventers to stop asthma attacks from starting and thus protect lung function.

Short courses of corticosteroid and other drugs (oral or injectable) may be required during acute attacks and are to be used after medical advice only.

An asthma patient should learn from the care-provider the correct method of using the inhalation devices (metered-dose inhalers, dry-powder inhalers, spacers, etc) used for the medication and always carry the quick-reliever medication with him/her.

Management

Medications: Medicines in asthma is generally given through the inhaled route. “Metered dose” and “dry powder” inhalers are equally effective for long term use, the “nebulized” form being generally used during acute attacks. Inhaling a drug is an effective way of taking an asthma medicine as it goes straight to the lungs, with very little ending up elsewhere in the body. There are two types of inhaled medications. Since asthma is an inflammatory disease, preventer medication should not be discontinued without medical advice.

“Airway-opening medication or Quick-Relief” (Reliever) inhaler: The inhaler usually contains a short-acting beta 2-agonist. It works by relaxing the muscles surrounding the narrowed airways. Examples of reliever medicines include salbutamol, levo-salbutamol and terbutaline. They are utilized in stopping asthma attacks.

“Controller medication” (Preventer) inhaler: It works to reduce the amount of inflammation and ‘twitchiness’ in the airways and prevent asthma attacks occurring. Examples of preventer inhalers are beclomethasone, budesonide, fluticasone and mometasone; often combination of these drugs with long-acting bronchodilators like salmeterol and formoterol are used as preventers to stop asthma attacks from starting and thus protect lung function.

Short courses of corticosteroid and other drugs (oral or injectable) may be required during acute attacks and are to be used after medical advice only.

An asthma patient should learn from the care-provider the correct method of using the inhalation devices (metered-dose inhalers, dry-powder inhalers, spacers, etc) used for the medication and always carry the quick-reliever medication with him/her.

Complications

Symptoms that interfere with sleep, work or recreational activities

Permanent narrowing of the bronchial tubes (airway remodelling) that affects how well you can breathe

Sick days from work or school during asthma flare-ups

Side effects from long-term use of some medications used to stabilize severe asthma

ACHIEVING CONTROL OVER ASTHMA

Although not curable, good control of asthma can be easily achieved. When under control, the asthma patient can lead a perfectly normal life, work, attend classes, take part in sports, avoid most asthma attacks and sleep well. In order to achieve asthma control the asthma medication has to be taken as advised by the physician and one should also avoid things that trigger asthma attacks which may include animals with fur, cigarette smoke, smoke, dust from sweeping, dust in beds and pillows, strong smells, pollen, inclement weather, and colds. One should also well acquaint with symptoms and signs of worsening of asthma control and know how to respond to it.

Preventer medicines (inhaled form) can, if so advised, be taken regularly on long term basis and are not habit forming. It may be necessary to take the preventive medicine every day if one coughs and wheezes or has a tight chest more than twice a week, wakes up at night due to asthma attacks, or has to use the reliever medication more often than twice a week to stop an asthma attack. A carefully decided self-monitoring of symptoms as well as an asthma treatment plan should be designed for every patient by the care provider and discussed in detail.

Special populations like pregnancy, obesity and elderly subjects need special attention for control of asthma.

Common myths about asthma

You need to take asthma medication only during an asthma attack: Patients with persistent asthma (mild, moderate or severe) need to use the preventer (controller) medication on a long term basis to prevent such attacks in future.

A child with asthma will outgrow the disease: The disease would probably become milder and less symptomatic. Although asthma is a chronic condition, there are excellent means to control this disorder.

Patients with asthma should not take part in physical exercise: Exercise is good for asthma patients just as well as those without it. Proper medical advice is essential before undertaking such activities.

Asthma cure can be achieved with transfer of residence to a “better” climate: Proper use of medication and usual precautions at home and workplace is most important for achieving asthma control.

“Inhalers” are the last resort for control of asthma: Asthma medication is ideally administered by the inhaled route so as to ensure prompt and targeted drug delivery with least side effects. It is true for even the mildest form of the disease.

“Inhalers” are addictive or habit forming: These are not habit forming medicines at all. However, asthma being a chronic disease, they may be required to be administered on a long term basis under proper medical guidance.

Steroids used in asthma are dangerous drugs: The benefits of inhaled corticosteroids that are used in asthma are far more than the risks involved. This is true even in growing children. The use of asthma medication should be under medical guidance.

Asthma is a psychological disease: Asthma is NOT a psychological disease although emotional factors can trigger an asthma attack.

Asthma is contagious disease: This is not true.

Asthma patients should avoid “cold” food like milk, curd etc.: There are no food restrictions in asthma. However in case there is an identifiable food item that has been known to trigger asthma attack in a particular patient, this item must be avoided.

Regular use of asthma medicines make them ineffective: This is incorrect. Some medicines are effective only if used regularly. Use of any asthma medication should be under medical guidance.

In children nebulizers are the ideal method of administering asthma medication: Metered dose inhaler with spacer and mask device are equally effective in drug delivery in small children.

Anaemia

Introduction

The condition of having a lower-than-normal number of red blood cells or quantity of hemoglobin.

Normal results vary, but in general are:

Male: 13.8 to 17.2 gm/dL

Female: 12.1 to 15.1 gm/dL

(Note: gm/dL = grams per deciliter)

Anaemia has three main causes: blood loss, lack of red blood cell production, and high rates of red blood cell destruction.

Conditions that may lead to anaemia include

Heavy periods

Pregnancy

Ulcers

Colon polyps or colon cancer

Inherited disorders

A diet that does not have enough iron, folic acid or vitamin B12

Blood disorders such as sickle cell anaemia and thalassemia, or cancer

Aplastic anaemia, a condition that can be inherited or acquired

Anaemia can make you feel tired, cold, dizzy, and irritable. You may be short of breath or have a headache.

Symptoms

The most common symptom of anaemia is fatigue or weakness.

Other signs and symptoms of anaemia include:

Shortness of breath

Dizziness

Headache

Coldness in the hands and feet

Pale skin

Chest pain

Causes

Three main cause of anaemia are:

1) Blood loss

2) Lack of red cell production

3) High rates of red blood cell destruction

1) Blood loss: Blood loss is the most common cause of anaemia, especially in iron-deficiency anaemia. Blood loss can be short term or long term depending upon the conditions.

Bleeding in the digestive or urinary tract can cause blood loss. Surgery, trauma, or cancer also can cause blood loss. Heavy blood loss due to menstruation.

If a lot of blood is lost, the body may lose enough red blood cells to cause anaemia.

2) Lack of Red Blood cell production:

It can be due to "acquired" or "Inherited".

["Acquired" means that the person is not born with the condition, but may develop it at later stages.

"Inherited" means that the condition has been passed by the parents.]

Acquired conditions and factors that can lead to anaemia include:

Poor diet

Unusual hormonal levels

Chronic diseases

Pregnancy

Aplastic anaemia can also prevent body from making enough red blood cells. This condition can be both acquired or inherited.

3) High rates of RBCs destruction:

Factors that can cause destruction of red blood cells.

One condition can be an enlarged or diseased spleen.This is an acquired condition.

Inherited conditions are the one when body destroy too many red blood cells. It can be in sickle cell anaemia, thalassemias, and lack of certain enzymes. These conditions create defects in the red blood cells that cause them to die faster than healthy red blood cells.

Hemolytic anaemia is another example of a condition in which body destroys its red blood cells. Both inherited or acquired conditions or other factors can cause hemolytic anaemia. Examples include immune disorders, infections, certain medicines, or reactions to blood transfusions.

Diagnosis

Medical History:

Signs and symptoms like weakness, malaise or body aches

Blood tests:

To check for the levels of hemoglobin (it is a protein that transports oxygen)

Red blood cells (cells that contain hemoglobin)is lower than normal.

Physical examination:

Rapid or irregular heartbeat

Rapid or irregular breathing

Enlarged liver or spleen

Complete blood count (CBC): A CBC is generally done to know the number of blood cells in the blood. To check anaemia, physician will see the levels of the red blood cells contained in the blood (hematocrit) and the hemoglobin in blood. Normal adult hematocrit values vary from one medical practice to another but are generally between 38.8 and 50 percent for men and 34.9 and 44.5 percent for women.

A test to determine the size and shape of your red blood cellsSome of red blood cells may also be examined for unusual size, shape and color. This will help in diagnosis. For example, in iron deficiency anaemia, red blood cells are smaller and paler in color than normal. In vitamin deficiency anaemia's, red blood cells are enlarged and fewer in number.

Management

Iron supplements: The most commonly prescribed supplement is ferrous sulphate, taken orally (by mouth) two or three times a day.

Dietary supplements: Iron-rich foods include:

Dark-green leafy vegetables, such as spinach

Iron-fortified cereals

Whole grains, such as brown rice

Beans

Nuts

Meat

Apricots

Complications

Iron deficiency anaemia rarely causes any serious or long-term complications. However, some of the complications are listed below:

Tiredness

Iron deficiency anaemia can leave a person tired and lethargic (lacking in energy), as a result person may be less productive and active at work.

Immune system

Iron deficiency anaemia can affect immune system (the body’s natural defence system), making a person more susceptible to illness and infection.

Heart and lung complications

Adults with severe anaemia may be at risk of developing complications that affect their heart or lungs. For example,

• Tachycardia (an abnormally fast heartbeat)

• Heart failure, when your heart is not pumping blood around your body very efficiently

Pregnancy

Pregnant women with severe anaemia have an increased risk of developing complications, particularly during and after the birth. They may also develop postnatal depression (a type of depression some women experience after having a baby).

Anxiety

Introduction

Anxiety is an unpleasant emotional state of uneasiness and distress. It is generally characterized by apprehension and worry. An anxiety disorder can have a devastating effect on the person. Most of the people go through this disease and end up in a depression.

Some of the warning signals are:

Intense fear or apprehension

Restlessness

Easily tired

Disturbance sleep

Weight and appetite disturbances

Symptoms

Some of the symptoms include:

Fatigue

Dry Mouth

Abdominal cramps

Sleep disturbances and headaches

Muscle tension and muscle aches

Difficulty swallowing

Trembling and feeling irritable

Twitching

Sweating and hot flashes

Causes

The exact reason for the anxiety is still not known.

Some of the researchers suggest that anxiety disorder is due to an imbalance of certain chemical that is present in the brain, these chemicals are known as neurotransmitter.

Other causes of Anxiety disorder are:

Many people have anxiety, when there is change in their life like: Starting new job, getting married, Having a child, breaking up with the someone.

Some medications can also cause anxiety. These medications include inhaler medicines to treat asthma, thyroid drugs, diet pills.

Caffeine, alcohol and tobacco products may also cause anxiety.

Diagnosis

It can be diagnosed by the signs and symptoms. Psychiatric evaluation helps in diagnosing the disease.

Management

Anxiety can be treated with psychiatric therapy, medication, or both.

Psychiatric therapy: This type of therapy is called cognitive behavior therapy is mainly useful for treating anxiety. It helps a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious and worried.

Medication: Some time doctors may prescribe medication to help treat anxiety. Two types of medications like anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.

Antidepressants are used to treat depression, but they also are helpful for anxiety. They may take several weeks to start working. These medications may cause side effects such as headache, nausea, or difficulty sleeping.

It's important to know that although antidepressants can be safe and effective for many people, but it may be risky for some, especially children, teens, and young adults. Thus it should be taken after doctor's prescription.

Prevention

In today's lives, everybody is stressed. A person can indulge in activities like Yoga, meditation, games and music to avoid stress.

Also, one should try to develop some hobby to occupy in free time

Autism

Introduction

Autism spectrum disorder (ASD) is a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped pattern of behavior. It is a brain disorder that typically affects a person's ability to communicate with others. ASD form of disease generally begins in childhood and last through adulthood.

Types of ASDs are:

Autistic Disorder (also called "classic" autism): This is what most general form of autism. People with autistic disorder typically have significant language interruption, social and communication challenges, and unusual behaviors and interests. Many people with this disorder may also have intellectual disability.

Asperger Syndrome: People with Asperger syndrome, have mild symptoms of autistic disorder. They might have social challenges and unusual behaviors and interests. However, they typically do not have problems with language or intellectual disability.

Pervasive Developmental Disorder(PDD): It is called as "atypical autism". People who meet some of the criteria for autistic disorder or Asperger syndrome, but not all, may be diagnosed with PDD-NOS. People with PDD usually have fewer and milder symptoms than those with autistic disorder. The symptoms might cause only social and communication challenges.

Symptoms

ASDs generally begin at or before the age of 3 and last throughout a person's life, even though symptoms may improve over time. Most of the children with an ASD may exhibit hints of future problems within the first few months of life. While others, show symptoms until 24 months or later. Some children with an ASD seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had.

A child with an ASD might:

Does not react to his/her name by 12 months

Does not play by 18 months

They generally avoid eye contact and stay alone

These children also have difficulty in understanding other people's feelings or talking about their own feelings

These children may show delayed speech and language skills

Repeat words or phrases over and over (echolalia)

Give unrelated answers to questions

Does not like even minor changes

Have obsessive interests

Some time they flap their hands, rock their body, or spin in circles

Have unusual reactions to the way things sound, smell, taste, look, or feel

Causes

The exact reason for the causes of ASD is not known, but it’s likely to be associated to genetics and environment factors. Number of genes have been identified that are associated with this disorder.

Studies of patients with ASD have also found irregularities in several regions of the brain.

Other studies suggest that people with ASD have abnormal levels of serotonin or other neurotransmitters in the brain.

All these abnormalities suggest that ASD could result from the disturbance of normal brain development early in fetal development caused by defects in genes that control brain growth and that regulate how brain cells communicate with each other, possibly due to the influence of environmental factors on gene function.

Diagnosis

Diagnosis of ASDs can be difficult as there is no medical test, like a blood test, to diagnose the disorders. Physician may look at the child’s behavior and development to make a diagnosis.

However, the children might receive an audiologic evaluation and a screening test for autism such as Checklist for autism in toddlers.

Management

There is no cure for the disease. However, it can be managed with the help of medications and specialist education.

Early intervention services can help in child's improvement. These services include that help child talk, walk and interact with others.

Therefore, it is important to talk to child's doctor as soon as possible.

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