All About Positive Health

Bed sore are pressure point ulcers develop in the bed ridden patients. Many patients unable to move and even change the sides become the victim of pressure sores. Unconscious, paralytic, old ages, fracture of hip or neurological deficit patients remaining bed ridden are prone to it. These bed sores refuse to heal and go worse from day to day. Best way is to prevent it than to treat it.
Some points are to be kept in mind while managing bed ridden patients;

• Bed should be soft and without any folds.
• A water bed is always better if can be affordable.
• Bed sheets should not be of rough type and there should not be any creases.
• Change of sides of patient at frequent intervals.
• The bed should not be soiled with water, urine or feces
• The patients should be cleaned daily and body sprayed with talc powder. Surgical spirit can be applied all over body; especially over the pressure points like; hip, gluteal region, shoulder blades, heels and back etc. two to three times a week.

All of the above will prevent development of bed sore.
But if develops, all of the above steps must be followed rigorously. A dressing is to be applied over the wound after cleaning with a mild antiseptic lotion. Diabetic status is to be checked and if present will be controlled. Oral protein supplementation should be continued if otherwise not contraindicated e.g. patients suffering from hepatic coma; but can be given through intravenous route. A short course of antibiotic coverage keeping an eye on anaerobic bacteria coverage is to be given; but a culture and sensitivity test to choose an antibiotic is better than empirical choice. Vitamin B can be given to assist in healing. Sometimes blood and blood fractions may be required if there is anemia.
The gold standard is “Prevention is better than cure”.

Saying no is a difficult affair for some and they suffer for it. People say yes, even to illegal works in order to be popular; sometimes to keep friendship and sometimes with hope of getting illegal gratification. These are the people with vested interest and they thrive well in their illegial sphere and go on expanding the network. But, sometimes may be cought red handed. Good people do say yes under some compulsion and keep grumbling, being unable to avoid it all together. And, these people atfer induldging in the activity,when refuse to oblige later on due to some or other cause, breed enimity to the severest extent. So, it is better to learn to say a big “No” when somebody does not approve the “Yes” from the inner corner of the heart. It may be unpleasant for time being, but there is no future problem associated with it. Again he will not be approached to gratify the illegal request. That keeps stress and strain out from the person. But, it requires a lot of courage to say “NO”. It is rather difficult but not impossible an act.

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.

Rice is the staple diet of more than 50% of population of world. In India, most of the people depend on rice as food. India is one of the most important countries in production of varieties of paddy. It is a good source of carbohydrate and contains about 8-9% of good quality protein. It also contain some B vitamins.

Rice is extracted from paddy after milling. Too much milling or polishing removes most of nutritional value. Washing with a lot of water; cooking in more than required amount of water and draining the water removes much of vitamins from it. Thiamine is a important B vitamin, it contains. In it’s deficiency, people suffer from beriberi. Beriberi is marked by soreness in tongue, anemia, swelling of body due to involvement of circulatory system; and blunting of sensory and motor nervous system etc. Rice consists of three parts namely; germ,endosperm and the outer layer called pericap. The endosperm contains most of carbohydrate where as germ and pericap contain most of vitamins.

Parboiling is an age old established process of preserving the nutritional value of rice in India. This is done in tree steps; 1) soaking paddy in water heated upto about 65 degrees Celsius temperature for 4-5 hours and draining the water; 2) steaming as such; and 3) drying under sun. This process hardens the outer layer of rice making it resistant to insects; the vitamins and nutrients percolate into the deeper layer making those relatively non removable to milling and making it easily digestible by gelatining the starch. Thus, parboiling helps it in many ways in preserving the nutritional value. Rice should not be washed in copious amount of water for many times making the water soluble vitamins vulnerable to be washed away. It also should not be cooked in a large amount of water, and water be drained;which will take away nutrients with it.

So, parboiling and cooking in just the amount of water will protect the nutritional value.

There is pain of varying degree in the anus during passing of motions, compelling the patient to hold stool. The pain lasts for sometimes after the act. Most of the sufferers are ladies. It may follow after passing of hard stool in the recent past.

It is called Fissure-in-Ano. Non-vegetarian food of animal origin is responsible for it as that causes constipation. A life style change with more protein intake has increased it many fold. Some patients have an inherent problem of high sphincter tone. Fissure is a linear ulcer seen in the external anal region. It may occupy either front or back side of anal canal, or sometimes both the sides. In female, it is usally seen in the anterior (front) side whereas in male in the posterior side (back). Usually always, covered by a skin fold in the out side. As the skin fold guards the fissure like a sentry, called sentinel pile, is always painful to touch. The fissure sometimes bleeds and blood comes as a streak attached to the stool.

Fiber in diet prevents it. Most commonly treated in a conservative manner keeping in view to make the stool soft. So, stool softeners paly a major role. Liguid paraffin containing liquids are avoided, as they delay healing. To get ride of pain anesthetic gels are prescribed. A warm bath to anus, called sitz bath is advised after defaecation. An antibacterial gel is also advised. A smooth muscle relaxant gel is also prescribed. If conservative treatment fails a sphincter cutting surgery is contemplated. But, such surgery has the problem of anal incontenence. Most of my patients get relief from dietary modification and conservative treatment.

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Hydatid disease is caused by Echinococcus Granulosus. These larva remain in the muscle tissue of animals. The undercooked or uncooked flesh if taken, may cause the disease. These larva migrate from the intestine of human beings and gets lodged into the liver. They can form cysts there or may go to any other location and from cyst. The common sites of cyst formation are; liver, lungs, spleen and abdomen etc..These take time to grow in size and exert pressure on the neighborhood to manifest. So, depending on the site, the symptoms may vary. It gives rise to severe allergic reaction, if the contents leak into abdominal cavity and other places. The anaphylaxis may cause death. Sometimes the spill over may cause daughter cysts to develop in the vicinity to spread the disease.

The diagnosis is much more easy now-a-days in the advent of ultrasound. Plain x-rays are also helpful. A Test called Casoni’s test, may not be needed to-day. Small cysts can be treated by antihelminthics like albendazole or mebendazole. Surgical enucleation done with utmost care, prevent spillage and, is the choice for the bigger cysts.

CT Of Liver Showing Hydatid Cysts

It has been well established fact that monounsaturated and polyunsaturated fatty acids help in lowering bad fat level. those have also antioxidant activity. So,those are protective to heart. Now the quoted article below shows that it may have antidepressant activity. It is interesting to read.

Mediterranean diet, which emphasizes plentiful use of olive oil, fruits, and vegetables, and minimizes the consumption of red meat and dairy products, may help prevent depression.

n discussing possible reasons for the beneficial influence of the Mediterranean diet on depression, the investigators highlighted the effects on endothelial function and the secretion of brain-derived neurotrophic factor, as well as reductions in low-grade systemic inflammation.Of particular interest were the monounsaturated fatty acids plentiful in olive oil, which may improve the binding of serotonin to its receptors, and polyunsaturated fatty acids, which also may facilitate serotonin transport by means of structural effects on neuronal membranes.

B vitamins and folate from legumes, vegetables, and fruit and nuts also may contribute through effects on methionine and homocysteine metabolism.

“However,” they wrote, “the role of the overall dietary pattern may be more important than the effect of single components” and the synergistic effects of unsaturated fatty acids, antioxidants, and other phytochemicals in the Mediterranean diet “may exert a fair degree of protection against depression.”

Another possible explanation for their findings could be the influence of genetic or environmental factors, they wrote, and they acknowledged that the association between diet and depression may not be causal.

They also noted that the study was limited by its observational nature and its use of self-reporting, and by the fact that their data did not address potential confounders such as family history of depression, so their findings must be confirmed by others.

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Sometimes cases are noticed, where drug treatment is started straight in the first visit of a newly diagnosed patient of hypertension. I, somehow could not digest this. If it is too high when first noticed drug treatment may be started but with mild to moderate rise in pressure, some other things should be tried first. Researchers also agree to it. It may have a cause to be designated as secondary hypertension. When a cause is not found it is termed as idiopathic or primary hypertension. However many theories are advanced to explain it.

• Atherosclerosis is the main contributing factor. Here fat plaques form on the inner layer of the blood vessels, thereby narrowing the lumen. That gives resistance to flow of blood and the pumping force of heart has to increase to maintain adequate flow. So, the result is increased pressure.
• Stress and strain induces a variety of endocrine hormones such as corticosteroids and adrenaline play a major role in sustaing it.
• Rennin, angiotensin and aldosterone axis also plays a major role.
• Obesity is a major cause of it. It is measured by what is called body mass index (BMI), which is arrived at by the formula body weight in kgs/body surface in square meter. If it is more than 30 the person is obese. And around 25 is normal

Blood pressure has two components namely systolic and diastolic. Systolic is the pressure when the heart pumps blood and diastolic is the pressure when the heart receives blood from vein and getting filled. Normally systolic blood pressure ranges from 90 mm. to 130 mm. of mercury and diastolic pressure ranges from 60 mm. to 90 mm. of mercury. When its value exceeds 130/90 mm. it is termed as hypertension. However, the patient should not be stamped as hypertensive right in the first visit, because simple tension of being examined may raise the blood pressure of a person. We usually take three recordings in three different occasions to confirm the disease.
Relevant investigations for diabetes mellitus, lipid profile, ECG, ultrasonogram, kidney profile and urine examination are to be done to exclude any other cause for it or to find out associated diseases. If no specific cause is found it is termed as idiopathic and presumed to be due to atherosclerosis.
The hierarchy of treatment should be as follows.

• Life style modification. Patients leading a sedentary life should be encouraged to go for physical exercise. That will give relaxation, reduce weight, mobilize fat and keep the arteries clean from the deposits of atheromatous plaques. That will streamline blood flow and reduce hypertension.
• Restriction of salt intake will go a long way in reducing the hypertension influencing the rennin-angiotensin-aldosterone axis.
• Meditation will give relaxation and reduce stress which in turn will reduce the steroid hormone level to facilitate reduction of blood pressure.
• Taking a few petals of garlic is said to have positive health benefits,as well as Yogic practices.
• Thereafter, comes the role of drugs and first being a diuretic. And there is a long list of drugs which are to be prescribed by the expert physician.

Therefore, hypertension should be treated in a planned way. If pre-drug treatment practices are followed a number of patients may not require medications at all.

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Alcoholics have the exclusive right to suffer from a disease called pancreatitis.Gall stone disease also take a sizable share from this. All others have some share.

Pancreas is responsible for digestion of protein and fat.If some injury to it’s integrity done by way of being toxic to it ,there occurs inflammation of it’s tissue.There is pain in the upper abdomen. Patient prefers a prop up position or feels better if leans forward.Symptoms may range from mild attack to severe.There may be features of severe shock in form of sweating ,pulselessness and vomiting.Abdomen may be distended and there may be a firm feeling of abdominal wall.

There are several scoring systems to asses the severity of the disease.Diagnosis is based on several blood tests and ultrasonogram.A CT scanning may be needed sometimes.The disease is usually serious and mortality is high.Treatment is usually medicinal and sometimes surgery may be required.

Steps to prevent it is by far the best solution.And the key to it is to leave drinking alcohol.

My senior colleague was treating a patient for penile infection since some days  but there is no regression of the ulcer .To-day he appeared before me to tell that he urinated somewhere and caught the infection and subsequently the ulceration of penis.This man was in his fifties.This is the usual statement of a patient .I do not understand the rationality.Anyway this patient does not know his diabetic status and my collegue neither bothered to go for that.Several patient with a undiagnosed diabetes mellitus present with with ulceration of penis.The infection of glans and prepuce combined called balanoprosthitis.Now I have ordered  for fasting and post-lunch blood sugar estimation.A culture and sensitivity test of pus as well as a routine and and microscopic test of urine also has been ordered.Even somebody not being a frank diabetic might be suffering from a pre-diabetic state called an impaired glucose tolerant.Here the blood sugar levels are more than prescribed limit but not sufficient to stamp as diabetic.The blood sugar level is something like below.There are several values prescribed by different diabetic associations.

Normal level                      Impaired Tolerance                     Diabetic

Fasting                                   60-110 mgs/dl                         110-126 mg/dl                                       >126mg/dl

Post lunch                                 <140mg/dl                           140-180mg/dl                                     >180mg/dl

Diabetic catch infection in skin and other parts easily.Here, as per researchers the resistance to infection decreases.The white blood cell responsible for the defense against invasion of microbes did not reach the site and there is a dysfunction .So even a trivial infection spreads quickly.