Bleeding During Catheterization of Male Urethra I was called at 10.30 PM to attend a case of bleeding from urethra following urethral catheterization in a semiconscious male, admitted to the medicine ward. I went and saw a healthy male in sixties bleeding from urethra. The foley's catheter, a narrow silicon tube used for draining the retained urine was […]
A Common Blood Pressure Lowering Drug Verapamil may Slow Or Reverse Diabetes A common medication for high-blood-pressure and angina, verapamil, a calcium channel blocker has been seen to protect or reverse diabetes-related death of pancreatic beta cells, those responsible for secretion of insulin; according to a University of Alabama at Birmingham study publ […]
Initial Study Links White Rice Consumption to Type II Diabetes Mellitus In a recent study in Asian countries , a possible association between white rice consumption and diabetes has been suspected. The researchers suspect that white rice contributes to diabetes risk because of its high glycemic index (64) when compared with brown rice (55), whole wheat (41), […]
Bleeding During Catheterization of Male Urethra I was called at 10.30 PM to attend a case of bleeding from urethra following urethral catheterization in a semiconscious male, admitted to the medicine ward. I went and saw a healthy male in sixties bleeding from urethra. The foley's catheter, a narrow silicon tube used for draining the retained urine was […]
A Common Blood Pressure Lowering Drug Verapamil may Slow Or Reverse Diabetes A common medication for high-blood-pressure and angina, verapamil, a calcium channel blocker has been seen to protect or reverse diabetes-related death of pancreatic beta cells, those responsible for secretion of insulin; according to a University of Alabama at Birmingham study publ […]
A common medication for high-blood-pressure and angina, verapamil, a calcium channel blocker has been seen to protect or reverse diabetes-related death of pancreatic beta cells, those responsible for... [[ This is a content summary only. Visit my website for full links, other content, and more! ]] […]
Some years back, one of my friends asked me that a person known to him is having pain in the left arm while walking, compelling him to take a break; and gets back the pain sometimes after resuming his walk. I suggested an electrocardiogram (ECG), and as expected by me a coronary artery disease was diagnosed. This symptom is somewhat a tale tell story of angina pain of heart. In my childhood, I have seen dancing of some superficial arteries of old aged persons and surprised over it; now, I am clear about its cause i.e. it is due to thickening of wall of peripheral arteries from atherosclerosis. In atherosclerosis; there occurs deposit of cholesterol, calcium, some blood cells and some other components in the inner layer of blood vessels called intima. This is equally seen larger as well as smaller blood vessels in the body. Smoking is an important cause of atherosclerosis.
Recently, researchers have found out the role of immune cells in the formation of atheroma after triggering an inflammation in the intima of blood vessels. Drugs targeting these cells also cause harm to useful effects of these cells. So, now they are targeting research, how to destroy the bad effect of cells leaving ahead the good effects. They also found out one molecule that switches on the harmful effect of these immune cells. The new research will be focusing more on blocking the action of the molecule.
Pot bellied persons due excess abdominal fat; the apples are prone to develop atherosclerosis than the pears; persons having fat deposit around hip, researchers say. Smoking, alcohol, sedentary life style and more saturated fat consumption are some of the contributing factors for atherosclerosis. Measurements of waist circumference (WC), waist to hip ratio (WHR) and Body mass index (BMI) are some of predictors of risk of heart attack. Waist circumference >32 inches in female and >37 inches in male have the risk of heart attack. Persons having WHR > 0.7 and BMI >30 are at the risk of developing atherosclerosis.
Pain in middle of upper abdomen in a commonly encountered complain from patients in any hospital.There are vast nuber of causes for it.Many of them are for academic interest.Among the most commonly encountered conditions Acid Peptic disease is one.
Here there is pain in the middle of upper abdomen .This pain may come in empty stomach or after taking food.It is typically colicky in nature,sometimes subsides after taking food or aggravated after taking food.It my appear seasonally in the winter.Gradually this timing of pain changes and pain is always felt. There may appear vomiting which may contain freshly eaten food to stale food, blood and bile.Some times there occurs blood vomiting and passing of black stool.Some times patient may present in the emergency with a complication called perforation of stomach or duodenum.
This disease may be seen in the stomach,duodenum,Lower esophagus or in a mackel’s diverticulum.The symptoms and signs may differ according to the site of disease. To-day we will see the disease of stomach and duodenum.
Endoscopy Image of Stomach Ulcer
Hydrochloric acid secretion is an integral part of stomach inner layer called gastric mucosa.There in also secretion of protein digesting enzyme called pepsinogen.The digestion of own gastric mucosa hangs on a fine balance between the secretions and mucosal defense. Mucosal defense rests on the amount of bicarbonate and mucus present in the stomach.There are various means to dis-balance it.It my be stress and strain,Ingestion of analgesics and steroid,Severe trauma lading to blood loss and infection by a microbe called H.Pylori. There may occur inflammation to ulcerations in mucosa and may progress to other layers of stomach and duodenum.
The disease can very nicely be diagnosed by an endoscopy.This can be treated by newer proton pump inhibitor drugs.This drug has left the surgical option for this disease limited to the complications only.If drug treatment fails nice surgical options are available.
One patient came to me in great distress with hiccup,pain in the abdomen and inability to stand. Apart from this ,patients present to a doctor with complains of vomiting of stale food some hours or days of taking food.There is loss of appetite ,weakness,malnutrition,hiccup and desire to induce vomiting to get relief from pain.
These are the cardinal symptoms of obstruction to passage of food from stomach called Pyloric obstruction/Duodenal stenosis.Causes are varied.Important common cause are development of stenosis after a benign duodenal or pyloric ulcer,a cancer obstructing the passage from stomach and a foreign body such as leaves or hair ball(eaten) seen in psychotics.After invent of stomach acid suppressing drugs these cases are seldom seen.But the patient in question was a road side vendor with irregular and bad eating habit.The patient said that he is in empty stomach .So to find out the cause in hope of some interesting findings the endoscope was put. Read the rest of this entry »
My friend in PeerPower.com has sent this message to me requesting for wide circulation.I would like to add a few things a few here.As regards the mask and precautions he is right.But using a mask is better to no use.What I called something is better than nothing.Moreover it will obstruct other secondary bacterial invasion to cause a pneumonia in the already immune compromised patient.It may be helpful to the patient if not to the contacts.Tamiflu is a virostatic drug which will prevent rapid proliferation.I can conclude that confining the less sever cases to home with usual precautions is a good strategy.And sever cases be treated at hospital.
Message:
Dear All
A very logical and constructive solution to prevent you from getting infected with H1N1..Plz share it to all friends and relatives.
The hype in media about the utility of face masks and N95 respirators as a tool for general protection against H1N1 can’t be deplored enough. Please realize that this is not an official advice, especially the one about face masks or N95.
·Most N95 respirators are designed to filter 95% particulates of 0.3µ, while the size of H1N1 virus is about 0.1µ. Hence, dependence on N95 to protect against H1N1 is like protecting against rain with an umbrella made of mosquito net.
·Tamiflu does not kill but prevents H1N1 from further proliferation till the virus limits itself in about 1-2 weeks (its natural cycle).
about 1-2 weeks (its natural cycle).
H1N1, like other Influenza Aviruses, only infects the upper respiratory tract and proliferates (only) there. The only portals of entry are the nostrils and mouth/ throat. In a global epidemic of this nature, it’s almost impossible not coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.
While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps – can be practiced:
1. Frequent hand-washing (well highlighted in all official communications)..
2. “Hands-off-the-face” approach. Resist all temptations to touch any part of face (unless you want to eat, bathe or slap).
3. Gargle twice a day with warm salt water (use Listerine if you don’t trust salt). H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms.
Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don’t underestimate this simple, inexpensive and powerful preventative method.
4. Similar to 3 above, clean your nostrils at least once every day with warm salt water. Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.
5. Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.
6. Drink as much of warm liquids as you can. Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.
Happy breathing!
Some times some people do not avail a chance and let that go. A folk tale in Orissa,India describes how people ignore the opportunities.Once “Lord Shiva and His wife Goddess Parbati“were in the sky to observe the people of earth.They saw a poor man in skeletons begging for food but was not getting anything.Parbati became felt pity for him and asked Shiva to see this and also asked why people created by them should suffer like this.God replied to it with a smile that some do not like a grab an opportunity and are lazy ,consequently suffer.And He wanted to show that to Goddess Parbati then and there.The god put a pot full of gold coins on the road of the beggar .But the beggar at that moment wanted to mimick a blind man and walked closing his eyes.He gave a kick to the pot and walked past to open his eyes later .Consequently he missed the gold filled pot.Then the god asked his wife to interpret it and they went on the voyage.
Something of the sort happened to-day in our hospital.A person injuring his Achilles tendon came to me.Since ours is a private hospital only for port trust employees ,other people have to pay for the service with a token price only.I inspected the injury and asked him to deposit the required fees to get the tendon repaired .But the person expressed his inability to pay.I suggested him if he does not have the money he can pay it later also.He was not willing for that also.But on humanitarian ground I offered him to repaired it free of cost using material we get as physician’s sample but he has to get admitted to the hospital for some time.And to my utter surprise he declined for that and went away. Instantly my staffs reminded me of the story I just narrated.
The thick tendon through which the calf muscles get anchored to the heel bone is called Achilles tendon named after the Greek mythological hero Achilles.This is a tough tendon in the body.This tedon lifts the body weight off the ground while walking.
This tendon gets severed mainly by accidents,assault or in collagen diseases.When partially torn the person can walk limping and disability is more severe if completely torn.The person can not stand on toes of the affected foot.And if completely severed a distinct gap can be felt over an intact skin or the end can be seen if skin is cut.The upper end of severed tendon usually is dragged by the calf muscles to an upper level and may not be seen.Tendon repair is a special procedure and done under aseptic conditions .It can be performed under local.regional or general anaesthesia.The repair is done using a non-absorbable suture material.After repair a plaster of paris cast is given to immobilise the foot for 6 weeks.After that period a gentle physiotherapy makes the patient fit for duty.The results are good.
This is a very nasty disease to me.Somehow I am not comfortable to treat this one.Patient comes with a painful swelling near to anus,fever and prostration .On examination a painful swelling will be found near the anal opening.Once drained a large amount of foul swelling pus will come out and relief the patient to a considerable extent. And this cycle goes on unless the patient is not throughly investigated for possibility of Fistula-In-Ano. It is a condition where there is build up of a tunnelled connection ,of course small in caliber between interior of lower gut and the exterior i.e. skin.This occurs from an infection of anal glands located inside the anus and rectum and gradually enlarge to burst to the out side.With passing of time the inside of the fistula or tunnel matures and continuously discharges pus.That is why I call a nasty disease. Fistula may also manifestation of some diseases like TB,Ulcerative Colitis,Chron’s Disease ,A rectal cancer and some other diseases.These are of various types and classified in various manner. Most accepted being superficiel,deep,intershincteric,transphencteric and high etc.which is required for the treating doctors.Treatment of more complex fistulas are not very much satisfactioy.A fistulogram gives good idea of it’s extension to help in operation.Besides trans rectal ultrasonogram is helpful.Tuberculosis if suspected should be searched for the primary site of infection .A simple per rectal examination is helpful to supect a cancer inside. Surgery is the option for most of fistulas except TB and some other diseases.Here the whole tract is excised leaving a raw area to heal from the depth. And if dressing done properly and wound heals fromthe depth probably the surgeon should be able to sleep cmfortably.The excised specimen is to be subjected to histopathological study to exclude associated cancer and TB in the tract.And in that case furhter treatment for the specific disease to be taken up.
Most common complication of surgery is inardverent injury to the anal sphincture making the patient incompetent to hold faecal matter.And the next is recurrance. So this surgey many times brings down the ranking of the surgeon’s popualrity.People taking non-veg diet and suffering fron constipation are prone for this disease.
Poor, most of the time bear the brunt of disease aggression.One of the serious complications of appendicitis is appendicular lump.After an acute attack if not treated adequately (without Surgery) body tries to contain the infection.In the process the near by intestine and omentum try to isolate the infected appendix by surrounding it from all the sides and in the process a mass or lump is formed in side the abdomen to be felt from lower abdomen.This may in turn progress to abscess (collection of pus) formation,perforation of apendix and even infection of blood called septicemia.
Infected appendix
These patients are usually treated conservatively as surgery at this stage is riskier. But still if the lump progresses the conservstive treatment is abandoned in favor of intervention (Surgery).Again here it may not be possible for the surgeon to treat for cure of disease .He has to amelorate the potentially grave situation and defer a definitive surgery to a later date.
All these carry risk for the patient.And in this part of India there are poor people who do not have any other option rather than to accept the situation.They come late because of various reasons.One important aspect being their financial status.Initially they they expect this pain in abdomen may not be severe and go away automatically,better to wait rather than to go to a doctor and spend money which is a wastage .That amount can be used to feed themselves.But in the long run when it aggravates they even sell all their property to get treated. Treatment facilities in terms of man power and infrastructure is lacking in this part .Added to it is the high pricing of drugs and indifferent attitude of Govt. service providing agencies compels the poor to sit at home expecting auto cure , go to quack or indulge in folk remedies.
This grim situation should improve to claim that India is a welfare state.
Red blood cells(RBC) in blood are responsible for carrying oxygen to the cells and bring out carbon-dioxide from there.The protein iron complex in it called haemoglobin is the carrier of oxygen and carbon-dioxide. Normal hemoglobin is termed as HbA. But many abnormalities do occur. One is HbS ( Sickle haemoglobin) derived the name from sickle as it transforms the RBC in a oxygen deprived condition . It is hereditary and mostly circulates in a closed area and consanguineous marriage spreads it in a local population.Western Orissa is the storehouse of this disease.
RBC is a microscopic cell of discoid shape and is biconcave.This means if a RBC will be likened to a coin the sides of coin should cave in to resemble a RBC. This shape facilitates it to deform while passing through a narrow road inside the smallest calibered blood vessel called capillary.This quality lacks in a RBC containing HbS. It may sometimes occurs in conjunction with other abnormal type of Hb such as HbF which is the cause of Thalassaemia. So what happens when these RBCs negotiate through a capillary and delivered
Sickle cell RBC
oxygen to cause a oxygen deprived environment where these get deformed to a sickle shape and become rigid to conglomerate with each other blocking the blood flow causing more oxygen deprived environment to form more sickles and the cascading effect.The blocked site hampers blood flow causing death of cells beyond the segment.So commonly this effect is seen in spleen,bone marrow,lungs,kidneys and liver etc. This causes various symptoms such as pain arising from the organ,blood in urine,anemia and infection of bone and lungs etc. This can be screened by sickling test in a oxygen deprived environment and conformed by electrophoresis of haemoglobin. Treatment is not very satisfactory. It can be prevented by marriage counseling and diagnosis of condition in utero where the parents may like to discontinue the pregnancy. Folate deficiency precipitates this condition as well as acidosis . So folate supplementation and avoiding oxygen deprived situation are two important steps. Prevention of infection by different vaccinations against infectious diseases and prophylaxis for malaria will enable the patient to lead a near normal life.
Glutamic acid is changed to valine in the position 6 in B chain in the protein in HbS.
Marriage counseling should be based on blood matching tests and not merely basing on horoscopes.
Burn is a dangerous condition and a pathetic looking disease.The victim always feels shrunk.A lot of complications follow a moderate to severe burn.In hospitalized patient nosocomialinfection plays a major deteriorating factor .Isolation and careful choosing of antibiotics and a good dressing will help to a great extent if not full to control infection.Pain has to be addressed.Good nutrition with protein supplementation is important for recovery. The main long term effects are scar formation,disfigurement,scar retraction and deformity,keloid formation,recurrent infection of keloid and a cancer called marjolin’s ulcer.To minimize the scar formation skin grafting and if not available, in a major burn synthetic skin substitutes will play a good role.Now-a-days cultured skin cells are being developed but not available everywhere for use.Still, to minimize scar formation different stockings( compression bandages) are in use. Once scar is formed it comes with it’s inherent problems of retraction causing disfigurements of different types as imaginable to imagine depending on the site.Scars may hypertrophy and lead to ugly keloid formation.Keloids are unorganized growth of scar tissue and encroach on to the healthy surrounding tissue.Again that is difficult to treat.The treatment range from application of silicon gel to local injection of steroids.but nothing is satisfactory. Contractures due to scar tissue may limit the movement if located near a joint and has to be released and skin grafted. The most dreaded long term complication is a cancer on the scar tissue called Marjolin’s ulcer and fortunately it is a little bit easier to treat. So some precautions at some dangerous places may prevent these cascading effect of burn.
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Burn is a dangerous condition and a pathetic looking disease.The victim always feels shrunk.A lot of complications follow a moderate to severe burn.In hospitalized patient 
Dr.Prahallad Panda