REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTRODUCTION-

Brain and spinal cord lesions have an increasing social and economic importance. Accidental trauma of various kinds is the main cause of mortality of children and young adults in developed countries. Only cardiac disease and cancer surpass the number of death caused by accidents and, examining the number of potential work years lost, CNS lesions surpass all other problems. Most brain and spinal cord injuries cause chronic incapacity and frequently occur to individuals under 45 years of age. Edema and other acute events can be efficiently treated and CNS lesions may not be mortal, but are incurable.

Traumatic Brain Injury (TBI) is a disruption in the normal function of the brain that can be caused by a blow, bump or jolt to the head, the head suddenly and violently hitting an object or when an object pierces the skull and enters brain tissue. Observing one of the following clinical signs constitutes alteration in the normal brain function:

• Loss of or decreased consciousness
• Loss of memory for events before or after the event (amnesia)
• Focal neurological deficits such as muscle weakness, loss of vision, change in speech
• Alteration in mental state such as disorientation, slow thinking or difficulty concentrating

Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of damage to the brain. Mild cases may result in a brief change in mental state or consciousness. Severe cases may result in extended periods of unconsciousness, coma, or even death.

he final outcome of CNS injury depend on the area damaged and the extent of the lesion, but the best present therapies can offer is relief of the symptoms and rehabilitation. This review examines the present state of functional repair of experimental central nervous system trauma.

TRAUMA-

Cellular infiltrates in the CSF of victims of CNS trauma are indistinguishable from the cells seen in subarachnoid hemorrhage and destructive lesions of other etiologies. Thus, red blood cells and macrophages containing hemosiderin or myelin debris are the most common manifestations of trauma in CSF. Patients with sinus and basilar skull fractures with tears in the meninges are at risk for developing leakage of sinus contents into the SAS. The CSF in this setting contains a marked acute inflammatory reaction. Bacteria and other elements, such as fragments of Candida and ciliated respiratory epithelial cells from the sinus lining, may also be seen.

Key features of trauma•

Red blood cells; and•

Macrophages containing hemosiderin or myelin debris.

The Problem

Traumatic brain injury (TBI) remains a major health problem with serious socio-economic consequences. Although its incidence is decreasing in most western countries according to some estimates, severe TBI will become the third most common cause of death and disability globally by the year 2020.

In 1996, 3740 deaths from serious injuries were recorded in the United Kingdom. The death rate for all ages from a head injury in the United Kingdom is 9 deaths per 100,000 population per year, or 1% of all deaths, or 15-20% of deaths of persons aged 5-35 years

CAUSES-

Brain trauma can be caused by a direct impact or by acceleration alone. In addition to the damage caused at the moment of injury, brain trauma causes secondary injury, a variety of events that take place in the minutes and days following the injury. These processes, which include alterations in cerebral blood flow and the pressure within the skull, contribute substantially to the damage from the initial injury.

TYPES-

Brain injuries can be classified into mild, moderate, and severe categories. The Glasgow Coma Scale (GCS), the most commonly used system for classifying TBI severity, grades a person’s level of consciousness on a scale of 3–15 based on verbal, motor, and eye-opening reactions to stimuli. It is generally agreed that a TBI with a GCS of 13 or above is mild, 9–12 is moderate, and 8 or below is severe.

TBIs can cause “mass lesions,” w an area of localized injury such as hematomas and contusions that increase pressure within the brain. Summarized below are different types of sequelae deveoped from TBIs:

Hematoma: A hematoma is a blood clot within the brain or on its surface. Hematomas may occur anywhere within the brain. An epidural hematoma is a collection of blood between the dura mater (the protective covering of the brain) and the inside of the skull. A subdural hematoma is a collection of blood between the dura mater and the arachnoid layer, which sits directly on the surface of the brain.

Contusion: A cerebral contusion is bruising of brain tissue. When examined under a microscope, cerebral contusions are comparable to bruises in other parts of the body. They consist of areas of injured or swollen brain mixed with blood that has leaked from arteries, veins, or capillaries. Most commonly, contusions are at the base of the front parts of the brain, but may occur anywhere.

Intracerebral Hemorrhage: An intracerebral hemorrhage (ICH) describes bleeding within the brain tissue, may be related to other brain injuries, especially contusions. The size and location of the hemorrhage helps determine whether it can be removed surgically.

Subarachnoid Hemorrhage: Subarachnoid hemorrhage (SAH) is caused by bleeding into the subarachnoid space. It appears as diffuse blood spread thinly over the surface of the brain and commonly after TBI. Most cases of SAH associated with head trauma are mild. Hydrocephalus may result from severe traumatic SAH.

Diffuse Injuries: TBIs can produce microscopic changes that do not appear on CT scans and are scattered throughout the brain. This category of injuries, called diffuse brain injury, may occur with or without an associated mass lesion.

Diffuse Axonal Injury: Axonal injury refers to impaired function and gradual loss of axons.These long extensions of nerve cells enable them to communicate with each other. If enough axons are harmed in this way, the ability of nerve cells to communicate with each other and to integrate their function may be lost or greatly impaired, possibly leaving a patient with severe disabilities.

Ischemia: Another type of diffuse injury is ischemia or insufficient blood supply to certain parts of the brain. A decrease in blood supply to very low levels may occur commonly in a significant number of TBI patients. This is crucial since a brain that has just undergone a traumatic injury is especially sensitive to slight reductions in blood flow. Changes in blood pressure during the first few days after head injury can also have an adverse effect.

Skull Fractures: Linear skull fractures or simple breaks or “cracks” in the skull may accompany TBIs.

Possible forces, strong enough to cause a skull fracture may damage the underlying brain. Skull fractures may be alarming, if found on a patient evaluation. Fractures at the base of the skull are problematic since they can cause injury to nerves, arteries, or other structures. If the fracture extends into the sinuses, a leakage of cerebrospinal fluid (CSF) from the nose or ears may occur. Depressed skull fractures, in which part of the bone presses on or into the brain, can also occur.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

SYMPTOM-

Symptoms vary greatly depending on the severity of the head injury. They may include any of the following:

• Vomiting
• Lethargy
• Headache
• Confusion
• Paralysis
• Coma
• Loss of consciousness
• Dilated pupils
• Vision changes (blurred vision or seeing double, unable to tolerate bright light, loss of eye movement, blindness)
• Cerebrospinal fluid (CSF) (clear or blood-tinged) appear from the ears or nose
• Dizziness and balance concerns
• Breathing problems
• Slow pulse
• Slow breathing ratewith an increase in blood pressure
• Ringing in the ears or changes in hearing
• Cognitive difficulties
• Inappropriate emotional responses
• Speech difficulties (slurred speech, inability to understand and/or articulate words)
• Difficulty swallowing
• Body numbness or tingling
• Droopy eyelid or facial weakness
• Loss of bowel control or bladder control

If a TBI is suspected, call 911 immediately or take the person to an emergency room.

Side Effects and Complications

Subdural hematoma is a possible result of traumatic head injury: In this image, the single arrow marks spread of the subdural haematoma and the double arrow marks the midline shift.

TBI can cause a host of physical, cognitive, social, emotional, and behavioral effects, and the outcome can range from complete recovery to permanent disability or death. The 20^th century saw critical developments in diagnosis and treatment that decreased death rates and improved outcome. Some of the current imaging techniques used for diagnosis and treatment include CT scans (computed tomography) and MRIs (magnetic resonance imaging). Depending on the injury, treatment required may be minimal or may include interventions such as medications, emergency surgery or surgery years later. Physical therapy, speech therapy, recreation therapy, and occupational therapy may be employed for rehabilitation.

Complications are distinct medical problems that may arise as a result of the TBI. TBI can cause prolonged or permanent effects on consciousness, such as coma, brain death, persistent vegetative state (in which patients are unable to achieve a state of alertness to interact with their surroundings), and minimally conscious state. Lying still for long periods can cause complications including pressure sores, pneumonia or other infections, progressive multiple organ failure, and deep venous thrombosis, which can cause pulmonary embolism. Complications involving the blood vessels include vasospasm, in which vessels constrict and restrict blood flow, the formation of aneurysms, in which the side of a vessel weakens and balloons out, and stroke. Movement disorders that may develop after TBI include tremor, ataxia (uncoordinated muscle movements), myoclonus (shock-like contractions of muscles), and loss of movement range and control (in particular with a loss of movement repertoire). The risk of post-traumatic seizures increases with severity of trauma and is particularly elevated with certain types of brain trauma such as cerebral contusions or hematomas.

TESTING AND DIAGNOSIS-

Anyone with signs of moderate or severe TBI should receive medical attention as soon as possible. Because we cannot do much to reverse the initial brain damage caused by trauma, medical providers try to stabilize an individual with TBI and focus on preventing further injury.

First, the cardiac and pulmonary function is assessed. Next, a quick examination of the entire body is performed, followed by a complete neurological examination. The neurological examination includes an assessment utilizing the Glasgow Coma Scale (GCS). In addition to the GCS, also tested is the ability of the pupils to become smaller in bright light. In patients with large mass lesions or with high intracranial pressure (ICP), one or both pupils may be very wide or “blown.” The presence of a wide or dilated pupil on only one side suggests a large mass lesion may be present. Brainstem reflexes including gag and corneal (blink) may also be tested.

Radiological Tests

A computed tomography scan (CT or CAT scan) is the gold standard for the radiological assessment of a TBI patient. A CT scan is easy to perform and an excellent test for detecting the presence of blood and fractures, the most crucial lesions to identify in medical trauma cases. Plain x-rays of the skull are recommended by some as a way to evaluate patients with only mild neurological dysfunction. However, most centers in the U.S. have readily available CT scanning, a more accurate test, rendering the routine use of skull x-rays for TBI patients to decline.

Magnetic resonance imaging (MRI) is not commonly used for acute head injury since it takes longer to perform a MRI than a CT. Because it is difficult to transport an acutely-injured patient from the emergency room to a MRI scanner, the use of MRI is impractical. However, once a patient is stabilized, MRI may demonstrate the existence of lesions that were not detected on the CT scan. This information is generally more useful for determining prognosis than for influencing treatment.

TREATMENT-

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Surgery–

Many patients with moderate or severe head injuries head directly from the emergency room to the operating room. In many cases, surgery is performed to remove a large hematoma or contusion that is significantly compressing the brain or raising the pressure within the skull. After surgery, these patients are under observation in the intensive care unit (ICU).

Other head-injured patients may not head to the operating room immediately, instead are taken from the emergency room to the ICU. Since contusions or hematomas may enlarge over the first hours or days after head injury, immediate surgery is not recommended on these patients until several days after their injury. Delayed hematomas may be discovered when a patient’s neurological exam worsens or when their ICP increases. On other occasions, a routine follow-up CT scanto determine whether a small lesion has changed in size indicates that the hematoma or contusion has enlarged significantly. In these cases, the safest approach is to remove the lesion before it enlarges and causes neurological damage.

During surgery, the hair over the affected part of the head is usually shaved. After the scalp incision, the removed bone is extracted in a single piece or flap, then replaced after surgery unless contaminated. The dura mater is carefully cut to reveal the underlying brain. After any hematoma or contusion is removed, the neurosurgeon ensures the area is not bleeding. He or she then closes the dura, replaces the bone and closes the scalp. If the brain is very swollen, some neurosurgeons may decide not to replace the bone until the swelling decreases, which may take up to several weeks. The neurosurgeon may elect to place an ICP monitor or other types of monitors if these were not already in place. The patient is returned to the ICU for observation and additional care.

Non-Surgical Treatments

At present, medication administered to prevent nerve damage or promote nerve healing after TBI not available. The primary goal in the ICU is to prevent any secondary injury to the brain. The “primary insult” refers to the initial trauma to the brain, whereas the “secondary insult” is any subsequent development that may contribute to neurological injury. For example, an injured brain is especially sensitive and vulnerable to decreases in blood pressure otherwise well tolerated. One way to avoid secondary insults is to attempt normal or slightly elevated blood pressure levels. Likewise, increases in ICP, decreases in blood oxygenation, increases in body temperature, increases in blood glucose and many other disturbances can potentially worsen neurological damage. The major role of ICU management is the prevention of secondary insults in head-injured patients.

Various monitoring devices may assist health care personnel in caring for the patient. Placement of an ICP monitor into the brain can help detect excessive swelling. One commonly used type of ICP monitor is a ventriculostomy, a narrow, flexible, hollow catheter that is passed into the ventricles, or fluid spaces in the center of the brain, to monitor ICP and drain CSF if ICP increases. Another commonly used type of intracranial pressure monitoring device involves placement of a small fiberoptic catheter directly into the brain tissue. Additional catheters may be added to measure brain temperature and brain tissue oxygenation. Placement of an oxygen sensor into the jugular vein can detect how much oxygen the brain is using. This may be related to the degree of brain damage. Many other monitoring techniques currently under investigation to determine whether they can help improve outcome after head injury or provide additional information about caring for TBI patients.

Rehabilitation

Once head-injured patients leave the acute-care hospital, some benefit from a rehabilitation program. Prime candidates for rehabilitation are patients with less severe initial injuries or those that started to show significant improvement.

In some cases, transfer to a rehabilitation hospital or to the rehabilitation service of a large hospital may expedite further recovery. For more severely injured patients or those with slow recovery, constant vigilance is required to prevent the gradual onset of problems with joint mobility, skin integrity, respiratory status, infection and many other physiological functions. Patients with moderate or mild injuries, or severely injured patients who have improved sufficiently, are likely candidates for outpatient therapy.

Most head-injury rehabilitation centers emphasize compensatory strategies to help patients learn to reach the maximum level of function allowed by their impairments. The concept of cognitive retraining, a controversial concept, which presumes that at least some of the brain’s cognitive capacity can be restored by constant repetition of certain simple tasks, is also emphasized at many centers. Head injury rehabilitation centers work with patients’ families to educate them about realistic expectations and best help their injured family member.

General Head Injury Prevention Tips

• Wear a seatbelt every time you drive or ride in a motor vehicle.
• Never drive while under the influence of drugs, alcohol or ride as a passenger with anyone who is under the influence.
• Keep firearms unloaded in a locked cabinet or safe, and store ammunition in a separate, secure location.
• Remove hazards in the home that may contribute to falls. Secure rugs and loose electrical cords, put away toys, use safety gates and install window guards. Install grab bars and handrails if you are frail or elderly.

Sports and Recreation Head Injury Prevention Tips

• For specific sports, 100 percent of the time, buy and use helmets or protective headgear approved by the American Society for Testing and Materials (ASTM).
• Supervise younger children at all times.
• Do not allow younger children to use sporting equipment or play sports unsuitable for their age.
• Avoid the use of playgrounds with hard surfaces.
• Follow all rules and warning signs at water parks, swimming pools and public beaches.
• Do not dive in water less than 12 feet deep or in above-ground pools. Check the depth – and check for debris in the water before diving.
• Wear appropriate clothing for the sport.
• Do not wear any clothing that can interfere with your vision.
• Do not participate in sports when you are ill or very tired.
• Obey all traffic signals, and be aware of drivers when cycling or skateboarding.
• Avoid uneven or unpaved surfaces when cycling, skateboarding or in-line skating.
• Perform regular safety checks of sports fields, playgrounds and equipment.
• Discard and replace damaged sporting equipment or protective gear
• Never slide head-first when stealing a base.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTRODUCTION-

Leprosy, also known as Hansen’s disease, is a chronic infectious disease caused by Mycobacterium leprae. The disease mainly affects the skin, the peripheral nerves, mucosal surfaces of the upper respiratory tract and the eyes. Leprosy is known to occur at all ages ranging from early infancy to very old age. Leprosy is curable and early treatment averts most disabilities.

Leprosy is an infectious disease that causes severe, disfiguring skin sores and nerve damage in the arms, legs, and skin areas around the body. The disease has been around since ancient times, often surrounded by terrifying, negative stigmas and tales of leprosy patients being shunned as outcasts. Outbreaks of leprosy have affected, and panicked, people on every continent. The oldest civilizations of China, Egypt, and India feared leprosy was an incurable, mutilating, and contagious disease.

However, leprosy is actually not that contagious. You can catch it only if you come into close and repeated contact with nose and mouth droplets from someone with untreated leprosy. Children are more likely to get leprosy than adults.

Today, about 180,000 people worldwide are infected with leprosy, according to the World Health Organization, most of them in Africa and Asia. About 100 people are diagnosed with leprosy in the U.S. every year, mostly in the South, California, Hawaii, and some U.S. territories.

CAUSES-

Leprosy is caused by a slow-growing type of bacteria called Mycobacterium leprae (M. leprae). Leprosy is also known as Hansen’s disease, after the scientist who discovered M. leprae in 1873

SYMPTOM-

Leprosy primarily affects the skin and the nerves outside the brain and spinal cord, called the peripheral nerves. It may also strike the eyes and the thin tissue lining the inside of the nose.

The main symptom of leprosy is disfiguring skin sores, lumps, or bumps that do not go away after several weeks or months. The skin sores are pale-colored.

Nerve damage can lead to:

• Loss of feeling in the arms and legs
• Muscle weakness

It usually takes about 3 to 5 years for symptoms to appear after coming into contact with the leprosy-causing bacteria. Some people do not develop symptoms until 20 years later. The time between contact with the bacteria and the appearance of symptoms is called the incubation period. Leprosy’s long incubation period makes it very difficult for doctors to determine when and where a person with leprosy got infected.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

DIAGNOSIS-

Clinical signs are easy to observe. In a country or area with a high incidence of leprosy, an individual should be regarded as having leprosy if he or she shows ONE of the following cardinal signs:

• skin lesion consistent with leprosy and with definite sensory loss, with or without thickened nerves
• positive skin smears

The skin lesion can be single or multiple, usually less pigmented than the surrounding normal skin. Sometimes the lesion is reddish or copper-coloured. A variety of skin lesions may be seen but macules (flat), papules (raised), or nodules are common. Sensory loss is a typical feature of leprosy. The skin lesion may show loss of sensation to pin pick and/or light touch. Thickened nerves, mainly peripheral nerve trunks constitute another feature of leprosy. A thickened nerve is often accompanied by other signs as a result of damage to the nerve. These may be loss of sensation in the skin and weakness of muscles supplied by the affected nerve. In the absence of these signs, nerve thickening by itself, without sensory loss and/or muscle weakness is often not a reliable sign of leprosy.

Leprosy can be classified on the basis of clinical manifestations and skin smear results. In the classification based on skin smears, patients showing negative smears at all sites are said to have paucibacillary leprosy (PB), while those showing positive smears at any site are said to have multibacillary leprosy (MB).

TREATMENT

Leprosy is curable with a combination of drugs known as multidrug therapy (MDT), as the treatment of leprosy with only one antileprosy drug (monotherapy) will result in development of drug resistance to that drug. The combination of drugs used in the MDT depends on the classification of the disease. Rifampicin, the most important antileprosy medicine, is included in the treatment of both types of leprosy. For the treatment of patients with multibacillary leprosy, WHO recommends a combination of rifampicin, clofazimine and dapsone; for patients with paucibacillary leprosy, MDT uses a combination of rifampicin and dapsone.

Access to treatment

Multidrug therapy (MDT), first recommended by a WHO Expert Committee in 1984, rapidly became the standard treatment of leprosy and has been supplied by WHO free of charge to all endemic countries since 1995.

As a major supplier of very close to 100% of global MDT needs, WHO works closely with donors and manufacturers to plan the manufacture, procurement and shipment of the MDT drugs having the maximum available shelf life, at the time most appropriate for each national programme. WHO also arranges independent laboratory testing of the drugs at the manufacturer’s own expense in order to ensure that the finished WHO product is the best available for national programmes. Such testing is considered essential to maintain the confidence of national programmes in the donated product.

In order to meet emergency requests for MDT, WHO maintains at the donor’s expense, substantial buffer stocks at the manufacturing plant. Currently these buffer stocks are equivalent to around 40% of global annual requirements but vary depending on perceived need. To ensure a rapid response to requests for smaller emergency supplies, WHO maintains additional buffer stocks at its headquarters in Geneva and Regional Office in Manila. Response times from WHO Geneva are typically 48 hours and most despatches are made via courier.

he Global Leprosy Strategy

In 2016 WHO launched the Global Leprosy Strategy 2016–2020: Accelerating towards a leprosy-free world, which aims to reinvigorate efforts to control leprosy and avert disabilities, especially among children still affected by the disease in endemic countries.

The strategy emphasizes the need to sustain expertise and increase the number of skilled leprosy staff, improve the participation of affected persons in leprosy services and reduce visible deformities as well as stigmatization associated with the disease. It also calls for renewed political commitment and enhanced coordination among partners while highlighting the importance of research and improved data collection and analysis.

The key interventions needed to achieve the targets include:

• detecting cases early before visible disabilities occur, with a special focus on children as a way to reduce disabilities and reduce transmission;
• targeting detection among higher risk groups through campaigns in highly endemic areas or communities; and
• improving health care coverage and access for marginalized populations.

Endemic countries need to include other strategic interventions in their national plans to meet the new targets, namely:

• screening all close contacts of persons affected by leprosy;
• promoting a shorter and uniform treatment regimen; and
• incorporating specific interventions against stigmatization and discrimination.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTRODUCTION-

Tenosynovitis is inflammation of a tendon and its sheath. Most acute cases of flexor tenosynovitis (FT)—which involves disruption of normal flexor tendon function in the hand—result from infection. However, FT also can develop secondary to acute or chronic inflammation from a noninfectious cause, such as diabetes, overuse, or arthritis.

tenosynovitis is a painful condition affecting the tendons on the thumb side of your wrist. If you have de Quervain’s tenosynovitis, it will probably hurt when you turn your wrist, grasp anything or make a fist.

Although the exact cause of de Quervain’s tenosynovitis isn’t known, any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing golf or racket sports, or lifting your baby — can make it worse.

A tendon is a type of fibrous tissue that connects your muscles to your bones. These tissues help control actions such as running, jumping, grasping, and lifting. Without tendons, you wouldn’t be able to control the movement of your body.

A protective sheath known as the synovium covers tendons. This sheath produces synovial fluid, which keeps the tendon lubricated.

Injury to the tendon may result in the malfunction of the sheath. If this occurs, the sheath may fail to make synovial fluid or may not make enough fluid. This can cause inflammation or swelling of the sheath. This condition is known as tendon sheath inflammation. It’s also sometimes called tenosynovitis.

CAUSES-

Tendon sheath inflammation is typically the result of injury to the tendon or surrounding muscle or bone. It’s not limited to athletes and appears in people who perform a variety of repetitive-motion activities, such as assembly-line work, weeding, and typing. People working in certain jobs appear to have greater risk of it than others, including:

• carpenters
• dentists
• musicians
• office workers

It’s most common in the tendons of the wrist, hands, and feet. Injury can result from:

• repetitive-stress activities
• prolonged physical activities, such as running
• standing in the same position for long periods of time
• sudden sprains and strains

Tendon sheath inflammation can also be due to underlying health conditions. Examples of conditions that can result in this condition include:

• rheumatoid arthritis
• scleroderma
• gout
• diabetes
• reactive arthritis, such as Reiter’s syndrome
• gonorrhea

The cause of the disease can’t be determined in some people. In rare cases, tendon sheath inflammation is due to an infection that resulted from a cut or puncture to the tendon.

SYMPTOM-

Symptoms of tenosynovitis include:

• Pain near the base of your thumb
• Swelling near the base of your thumb
• Difficulty moving your thumb and wrist when you’re doing something that involves grasping or pinching
• A “sticking” or “stop-and-go” sensation in your thumb when moving it

If the condition goes too long without treatment, the pain may spread further into your thumb, back into your forearm or both. Pinching, grasping and other movements of your thumb and wrist aggravate the pain.

When to see a doctor

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Consult your doctor if you’re still having problems with pain or function and you’ve already tried:

• Not using your affected thumb
• Applying cold to the affected area
• Using nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve)

DIAGNOSIS-

Diagnosis of tendon sheath inflammation will require a physical exam of the affected area. Your doctor will check to see if redness and swelling are present. Your doctor may also ask you to move the affected area to see if pain is present.

In some cases, your doctor may order an ultrasound or MRI scan to confirm a diagnosis or rule out other possible causes such as arthritis.

Risk factors

Risk factors for de Quervain’s tenosynovitis include:

• Age. If you’re between the ages of 30 and 50, you have a higher risk of developing de Quervain’s tenosynovitis than do other age groups, including children.
• Sex. The condition is more common in women.
• Being pregnant. The condition may be associated with pregnancy.
• Baby care. Lifting your child repeatedly involves using your thumbs as leverage and may also be associated with the condition.
• Jobs or hobbies that involve repetitive hand and wrist motions. These may contribute to de Quervain’s tenosynovitis.

Complications

Untreated de Quervain’s tenosynovitis might make it hard to use your hand and wrist properly and limit your wrist’s range of motion.

Untreated de Quervain’s tenosynovitis might make it hard to use your hand and wrist properly and limit your wrist’s range of motion.

PREVENTION-

Tendon sheath inflammation is preventable if you avoid excessive movements or motions that are repetitive or forceful. Muscle strengthening around the site of the joint can also help prevent this type of injury, as well as stretching and range-of-motion exercises.

If you cut your hands, wrists, or feet, proper cleaning of the wound will help prevent infection and the possible development of tendon sheath inflammation.

TREATMENT-

The treatment for tendon sheath inflammation focuses on reducing inflammation and pain. One strategy is to rest the affected area and stop the activities that caused the initial injury. Your doctor may recommend the use of a brace or splint to immobilize the affected area.

Applying heat or cold may also help reduce swelling and pain. Other therapies that your doctor may recommend are:

• massage
• stretching the affected area
• transcutaneous electrical nerve stimulation (TENS)
• ultrasound

Your doctor may also prescribe medications for tendon sheath inflammation. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), or injectable corticosteroids are other options.

Injection of the tendon sheath with a steroid is usually successful (in noninfectious cases) and occasionally surgery is necessary to release the tendon sheath about the tendon. If your condition was caused by an infection, your doctor may prescribe antibiotics to fight the infection.

If your condition is due to an underlying health issue, such as rheumatoid arthritis or gout, treatment may also include medications to treat these disorders.

Once the tendon heals, your doctor may recommend exercises or physical therapy to help strengthen the muscle. Strengthening the muscle will help protect the tendon from injury in the future. If you have recurring tendon sheath inflammation, your doctor may recommend surgery to correct the problem.

PHYSICAL THERAPY

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Ice/Heat Packs – Heat can help relax and loosen tight musculature, and ice can be used to help relieve inflammation of the extensor sheath.

Massage – Deep tissue massage at the thenar eminence can help relax tight musculature that causes pain. (See video). Graston Technique of manual soft tissue mobilization along with the eccentric exercise is also helpful. Graston technique includes breaking down fascia restriction, stretching connective tissue and promoting better healing environment.

Stretching – Stretching the thenar eminence muscles into thumb extension and abduction can relax and lengthen this tight musculature that causes pain.

Increasing Strength

• Resisted finger and thumb extension
• Palm up position – for thumb extension and abduction strength
• Thumb up position – for thumb extension and abduction strength
• Resisted radial deviation
• In thumb up position
• Resisted supination
• In thumb up position
• Resisted thumb opposition
• In thumb up position

Improving Range of Motion Stretching as explained above can be used to improve range of motion. Ice/Heat packs can relax tight musculature so that you can attain a bigger range of motion.

Mobilization with movement has shown effectiveness in decreasing the pain, improving range of motion and improving the function of a patient with De-Quervain tenosynovitis. The therapist provides a manual radial glide of the proximal row of carpals, then asked the patient to move her thumb into radial abduction-adduction. Mobilization with movement performed for 3 sets of 10 repetitions and followed by eccentric hammer curl exercise with theraband and high voltage electrical stimulation has shown effective result after 6 months followup,

Kinesio-taping Technique can also be used to decrease pain and improve function.

Therapeutic Ultrasound has also better outcome in pain reduction and healing.

Decreasing Swelling To decrease swelling you can use:

• Thumb splinting
• Corticosteroid injections
• NSAIDs
• Ice/heat packs
• Massage
• Stretching

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTRODUCTION-

Primary nonspecific ulceration of the small intestine is a unique and characteristic lesion. The ulcer, usually single, occurs in the wall of the ileum or jejunum and is frequently accompanied by an annular ring of fibrous tissue. Perforation, although not common, does occur. The presenting symptoms are generally those of small-bowel obstruction, and the treatment is surgical.

This lesion was first described by Mattew Baillie in 1805, and since then has rarely been described in the medical literature. A review in 1963¹ produced only 170 case reports.

During the summer of 1964, a few scattered cases were reported describing a similar small intestinal lesion occurring in patients being treated with various formulations of potassium chloride or a diuretic for oral administration. In September and November 1964 two publications appeared, one by Lindholmer, Nyman, and Raf from Stockholm, and the other by Baker, Schrader, and Hitchcock from Minneapolis.

Ulcers of the small and large intestine are rare, yet they are responsible for a broad spectrum of disease. Ulcers can occur singly, as in solitary rectal ulcer syndrome, or diffusely, as in enteropathy-associated T-cell lymphoma. Clinical presentations vary widely with location and degree of intestinal involvement, ranging from anemia and hypoproteinemia to abdominal pain, hemorrhage, obstruction, and perforation.

This chapter is divided into two sections. The first section covers isolated intestinal ulcers, including nonspecific solitary ulcers of the small intestine, solitary rectal ulcer syndrome, stercoral ulcers, and ulcerations induced by nonsteroidal anti-inflammatory drugs (NSAIDs). The second section covers syndromes of diffuse intestinal ulceration, including ulcerative enteritis, refractory celiac disease types I and II, and enteropathy-associated T-cell lymphoma (EATL).

Because of the length and relative inaccessibility of the small intestine, diagnosis of small intestinal ulcerative diseases has been challenging. Currently, however, video-capsule endoscopy enables the entire small intestine to be viewed with clarity, and double-balloon enteroscopy offers the opportunity to evaluate the small intestine visually, obtain biopsy specimens, and provide a variety of endoscopic therapies.

SYMPTOM-

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Patients with nonspecific ulcers of the small intestine can present with acute or chronic gastrointestinal bleeding, symptoms of small bowel obstruction, abdominal pain, or perforation. Symptoms may be present from a few days to many years before diagnosis.

most presenting in the fifth and sixth decades of life; no gender predominance was found. The most common presenting symptom was intermittent small bowel obstruction (63%). Physical findings ranged from nonspecific abdominal tenderness and distention to an acute abdomen resulting from intestinal perforation. Laboratory evaluation was notable only for anemia in one half of the patients. Radiologic studies localized the ulcer in a minority of patients.

TREATMENT-

All patients were treated with segmental resection; only two patients had recurrent ulceration, 2 and 10 years after initial diagnosis and resection. Ischemia, central nervous system disease, infection, trauma, and hormonal influences all have been put forth as possible causes of primary nonspecific ulcerations, but the cause or causes still remains unknown. In the absence of more recent reviews, it is impossible to determine the current incidence rate of these ulcer.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTRODUCTION-

Gastritis is an inflammation of the protective lining of the stomach. Acute gastritis involves sudden, severe inflammation. Chronic gastritis involves long-term inflammation that can last for years if it’s left untreated.

Erosive gastritis is a less common form of the condition. It typically doesn’t cause much inflammation, but can lead to bleeding and ulcers in the lining of the stomach.

Gastritis is an inflammation, irritation, or erosion of the lining of the stomach. It can occur suddenly (acute) or gradually (chronic).

Gastritis is a general term for a group of conditions with one thing in common: inflammation of the lining of the stomach. The inflammation of gastritis is most often the result of infection with the same bacterium that causes most stomach ulcers. Regular use of certain pain relievers and drinking too much alcohol also can contribute to gastritis.

Gastritis may occur suddenly (acute gastritis), or appear slowly over time (chronic gastritis). In some cases, gastritis can lead to ulcers and an increased risk of stomach cancer. For most people, however, gastritis isn’t serious and improves quickly with treatment.

CAUSES-

Weakness in your stomach lining allows digestive juices to damage and inflame it, causing gastritis. Having a thin or damaged stomach lining raises your risk for gastritis.

A gastrointestinal bacterial infection can also cause gastritis. The most common bacterial infection that causes it is Helicobacter pylori. It’s a bacterium that infects the lining of the stomach. The infection is usually passed from person to person, but can also be transmitted through contaminated food or water.

Certain conditions and activities may increase your risk for developing gastritis. Other risk factors include:

• extreme alcohol consumption
• routine use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin
• cocaine use
• age, because the stomach lining thins naturally with age
• tobacco use

Other less common risk factors include:

• stress caused by severe injury, illness, or surgery
• autoimmune disorders
• digestive disorders like Crohn’s disease
• viral infections

Gastritis can be caused by irritation due to excessive alcohol use, chronic vomiting, stress, or the use of certain medications such as aspirin or other anti-inflammatory drugs. It may also be caused by any of the following:

• Helicobacter pylori (H. pylori): A bacteria that lives in the mucous lining of the stomach; without treatment, the infection can lead to ulcers, and in some people, stomach cancer.
• Bile reflux: A backflow of bile into the stomach from the bile tract (that connects to the liver and gallbladder)
• Infections caused by bacteria and viruses

If gastritis is left untreated, it can lead to a severe loss of blood and may increase the risk of developing stomach cancer

SYMPTOM-

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Gastritis doesn’t cause noticeable symptoms in everyone. The most common symptoms are:

• nausea
• vomiting
• a feeling of fullness in your upper abdomen, particularly after eating
• indigestion

Nausea or recurrent upset stomach Abdominal bloatingAbdominal pain Vomiting Indigestion Burning or gnawing feeling in the stomach between meals or at night Hiccups

If you have erosive gastritis, you might experience different symptoms, including:

• black, tarry stool
• vomiting blood or material that looks like coffee grounds

When to see a doctor

Nearly everyone has had a bout of indigestion and stomach irritation. Most cases of indigestion are short-lived and don’t require medical care. See your doctor if you have signs and symptoms of gastritis for a week or longer. Tell your doctor if your stomach discomfort occurs after taking prescription or over-the-counter drugs, especially aspirin or other pain relievers.

If you are vomiting blood, have blood in your stools or have stools that appear black, see your doctor right away to determine the cause.

DIAGNOSIS-

To diagnose gastritis, your doctor will review your personal and family medical history, perform a thorough physical evaluation, and may recommend any of the following tests:

• Upper endoscopy. An endoscope, a thin tube containing a tiny camera, is inserted through your mouth and down into your stomach to look at the stomach lining. The doctor will check for inflammation and may perform a biopsy, a procedure in which a tiny sample of tissue is removed and then sent to a laboratory for analysis.
• Blood tests. The doctor may perform various blood tests, such as checking your red blood cell count to determine whether you have anemia, which means that you do not have enough red blood cells. He or she can also screen for H. pylori infection and pernicious anemia with blood tests.
• Fecal occult blood test (stool test). This test checks for the presence of blood in your stool, a possible sign of gastritis.

Risk factors

Factors that increase your risk of gastritis include:

• Bacterial infection. Although infection with Helicobacter pylori is among the most common worldwide human infections, only some people with the infection develop gastritis or other upper gastrointestinal disorders. Doctors believe vulnerability to the bacterium could be inherited or could be caused by lifestyle choices, such as smoking and diet.
• Regular use of pain relievers. Common pain relievers — such as aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, Anaprox) — can cause both acute gastritis and chronic gastritis. Using these pain relievers regularly or taking too much of these drugs may reduce a key substance that helps preserve the protective lining of your stomach.
• Older age. Older adults have an increased risk of gastritis because the stomach lining tends to thin with age and because older adults are more likely to have H. pylori infection or autoimmune disorders than younger people are.
• Excessive alcohol use. Alcohol can irritate and erode your stomach lining, which makes your stomach more vulnerable to digestive juices. Excessive alcohol use is more likely to cause acute gastritis.
• Stress. Severe stress due to major surgery, injury, burns or severe infections can cause acute gastritis.

Your own body attacking cells in your stomach. Called autoimmune gastritis, this type of gastritis occurs when your body attacks the cells that make up your stomach lining. This reaction can wear away at your stomach’s protective barrier.

Autoimmune gastritis is more common in people with other autoimmune disorders, including Hashimoto’s disease and type 1 diabetes. Autoimmune gastritis can also be associated with vitamin B-12 deficiency.

Other diseases and conditions. Gastritis may be associated with other medical conditions, including HIV/AIDS, Crohn’s disease and parasitic infections.

Complications

Left untreated, gastritis may lead to stomach ulcers and stomach bleeding. Rarely, some forms of chronic gastritis may increase your risk of stomach cancer, especially if you have extensive thinning of the stomach lining and changes in the lining’s cells.

Tell your doctor if your signs and symptoms aren’t improving despite treatment for gastritis.

Prevention

Preventing H. pylori infection

It’s not clear how H. pylori spreads, but there’s some evidence that it could be transmitted from person to person or through contaminated food and water. You can take steps to protect yourself from infections, such as H. pylori, by frequently washing your hands with soap and water and by eating foods that have been cooked completely.

TREATMENT-

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

The treatment for gastritis depends on the cause of the condition. If you have gastritis caused by NSAIDs or other drugs, avoiding those drugs may be enough to relieve your symptoms. Gastritis as a result of H. pylori is routinely treated with antibiotics that kill the bacteria.

In addition to antibiotics, several other types of medication are used to treat gastritis:

Proton pump inhibitors

Medications called proton pump inhibitors work by blocking cells that create stomach acid. Common proton pump inhibitors include:

• omeprazole (Prilosec)
• lansoprazole (Prevacid)
• esomeprazole (Nexium)

However, long-term use of these medications, especially at high doses, can lead to an increased risk of spine, hip, and wrist fractures. It can also lead to increased risk of renal failure, dementia, and nutrient deficiencies.

Speak to your doctor before beginning one of these medications to create a treatment plan that is right for you.

Acid reducing medications

Medications that reduce the amount of acid your stomach produces include:

• famotidine (Pepcid)

By lowering the amount of acid that’s released into your digestive tract, these medications relieve the pain of gastritis and allow your stomach lining to heal.

Antacids

Your doctor may recommend that you use antacids for rapid relief of gastritis pain. These medications can neutralize the acid in your stomach.

Some antacids may cause diarrhea or constipation, so talk to your doctor if you experience any of these side effects.

Probiotics

Probiotics have been shown to help replenish digestive flora and heal gastric ulcers. However, there’s no evidence that they have any impact on acid secretion. There are currently no guidelines supporting the use of probiotics in ulcer management.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTRODUCTION-

neumoconiosis is one of a group of interstitial lung disease caused by breathing in certain kinds of dust particles that damage your lungs.

Because you are likely to encounter these dusts only in the workplace, pneumoconiosis is called an occupational lung disease.

Pneumoconiosis usually take years to develop. Because your lungs can’t get rid of all these dust particles, they cause inflammation in your lungs that can eventually lead to scar tissue.

Pneumoconiosis is a lung disease that affects miners, builders, and other workers who breathe in certain kinds of dust on the job.

Over time, the dust gathers in your lungs, and you may find it hard to get enough air.

You may hear other people call pneumoconiosis “black lung disease” or “popcorn lung.” There’s no cure, but treatments can make it easier for you to breathe and go about your regular activities

TYPE-

The disease appears in different forms, depending on the type of dust you inhale. One of the most common forms is black lung disease, also known as miner’s lung. It’s caused by breathing in coal dust. Another is brown lung, which comes from working around dust from cotton or other fibers. Other types of dusts that can cause pneumoconiosis include silica and asbestos. Diacetyl, the compound used to give movie popcorn its buttery flavor, also can lead to the disease. This is known as popcorn lung. 

Pneumoconiosis can be simple or complicated. Simple pneumoconiosis causes a small amount of scar tissue. The tissue may appear on an X-ray as round, thickened areas called nodules. This type of the disease is sometimes called coal worker pneumoconiosis, or CWP. Complicated pneumoconiosis is known as progressive massive fibrosis, or PMF. Fibrosis means that a lot of scarring is present in the lungs.

For either simple or complicated pneumoconiosis, the damage causes the loss of blood vessels and air sacs in your lungs. The tissues that surround your air sacs and air passages become thick and stiff from scarring. Breathing becomes increasingly difficult. This condition is called interstitial lung disease.

Types of dust that may cause pneumoconiosis include:

• coal dust from drilling into rock when mining
• asbestos fibers, often from insulation or roofing
• cotton dust, usually from textile manufacturing
• silica, often from sand and rock at a foundry
• beryllium, a lightweight metal used in electronics and aerospace industries
• aluminum oxide, cobalt, and talc

CAUSES-

Pneumoconiosis doesn’t show up overnight. It happens after you’ve spent years in a place where you breathe in fine mineral or chemical dust, such as silica, coal dust, or asbestos. When the specks of dust build up in your lungs, the immune system — your body’s defense against germs — swings into action. It sees the dust particles as invaders and tries to destroy them.

Your lung tissue often gets inflamed during this process. As a result, scar tissue may form in your lungs, just as it would after an injury. Since scar tissue is less stretchy than regular lung tissue, it may become harder for you to take a full, deep breath.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

SYMPTOM-

Symptoms of pneumoconiosis often depend on how severe the disease is. Simple CWP may have no or few symptoms and show up only on an X-ray. PMF may cause mild to severe difficulty breathing. Symptoms may include:

• Cough
• Lots of phlegm
• Shortness of breath

DIAGNOSIS-

Many employers offer a routine check for lung diseases, such as a chest X-ray or breathing test, if employees are exposed to harmful dust in the workplace.

If a person has symptoms of pneumoconiosis, a doctor will complete a physical examination and ask about medical history, including whether the person has been exposed to dust particles. A more detailed examination may be carried out by a doctor specializing in the lungs, known as a pulmonologist.

A chest X-ray or CT scan can reveal inflammation, excess fluid, or scarring in the lungs. A test may also be done to check how much oxygen is reaching the blood from the lungs. Sometimes a biopsy may be needed to rule out other diseases.

RISK FACTOR-

There are clear risk factors for pneumoconiosis and a range of jobs that are more likely to bring people into contact with harmful dust.

Some examples of occupations that may bring workers into contact with dust particles that cause pneumoconiosis include:

• plumbers, roofers, and builders who work with asbestos
• coal miners
• textile workers

Working with dust particles does not mean that a person will develop pneumoconiosis. Many steps can be taken to protect workers.

The Occupational Safety and Health Act (OSHA) is a law that instructs employers to make sure that their workplace is “free from recognized hazards,” which includes exposure to harmful dust.

Steps that can be taken to help prevent pneumoconiosis in the workplace include:

• keeping levels of dust down
• ventilating a workspace properly
• providing regular medical examinations
• making sure workers wear a face mask and protective clothing
• washing hands and face before eating or drinking

Being exposed to high levels of dust or working in unsafe conditions for a long time will increase the risk of pneumoconiosis. Smoking can also make someone more vulnerable to developing the condition.

Who’s at risk

Being exposed to dust that can cause  pneumoconiosis, in an everyday setting, is not enough to cause the disease. But you could be at risk if you’ve worked around or directly with these dusts. Studies show that about 16 percent of American coal miners may eventually develop interstitial fibrosis from coal dust. Other dust exposures that may put you at risk include working with asbestos fibers or silica dust. Your risk may also be increased by:

• Smoking
• Being exposed to a high level of dust
• Being exposed for a long time

Complications

The main complication is when simple pneumoconiosis progresses to PMF. These are other possible complications:

• Progressive respiratory failure
• Lung cancer
• Tuberculosis (but this is now rare)
• Heart failure caused by pressure inside the lungs

Prevention

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Prevention is important because the disease cannot be treated or reversed. The Occupational Safety and Health Administration sets standard prevention rules for workers at risk for pneumoconiosis. These are common prevention measures:

• Wearing a mask
• Washing areas of skin that come in contact with dust
• Safe removal of dust from clothing
• Washing your face and hands thoroughly before eating, drinking, or taking any medications
• Not smoking
• Letting your doctor and your employer know about any symptoms of pneumoconiosis
• Getting regular chest X-rays and physical exams

TREATMENT –

There isn’t any treatment that can remove the specks of mineral dust in your lungs. Instead, most treatments try to keep your lungs working.

You may need to stop doing the work that led to your pneumoconiosis. If you’re a smoker, your doctor will recommend you quit to improve your lung health.

Your doctor may prescribe an inhaled medication such as a bronchodilator or corticosteroid. Bronchodilators open up your airways if you have trouble breathing, while corticosteroids can curb airway inflammation.

If your tests show low levels of oxygen in your blood, your doctor may suggest you get “supplemental oxygen therapy.” In this treatment, you breathe in extra oxygen through a mask or prongs in your nose. The oxygen you get this way is stored in a tank or some other kind of device. Some people use this treatment throughout the day, while others may need it only

There isn’t any treatment that can remove the specks of mineral dust in your lungs. Instead, most treatments try to keep your lungs working.

You may need to stop doing the work that led to your pneumoconiosis. If you’re a smoker, your doctor will recommend you quit to improve your lung health.

Your doctor may prescribe an inhaled medication such as a bronchodilator or corticosteroid. Bronchodilators open up your airways if you have trouble breathing, while corticosteroids can curb airway inflammation.

If your tests show low levels of oxygen in your blood, your doctor may suggest you get “supplemental oxygen therapy.” In this treatment, you breathe in extra oxygen through a mask or prongs in your nose. The oxygen you get this way is stored in a tank or some other kind of device. Some people use this treatment throughout the day, while others may need it only

If your tests show low levels of oxygen in your blood, your doctor may suggest you get “supplemental oxygen therapy.” In this treatment, you breathe in extra oxygen through a mask or prongs in your nose. The oxygen you get this way is stored in a tank or some other kind of device. Some people use this treatment throughout the day, while others may need it only at night.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTRODUCTION-

Tuberculosis (TB) is a potentially serious infectious disease that mainly affects your lungs. The bacteria that cause tuberculosis are spread from one person to another through tiny droplets released into the air via coughs and sneezes.

Once rare in developed countries, tuberculosis infections began increasing in 1985, partly because of the emergence of HIV, the virus that causes AIDS. HIV weakens a person’s immune system so it can’t fight the TB germs. In the United States, because of stronger control programs, tuberculosis began to decrease again in 1993, but remains a concern.

Many strains of tuberculosis resist the drugs most used to treat the disease. People with active tuberculosis must take several types of medications for many months to eradicate the infection and prevent development of antibiotic resistance.

CAUSES-

Tuberculosis is caused by bacteria that spread from person to person through microscopic droplets released into the air. This can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings.

Although tuberculosis is contagious, it’s not easy to catch. You’re much more likely to get tuberculosis from someone you live with or work with than from a stranger. Most people with active TB who’ve had appropriate drug treatment for at least two weeks are no longer contagious.

HIV and TB

Since the 1980s, the number of cases of tuberculosis has increased dramatically because of the spread of HIV, the virus that causes AIDS. Infection with HIV suppresses the immune system, making it difficult for the body to control TB bacteria. As a result, people with HIV are many times more likely to get TB and to progress from latent to active disease than are people who aren’t HIV positive.

Drug-resistant TB

Another reason tuberculosis remains a major killer is the increase in drug-resistant strains of the bacterium. Since the first antibiotics were used to fight tuberculosis more than 60 years ago, some TB germs have developed the ability to survive despite medications, and that ability gets passed on to their descendants.

Drug-resistant strains of tuberculosis emerge when an antibiotic fails to kill all of the bacteria it targets. The surviving bacteria become resistant to that particular drug and frequently other antibiotics as well. Some TB bacteria have developed resistance to the most commonly used treatments, such as isoniazid and rifampin.

Some strains of TB have also developed resistance to drugs less commonly used in TB treatment, such as the antibiotics known as fluoroquinolones, and injectable medications including amikacin and capreomycin (Capastat). These medications are often used to treat infections that are resistant to the more commonly used drugs.

Tuberculosis Types

A TB infection doesn’t always mean you’ll get sick. There are two forms of the disease:

• Latent TB. You have the germs in your body, but your immune system keeps them from spreading. You don’t have any symptoms, and you’re not contagious. But the infection is still alive and can one day become active. If you’re at high risk for re-activation — for instance, if you have HIV, you had an infection in the past 2 years, your chest X-ray is unusual, or your immune system is weakened — your doctor will give you medications to prevent active TB.  
• Active TB. The germs multiply and make you sick. You can spread the disease to others. Ninety percent of active cases in adults come from a latent TB infection.

A latent or active TB infection can also be drug-resistant, meaning certain medications don’t work against the bacteria.

SYMPTOM-

Although your body may harbor the bacteria that cause tuberculosis (TB), your immune system usually can prevent you from becoming sick. For this reason, doctors make a distinction between:

• Latent TB. In this condition, you have a TB infection, but the bacteria remain in your body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB infection, isn’t contagious. It can turn into active TB, so treatment is important for the person with latent TB and to help control the spread of TB. An estimated 2 billion people have latent TB.
• Active TB. This condition makes you sick and in most cases can spread to others. It can occur in the first few weeks after infection with the TB bacteria, or it might occur years later.

Signs and symptoms of active TB include:

• Coughing that lasts three or more weeks
• Coughing up blood
• Chest pain, or pain with breathing or coughing
• Unintentional weight loss
• Fatigue
• Fever
• Night sweats
• Chills
• Loss of appetite

Tuberculosis can also affect other parts of your body, including your kidneys, spine or brain. When TB occurs outside your lungs, signs and symptoms vary according to the organs involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine.

When to see a doctor

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

See your doctor if you have a fever, unexplained weight loss, drenching night sweats or a persistent cough. These are often signs of TB, but they can also result from other medical problems. Your doctor can perform tests to help determine the cause.

The Centers for Disease Control and Prevention recommends that people who have an increased risk of tuberculosis be screened for latent TB infection. This recommendation includes people who:

• Have HIV/AIDS
• Use IV drugs
• Are in contact with infected individuals
• Are from a country where TB is common, such as several countries in Latin America, Africa and Asia
• Live or work in areas where TB is common, such as prisons or nursing homes
• Work in health care and treat people with a high risk of TB
• Are children and are exposed to adults at risk of TB

Risk factors

Anyone can get tuberculosis, but certain factors can increase your risk of the disease. These factors include:

Weakened immune system

A healthy immune system often successfully fights TB bacteria, but your body can’t mount an effective defense if your resistance is low. A number of diseases, conditions and medications can weaken your immune system, including:

• HIV/AIDS
• Diabetes
• Severe kidney disease
• Certain cancers
• Cancer treatment, such as chemotherapy
• Drugs to prevent rejection of transplanted organs
• Some drugs used to treat rheumatoid arthritis, Crohn’s disease and psoriasis
• Malnutrition
• Very young or advanced age

Traveling or living in certain areas

The risk of contracting tuberculosis is higher for people who live in or travel to areas that have high rates of tuberculosis and drug-resistant tuberculosis, including:

• Africa
• Eastern Europe
• Asia
• Russia
• Latin America
• Caribbean Islands

Poverty and substance use

• Lack of medical care. If you receive a low or fixed income, live in a remote area, have recently immigrated to the United States, or are homeless, you may lack access to the medical care needed to diagnose and treat TB.
• Substance use. Use of IV drugs or excessive alcohol weakens your immune system and makes you more vulnerable to tuberculosis.
• Tobacco use. Using tobacco greatly increases the risk of getting TB and dying of it.

Where you work or live

• Health care work. Regular contact with people who are ill increases your chances of exposure to TB bacteria. Wearing a mask and frequent hand-washing greatly reduce your risk.
• Living or working in a residential care facility. People who live or work in prisons, homeless shelters, psychiatric hospitals or nursing homes are all at a higher risk of tuberculosis. That’s because the risk of the disease is higher anywhere there is overcrowding and poor ventilation.
• Living in or emigrating from a country where TB is common. People from a country where TB is common may be at high risk of tuberculosis infection.
• Living with someone infected with TB. Living with someone who has TB increases your risk.

Complications

Without treatment, tuberculosis can be fatal. Untreated active disease typically affects your lungs, but it can spread to other parts of your body through your bloodstream. Examples of tuberculosis complications include:

• Spinal pain. Back pain and stiffness are common complications of tuberculosis.
• Joint damage. Tuberculous arthritis usually affects the hips and knees.
• Swelling of the membranes that cover your brain (meningitis). This can cause a lasting or intermittent headache that occurs for weeks. Mental changes also are possible.
• Liver or kidney problems. Your liver and kidneys help filter waste and impurities from your bloodstream. These functions become impaired if the liver or kidneys are affected by tuberculosis.
• Heart disorders. Rarely, tuberculosis can infect the tissues that surround your heart, causing inflammation and fluid collections that may interfere with your heart’s ability to pump effectively. This condition, called cardiac tamponade, can be fatal.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Prevention

If you test positive for latent TB infection, your doctor may advise you to take medications to reduce your risk of developing active tuberculosis. The only type of tuberculosis that is contagious is the active variety, when it affects the lungs. So if you can prevent your latent tuberculosis from becoming active, you won’t transmit tuberculosis to anyone else.

Protect your family and friends

If you have active TB, keep your germs to yourself. It generally takes a few weeks of treatment with TB medications before you’re not contagious anymore. Follow these tips to help keep your friends and family from getting sick:

• Stay home. Don’t go to work or school or sleep in a room with other people during the first few weeks of treatment for active tuberculosis.
• Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn’t move. If it’s not too cold outdoors, open the windows and use a fan to blow indoor air outside.
• Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away.
• Wear a mask. Wearing a surgical mask when you’re around other people during the first three weeks of treatment may help lessen the risk of transmission.

Finish your entire course of medication

This is the most important step you can take to protect yourself and others from tuberculosis. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that allow them to survive the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat.

Vaccinations

In countries where tuberculosis is more common, infants often are vaccinated with bacillus Calmette-Guerin (BCG) vaccine because it can prevent severe tuberculosis in children. The BCG vaccine isn’t recommended for general use in the United States because it isn’t very effective in adults. Dozens of new TB vaccines are in various stages of development and testing.

TRANSMISSION-

When someone who has TB coughs, sneezes, talks, laughs, or sings, they release tiny droplets that contain the germs. If you breathe in these germs, you can get it.

TB isn’t easy to catch. You usually have to spend a long time around someone who has a lot of the bacteria in their lungs. You’re most likely to catch it from co-workers, friends, and family members.

Tuberculosis germs don’t thrive on surfaces. You can’t get it from shaking hands with someone who has it or by sharing their food or drink. 

Tuberculosis Tests and Diagnosis

There are two common tests for tuberculosis:

• Skin test. This is also known as the Mantoux tuberculin skin test. A technician injects a small amount of fluid into the skin of your lower arm. After 2 or 3 days, they’ll check for swelling in your arm. If your results are positive, you probably have TB bacteria. But you could also get a false positive. If you’ve gotten a tuberculosis vaccine called bacillus Calmette-Guerin (BCG), the test could say that you have TB when you really don’t. The results can also be false negative, saying that you don’t have TB when you really do, if you have a very new infection. You might get this test more than once.
• Blood test. These tests, also called interferon-gamma release assays (IGRAs), measure the response when TB proteins are mixed with a small amount of your blood.

Those tests don’t tell you if your infection is latent or active. If you get a positive skin or blood test, your doctor will learn which type you have with:

• A chest X-ray or CT scan to look for changes in your lungs
• Acid-fast bacillus (AFB) tests for TB bacteria in your sputum, the mucus that comes up when you cough

---

Tuberculosis Treatment

Your treatment will depend on your infection.

• If you have latent TB, your doctor will give you medication to kill the bacteria so the infection doesn’t become active. You might get isoniazid, rifapentine, or rifampin, either alone or combined. You’ll have to take the drugs for up to 9 months. If you see any signs of active TB, call your doctor right away.
• A combination of medicines also treats active TB. The most common are ethambutol, isoniazid, pyrazinamide, and rifampin. You’ll take them for 6 to 12 months.
• If you have drug-resistant TB, your doctor might give you one or more different medicines. You may have to take them for much longer, up to 30 months, and they can cause more side effects.

Whatever kind of infection you have, it’s important to finish taking all of your medications, even when you feel better. If you quit too soon, the bacteria can become resistant to the drugs.

Tuberculosis Medication Side Effects

Like any medication, TB drugs can have side effects–

Common isoniazid side effects include:

• Numbness and tingling in your hands and feet
• Upset stomach, nausea, and vomiting
• Loss of appetite
• Weakness

Ethambutol side effects may include:

• Chills
• Painful or swollen joints
• Belly pain, nausea, and vomiting
• Loss of appetite
• Headache
• Confusion

Some pyrazinamide side effects include:

• Lack of energy
• Nausea and vomiting
• Loss of appetite
• Muscle or joint pain

Common rifampin side effects include:

• Skin rash
• Upset stomach, nausea, and vomiting
• Diarrhea
• Loss of appetite
• Inflamed pancreas

Tuberculosis Complications

Tuberculosis infection can cause complications such as:

• Joint damage
• Lung damage
• Infection or damage of your bones, spinal cord, brain, or lymph nodes
• Liver or kidney problems
• Inflammation of the tissues around your heart

Global commitments and the WHO response

On 26 September 2018, the United Nations (UN) held its first- ever high-level meeting on TB, elevating discussion about the status of the TB epidemic and how to end it to the level of heads of state and government. It followed the first global ministerial conference on TB hosted by WHO and the Russian government in November 2017. The outcome was a political declaration agreed by all UN Member States, in which existing commitments to the Sustainable Development Goals (SDGs) and WHO’s End TB Strategy were reaffirmed, and new ones added.

SDG Target 3.3 includes ending the TB epidemic by 2030. The End TB Strategy defines milestones (for 2020 and 2025) and targets (for 2030 and 2035) for reductions in TB cases and deaths. The targets for 2030 are a 90% reduction in the number of TB deaths and an 80% reduction in the TB incidence rate (new cases per 100 000 population per year) compared with levels in 2015. The milestones for 2020 are a 35% reduction in the number of TB deaths and a 20% reduction in the TB incidence rate. The strategy also includes a 2020 milestone that no TB patients and their households face catastrophic costs as a result of TB disease.

The political declaration of the UN high-level meeting included four new global targets:

• treat 40 million people for TB disease in the 5-year period 2018–2022;
• reach at least 30 million people with TB preventive treatment for a latent TB infection in the 5-year period 2018–2022;
• mobilize at least US$ 13 billion annually for universal access to TB diagnosis, treatment and care by 2022;
• mobilize at least US$ 2 billion annually for TB research.

The political declaration also requested the UN Secretary-General, with support from WHO, to provide a report in 2020 to the General Assembly on global and national progress, as the basis for a comprehensive review at a high-level meeting in 2023. The Director-General of WHO was requested to continue to develop a multisectoral accountability framework for TB (MAF-TB) and to ensure its timely implementation.

WHO is working closely with countries, partners and civil society in scaling up

the TB response. Six core functions are being pursued by WHO to contribute to achieving the targets of the UN high-level meeting political declaration, SDGs, End TB Strategy and WHO strategic priorities:

• Providing global leadership to end TB through strategy development, political and multisectoral engagement, strengthening review and accountability, advocacy, and partnerships, including with civil society;

• Shaping the TB research and innovation agenda and stimulating the generation, translation and dissemination of knowledge;
• Setting norms and standards on TB prevention and care and promoting and facilitating their implementation;
• Developing and promoting ethical and evidence-based policy options for TB prevention and care;
• Ensuring the provision of specialized technical support to Member States and partners jointly with WHO regional and country offices, catalyzing change, and building sustainable capacity;
• Monitoring and reporting on the status of the TB epidemic and progress in financing and implementation of the response at global, regional and country levels.

Mycobacterium tuberculosis

Mycobacterium tuberculosis is the etiologic agent of tuberculosis  in humans. Humans are the only reservoir for the bacterium.

Mycobacterium bovis is the etiologic agent of TB in cows and rarely in humans. Both cows and humans can serve as reservoirs. Humans can also be infected by the consumption of unpasteurized milk. This route of transmission can lead to the development of extrapulmonary TB, exemplified in history by bone infections that led to hunched backs.

Other human pathogens belonging to the Mycobacterium genus include Mycobacterium avium which causes a TB-like disease especially prevalent in AIDS patients, and Mycobacterium leprae, the causative agent of leprosy.

History and Present Day Importance

Mycobacterium tuberculosis (MTB) was the cause of the “White Plague” of the 17th and 18th centuries in Europe. During this period nearly 100 percent  of the European population was infected with MTB, and 25 percent of all adult deaths were caused by MTB (Note: The White Plague is not to be confused with the “Black Plague”, which was caused by Yersinia pestis and occurred about 3 centuries earlier).

General Characteristics

Mycobacterium tuberculosis is a fairly large nonmotile rod-shaped bacterium distantly related to the Actinomycetes. Many non pathogenic mycobacteria are components of the normal flora of humans, found most often in dry and oily locales. The rods are 2-4 micrometers in length and 0.2-0.5 um in width.

Mycobacterium tuberculosis is an obligate aerobe. For this reason, in the classic case of tuberculosis, MTB complexes are always found in the well-aerated upper lobes of the lungs. The bacterium is a facultative intracellular parasite, usually of macrophages, and has a slow generation time, 15-20 hours, a physiological characteristic that may contribute to its virulence.

Two media are used to grow MTB Middlebrook’s medium which is an agar based medium and Lowenstein-Jensen medium which is an egg based medium. MTB colonies are small and buff colored when grown on either medium. Both types of media contain inhibitors to keep contaminants from out-growing MT. It takes 4-6 weeks to get visual colonies on either type of media.

Chains of cells in smears made from in vitro-grown colonies often form distinctive serpentine cords. This observation was first made by Robert Koch who associated cord factor with virulent strains of the bacterium.

MTB is not classified as either Gram-positive  or Gram-negative because it does not have the chemical characteristics of either, although the bacteria do contain peptidoglycan (murein) in their cell wall. If a Gram stain is performed on MTB, it stains very weakly Gram-positive or not at all (cells referred to as “ghosts”).

Mycobacterium species, along with members of a related genus Nocardia, are classified as acid-fast bacteria due to their impermeability by certain dyes and stains. Despite this, once stained, acid-fast bacteria will retain dyes when heated and treated with acidified organic compounds. One acid-fast staining method for Mycobacterium tuberculosis is the Ziehl-Neelsen stain. When this method is used, the MTB. smear is fixed, stained with carbol-fuchsin (a pink dye), and decolorized with acid-alcohol. The smear is counterstained with methylene-blue or certain other dyes. Acid-fast bacilli appear pink in a contrasting background.

In order to detect Mycobacterium tuberculosis in a sputum sample, an excess of 10,000 organisms per ml of sputum are needed to visualize the bacilli with a 100X microscope objective (1000X mag). One acid-fast bacillus/slide is regarded as “suspicious” of an MTB infection.

The Disease Tuberculosis

TB infection means that MTB is in the body, but the immune system is keeping the bacteria under control. The immune system does this by producing macrophages that surround the tubercle bacilli. The cells form a hard shell that keeps the bacilli contained and under control. Most people with TB infection have a positive reaction to the tuberculin skin test.  People who have TB infection but not TB disease are NOT infectious, i.e., they cannot spread the infection to other people. These people usually have a normal  chest x-ray. TB infection is not considered a case of TB disease. Major similarities and differences between TB infection and TB disease are given in the table below.
Tuberculosis: Infection vs Disease

TB Infection	TB disease in lungs
MTB present	MTB present
Tuberculin skin test positive	Tuberculin skin test positive
Chest X-ray normal	Chest X-ray usually reveals lesion
Sputum smears and cultures negative	Sputum smears and cultures positive
No symptoms	Symptoms such as cough, fever, weight loss
Not infectious	Often infectious before treatment
Not defined as a case of TB	Defined as a case of TB

Predisposing factors for TB infection include:
– Close contact with large populations of people, i.e., schools, nursing homes, dormitories, prisons, etc.
– Poor nutrition
– iv drug use
– Alcoholism
– HIV infection is the #1 predisposing factor for MTB infection. 10 percent of all HIV-positive individuals harbor MTB. This is 400-times the rate associated with the general public

Only 3-4% of infected individuals will develop active disease upon initial infection, 5-10% within one year. These percentages are much higher if the individual is HIV+.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It’s typically caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions.

Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. These two conditions usually occur together and can vary in severity among individuals with COPD.

Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It’s characterized by daily cough and mucus (sputum) production.

Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter.

Although COPD is a progressive disease that gets worse over time, COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions.

CAUSES-

In developed countries like the United States, the single biggest cause of COPD is cigarette smoking. About 90 percent of people who have COPD are smokers or former smokers.

Among long-time smokers, 20 to 30 percent develop COPD. Many others develop lung conditions or have reduced lung function.

Most people with COPD are at least 40 years old and have at least some history of smoking. The longer and more tobacco products you smoke, the greater your risk of COPD is. In addition to cigarette smoke, cigar smoke, pipe smoke, and secondhand smoke can cause COPD.

Your risk of COPD is even greater if you have asthma and smoke.

You can also develop COPD if you’re exposed to chemicals and fumes in the workplace. Long-term exposure to air pollution and inhaling dust can also cause COPD.

In developing countries, along with tobacco smoke, homes are often poorly ventilated, forcing families to breathe fumes from burning fuel used for cooking and heating.

There may be a genetic predisposition to developing COPD. Up to an estimated 5 percent of people with COPD have a deficiency in a protein called alpha-1-antitrypsin. This deficiency causes the lungs to deteriorate and also can affect the liver. There may be other associated genetic factors at play as well.

COPD isn’t contagious.

SYMPTOMS-

COPD makes it harder to breathe. Symptoms may be mild at first, beginning with intermittent coughing and shortness of breath. As it progresses, symptoms can become more constant to where it can become increasingly difficult to breathe.

You may experience wheezing and tightness in the chest or have excess sputum production. Some people with COPD have acute exacerbations, which are flare-ups of severe symptoms.

At first, symptoms of COPD can be quite mild. You might mistake them for a cold.

Early symptoms include:

• occasional shortness of breath, especially after exercise
• mild but recurrent cough
• needing to clear your throat often, especially first thing in the morning

You might start making subtle changes, such as avoiding stairs and skipping physical activities.

Symptoms can get progressively worse and harder to ignore. As the lungs become more damaged, you may experience:

• shortness of breath, after even mild exercise such as walking up a flight of stairs
• wheezing, which is a type of higher pitched noisy breathing, especially during exhalations
• chest tightness
• chronic cough, with or without mucus
• need to clear mucus from your lungs every day
• frequent colds, flu, or other respiratory infections
• lack of energy

In later stages of COPD, symptoms may also include:

• fatigue
• swelling of the feet, ankles, or legs
• weight loss

Immediate medical care is needed if:

• you have bluish or gray fingernails or lips, as this indicates low oxygen levels in your blood
• you have trouble catching your breath or cannot talk
• you feel confused, muddled, or faint
• your heart is racing

Symptoms are likely to be much worse if you currently smoke or are regularly exposed to secondhand smoke.

When to see a doctor

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Talk to your doctor if your symptoms are not improving with treatment or getting worse, or if you notice symptoms of an infection, such as fever or a change in sputum.

Seek immediate medical care if you can’t catch your breath, if you experience severe blueness of your lips or fingernail beds (cyanosis) or a rapid heartbeat, or if you feel foggy and have trouble concentrating.

Risk factors

Risk factors for COPD include:

• Exposure to tobacco smoke. The most significant risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and marijuana smokers also may be at risk, as well as people exposed to large amounts of secondhand smoke.
• People with asthma. Asthma, a chronic inflammatory airway disease, may be a risk factor for developing COPD. The combination of asthma and smoking increases the risk of COPD even more.
• Occupational exposure to dusts and chemicals. Long-term exposure to chemical fumes, vapors and dusts in the workplace can irritate and inflame your lungs.
• Exposure to fumes from burning fuel. In the developing world, people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes are at higher risk of developing COPD.
• Genetics. The uncommon genetic disorder alpha-1-antitrypsin deficiency is the cause of some cases of COPD. Other genetic factors likely make certain smokers more susceptible to the disease.

Complications

COPD can cause many complications, including:

• Respiratory infections. People with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue.
• Heart problems. For reasons that aren’t fully understood, COPD can increase your risk of heart disease, including heart attack
• Lung cancer. People with COPD have a higher risk of developing lung cancer.
• High blood pressure in lung arteries. COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension).
• Depression. Difficulty breathing can keep you from doing activities that you enjoy. And dealing with serious illness can contribute to the development of depression.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Prevention

Unlike some diseases, COPD typically has a clear cause and a clear path of prevention, and there are ways to slow the progression of the disease. The majority of cases are directly related to cigarette smoking, and the best way to prevent COPD is to never smoke — or to stop smoking now.

If you’re a longtime smoker, these simple statements may not seem so simple, especially if you’ve tried quitting — once, twice or many times before. But keep trying to quit. It’s critical to find a tobacco cessation program that can help you quit for good. It’s your best chance for reducing damage to your lungs.

Occupational exposure to chemical fumes and dusts is another risk factor for COPD. If you work with these types of lung irritants, talk to your supervisor about the best ways to protect yourself, such as using respiratory protective equipment.

Here are some steps you can take to help prevent complications associated with COPD:

• Quit smoking to help reduce your risk of heart disease and lung cancer.
• Get an annual flu vaccination and regular vaccination against pneumococcal pneumonia to reduce your risk of or prevent some infections.
• Talk to your doctor if you feel sad or helpless or think that you may be experiencing depression.

TREATMENT

Treatment can ease symptoms, prevent complications, and generally slow disease progression. Your healthcare team may include a lung specialist (pulmonologist) and physical and respiratory therapists.

Medication

Bronchodilators are medications that help relax the muscles of the airways, widening the airways so you can breathe easier. They’re usually taken through an inhaler or a nebulizer. Glucocorticosteroids can be added to reduce inflammation in the airways.

To lower risk of other respiratory infections, ask your doctor if you should get a yearly flu shot, pneumococcal vaccine, and a tetanus booster that includes protection from pertussis (whooping cough).

Oxygen therapy

If your blood oxygen level is too low, you can receive supplemental oxygen through a mask or nasal cannula to help you breathe better. A portable unit can make it easier to get around.

Surgery

Surgery is reserved for severe COPD or when other treatments have failed, which is more likely when you have a form of severe emphysema.

One type of surgery is called bullectomy. During this procedure, surgeons remove large, abnormal air spaces (bullae) from the lungs.

Another is lung volume reduction surgery, which removes damaged upper lung tissue.

Lung transplantation is an option in some cases.

Lifestyle changes

Certain lifestyle changes may also help alleviate your symptoms or provide relief.

• If you smoke, quit. Your doctor can recommend appropriate products or support services.
• Whenever possible, avoid secondhand smoke and chemical fumes.
• Get the nutrition your body needs. Work with your doctor or dietician to create a healthy eating plan.
• Talk to your doctor about how much exercise is safe for you.

Medications for COPD

Medications can reduce symptoms and cut down on flare-ups. It may take some trial and error to find the medication and dosage that works best for you. These are some of your options:

Inhaled bronchodilators

Medicines called bronchodilators help loosen tight muscles of your airways. They’re typically taken through an inhaler or nebulizer.

Short-acting bronchodilators last from four to six hours. You only use them when you need them. For ongoing symptoms, there are long-acting versions you can use every day. They last about 12 hours.

Some bronchodilators are selective beta-2-agonists, and others are anticholinergics. These bronchodilators work by relaxing tightened muscles of the airways, which widens your airways for better air passage. They also help your body clear mucus from the lungs. These two types of bronchodilators can be taken separately or in combination by inhaler or with a nebulizer.

Corticosteroids

Long-acting bronchodilators are commonly combined with inhaled glucocorticosteroids. A glucocorticosteroid can reduce inflammation in the airways and lower mucus production. The long-acting bronchodilator can relax the airway muscle to help the airways stay wider. Corticosteroids are also available in pill form.

Phosphodiesterase-4 inhibitors

This type of medication can be taken in pill form to help reduce inflammation and relax the airways. It’s generally prescribed for severe COPD with chronic bronchitis.

Theophylline

This medication eases chest tightness and shortness of breath. It may also help prevent flare-ups. It’s available in pill form. Theophylline is an older medication that relaxes the muscle of the airways, and it may cause side effects. It’s generally not a first-line treatment for COPD therapy.

Antibiotics and antivirals

Antibiotics or antivirals may be prescribed when you develop certain respiratory infections.

Vaccines

COPD increases your risk of other respiratory problems. For that reason, your doctor might recommend that you get a yearly flu shot, the pneumococcal vaccine, or the whooping cough vaccine

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTRODUCTION-

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.

Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.

Pneumonia is a lung infection that can range from mild to so severe that you have to go to the hospital.

It happens when an infection causes the air sacs in your lungs (your doctor will call them alveoli) to fill with fluid or pus. That can make it hard for you to breathe in enough oxygen to reach your bloodstream.

Anyone can get this lung infection. But infants younger than age 2 and people over age 65 are at higher risk. That’s because their immune systems might not be strong enough to fight it.

You can get pneumonia in one or both lungs. You can also have it and not know it. Doctors call this walking pneumonia. Causes include bacteria, viruses, and fungi.  If your pneumonia results from bacteria or a virus, you can spread it to someone else. 

Lifestyle habits, like smoking cigarettes and drinking too much alcohol, can also raise your chances of getting pneumonia.

CAUSES-

Many germs can cause pneumonia. The most common are bacteria and viruses in the air we breathe. Your body usually prevents these germs from infecting your lungs. But sometimes these germs can overpower your immune system, even if your health is generally good.

Pneumonia is classified according to the types of germs that cause it and where you got the infection.

Community-acquired pneumonia

Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals or other health care facilities. It may be caused by:

• Bacteria. The most common cause of bacterial pneumonia in the U.S. is Streptococcus pneumoniae. This type of pneumonia can occur on its own or after you’ve had a cold or the flu. It may affect one part (lobe) of the lung, a condition called lobar pneumonia.
• Bacteria-like organisms. Mycoplasma pneumoniae also can cause pneumonia. It typically produces milder symptoms than do other types of pneumonia. Walking pneumonia is an informal name given to this type of pneumonia, which typically isn’t severe enough to require bed rest.
• Fungi. This type of pneumonia is most common in people with chronic health problems or weakened immune systems, and in people who have inhaled large doses of the organisms. The fungi that cause it can be found in soil or bird droppings and vary depending upon geographic location.
• Viruses, including COVID-19. Some of the viruses that cause colds and the flu can cause pneumonia. Viruses are the most common cause of pneumonia in children younger than 5 years. Viral pneumonia is usually mild. But in some cases it can become very serious. Coronavirus 2019 (COVID-19) may cause pneumonia, which can become severe.

Hospital-acquired pneumonia

Some people catch pneumonia during a hospital stay for another illness. Hospital-acquired pneumonia can be serious because the bacteria causing it may be more resistant to antibiotics and because the people who get it are already sick. People who are on breathing machines (ventilators), often used in intensive care units, are at higher risk of this type of pneumonia.

Health care-acquired pneumonia

Health care-acquired pneumonia is a bacterial infection that occurs in people who live in long-term care facilities or who receive care in outpatient clinics, including kidney dialysis centers. Like hospital-acquired pneumonia, health care-acquired pneumonia can be caused by bacteria that are more resistant to antibiotics.

Aspiration pneumonia

Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs. Aspiration is more likely if something disturbs your normal gag reflex, such as a brain injury or swallowing problem, or excessive use of alcohol or drug.

There are several types of infectious agents that can cause pneumonia.

Bacterial pneumonia

The most common cause of bacterial pneumonia is Streptococcus pneumoniae. Other causes include:

• Mycoplasma pneumoniae
• Haemophilus influenzae
• Legionella pneumophila

Viral pneumonia

Respiratory viruses are often the cause of pneumonia. Some examples include:

• influenza (flu)
• respiratory syncytial virus (RSV)
• rhinoviruses (common cold)

Viral pneumonia is usually milder and can improve in one to three weeks without treatment.

Fungal pneumonia

Fungi from soil or bird droppings can cause pneumonia. They most often cause pneumonia in people with weakened immune systems. Examples of fungi that can cause pneumonia include:

• Pneumocystis jirovecii
• Cryptococcus species
• Histoplasmosis species

Types of pneumonia

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Pneumonia can also be classified according to where or how it was acquired.

Hospital-acquired pneumonia (HAP)

This type of bacterial pneumonia is acquired during a hospital stay. It can be more serious than other types, as the bacteria involved may be more resistant to antibiotics.

Community-acquired pneumonia (CAP)

Community-acquired pneumonia (CAP) refers to pneumonia that’s acquired outside of a medical or institutional setting.

Ventilator-associated pneumonia (VAP)

When people who are using a ventilator get pneumonia, it’s called VAP.

Aspiration pneumonia

Aspiration pneumonia happens when you inhale bacteria into your lungs from food, drink, or saliva. This type is more likely to occur if you have a swallowing problem or if you’re too sedate from the use of medications, alcohol, or other drugs.

SYMPTOM

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

The signs and symptoms of pneumonia vary from mild to severe, depending on factors such as the type of germ causing the infection, and your age and overall health. Mild signs and symptoms often are similar to those of a cold or flu, but they last longer.

Signs and symptoms of pneumonia may include:

• Chest pain when you breathe or cough
• Confusion or changes in mental awareness (in adults age 65 and older)
• Cough, which may produce phlegm
• Fatigue
• Fever, sweating and shaking chills
• Lower than normal body temperature (in adults older than age 65 and people with weak immune systems)
• Nausea, vomiting or diarrhea
• Shortness of breath

Newborns and infants may not show any sign of the infection. Or they may vomit, have a fever and cough, appear restless or tired and without energy, or have difficulty breathing and eating.

DIAGNOSIS-

Your doctor will start with questions about your symptoms and your medical history, like whether you smoke and whether you’ve been around sick people at home, school, or work. Then, they’ll listen to your lungs. If you have pneumonia, they might hear cracking, bubbling, or rumbling sounds when you breathe in.

If your doctor thinks you might have pneumonia, they’ll probably give you tests, including:

• Blood tests to look for signs of a bacterial infection
• A chest X-ray to find the infection in your lungs and how far it’s spread
• Pulse oximetry to measure the level of oxygen in your blood
• A sputum test to check the fluid in your lungs for the cause of an infection

If your symptoms started in the hospital or you have other health problems, your doctor might give you more tests, such as:

• An arterial blood gas test to measure the oxygen in a small amount of blood taken from one of your arteries
• Bronchoscopy to check your airways for blockages or other problems
• A CT scan to get a more detailed image of your lungs
• A pleural fluid culture, in which the doctor removes a small amount of fluid from the tissues around your lungs to look for bacteria that might cause pneumonia.

When to see a doctor

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

See your doctor if you have difficulty breathing, chest pain, persistent fever of 102 F (39 C) or higher, or persistent cough, especially if you’re coughing up pus.

It’s especially important that people in these high-risk groups see a doctor:

• Adults older than age 65
• Children younger than age 2 with signs and symptoms
• People with an underlying health condition or weakened immune system
• People receiving chemotherapy or taking medication that suppresses the immune system

For some older adults and people with heart failure or chronic lung problems, pneumonia can quickly become a life-threatening condition.

Risk factors

Pneumonia can affect anyone. But the two age groups at highest risk are:

• Children who are 2 years old or younger
• People who are age 65 or older

Other risk factors include:

• Being hospitalized. You’re at greater risk of pneumonia if you’re in a hospital intensive care unit, especially if you’re on a machine that helps you breathe (a ventilator).
• Chronic disease. You’re more likely to get pneumonia if you have asthma, chronic obstructive pulmonary disease (COPD) or heart disease.
• Smoking. Smoking damages your body’s natural defenses against the bacteria and viruses that cause pneumonia.
• Weakened or suppressed immune system. People who have HIV/AIDS, who’ve had an organ transplant, or who receive chemotherapy or long-term steroids are at risk.

Complications

Even with treatment, some people with pneumonia, especially those in high-risk groups, may experience complications, including:

• Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from your lungs can spread the infection to other organs, potentially causing organ failure.
• Difficulty breathing. If your pneumonia is severe or you have chronic underlying lung diseases, you may have trouble breathing in enough oxygen. You may need to be hospitalized and use a breathing machine (ventilator) while your lung heals.
• Fluid accumulation around the lungs (pleural effusion). Pneumonia may cause fluid to build up in the thin space between layers of tissue that line the lungs and chest cavity (pleura). If the fluid becomes infected, you may need to have it drained through a chest tube or removed with surgery.
• Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is usually treated with antibiotics. Sometimes, surgery or drainage with a long needle or tube placed into the abscess is needed to remove the pus.

Prevention

To help prevent pneumonia:

• Get vaccinated. Vaccines are available to prevent some types of pneumonia and the flu. Talk with your doctor about getting these shots. The vaccination guidelines have changed over time so make sure to review your vaccination status with your doctor even if you recall previously receiving a pneumonia vaccine.
• Make sure children get vaccinated. Doctors recommend a different pneumonia vaccine for children younger than age 2 and for children ages 2 to 5 years who are at particular risk of pneumococcal disease. Children who attend a group child care center should also get the vaccine. Doctors also recommend flu shots for children older than 6 months.
• Practice good hygiene. To protect yourself against respiratory infections that sometimes lead to pneumonia, wash your hands regularly or use an alcohol-based hand sanitizer.
• Don’t smoke. Smoking damages your lungs’ natural defenses against respiratory infections.
• Keep your immune system strong. Get enough sleep, exercise regularly and eat a healthy diet.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

TREATMENT

Your doctor can tell you which treatment is right for you.

If you have bacterial pneumonia, you’ll get antibiotics. Make sure you take all of the medicine your doctor gives you, even if you start to feel better before you’re through with it.

If you have viral pneumonia, antibiotics won’t help. You’ll need to rest, drink a lot of fluids, and take medicine for your fever.

If your symptoms are severe or if you have other conditions that make you more likely to have complications, your doctor may send you to the hospital. 

With any kind of pneumonia, recovery will take time. You’re going to need lots of rest. You might need a week off your usual routines, and you could still feel tired for a month.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

INTRODUCTION-

Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever. The heart valve damage may start shortly after untreated or under-treated streptococcal infection such as strep throat or scarlet fever. An immune response causes an inflammatory condition in the body which can result in on-going valve damage.

Rheumatic heart disease is a condition where the heart valves have been permanently damaged by rheumatic fever. The heart valve damage may start shortly after untreated or under-treated streptococcal infection such as strep throat or scarlet fever. An immune response causes an inflammatory condition in the body. This can result in ongoing valve damage.

CAUSES-

heumatic heart disease is caused by rheumatic fever. This is an inflammatory disease that can affect many connective tissues, especially in the heart, joints, skin, or brain. The heart valves can be inflamed and become scarred over time. This can result in narrowing or leaking of the heart valve. This makes it harder for the heart to work normally. This may take years to develop and can lead to heart failure. Rheumatic fever can occur at any age. But it often occurs in children ages 5 to 15. It’s rare in developed countries like the U.S.

SYMPTOM-

A recent history of strep infection or rheumatic fever is key to the diagnosis of rheumatic heart disease. Symptoms of rheumatic fever vary and typically begin 1 to 6 weeks after a bout of strep throat. In some cases, the infection may have been too mild to have been recognized, or it may be gone by the time the person sees a doctor.

These are the most common symptoms of rheumatic fever:

• Fever
• Swollen, tender, red and extremely painful joints — particularly the knees and ankles
• Nodules (lumps under the skin)
• Red, raised, lattice-like rash, usually on the chest, back, and abdomen
• Shortness of breath and chest discomfort
• Uncontrolled movements of arms, legs, or facial muscles
• Weakness

Symptoms of rheumatic heart disease depend on the degree of valve damage and may include:

• Shortness of breath (especially with activity or when lying down)
• Chest pain
• Swelling

DIAGNOSIS-

People with rheumatic heart disease will have or recently had a strep infection. A throat culture or blood test may be used to check for strep.

They may have a murmur or rub that may be heard during a routine physical exam. The murmur is caused by the blood leaking around the damages valve. The rub is caused when the inflamed heart tissues move or rub against each other.

Along with a complete health history and physical exam, tests used to diagnose rheumatic heart disease may include:

• Echocardiogram (echo). This test uses sound waves to check the heart’s chambers and valves. The echo sound waves create a picture on a screen as a handheld ultrasound probe (transducer) is passed over the skin over the heart. Echo can show damage to the valve flaps, backflow of blood through a leaky valve, fluid around the heart, and heart enlargement. It’s the most useful test for diagnosing heart valve problems. For more in-depth pictures you may be given sedation and the probe is put into the throat (transesophageal echo or TEE).
• Electrocardiogram (ECG). This test records the strength and timing of the heart’s electrical activity. It shows abnormal rhythms (arrhythmias or dysrhythmias). And it can sometimes find heart muscle damage. Small sensors are taped to your skin to pick up the electrical activity.
• Chest X-ray. An X-ray may be done to check your lungs and see if your heart is enlarged.
• Cardiac MRI. This is an imaging test that takes detailed pictures of the heart. It may be used to get a more exact look at the heart valves and heart muscle.
• Blood tests. Certain blood tests may be used to look for infection and inflammation.

RISK FACTOR-

Untreated or under-treated strep infections can increase the risk for rheumatic heart disease. Children who get repeated strep throat infections are at the most risk for rheumatic fever and rheumatic heart disease.

COMPLICATION –

Some complications of rheumatic heart disease include:

• Heart failure. This can occur from either a severely narrowed or leaking heart valve.
• Bacterial endocarditis. This is an infection of the inner lining of the heart, and may occur when rheumatic fever has damaged the heart valves.
• Complications of pregnancy and delivery due to heart damage. Women with rheumatic heart disease should discuss their condition with their healthcare provider before getting pregnant.
• Ruptured heart valve. This is a medical emergency that must be treated with surgery to replace or repair the heart valve.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

PREVENTION-

Rheumatic heart disease can be prevented by preventing strep infections. Or by treating them with antibiotics when they do occur. It’s important to take antibiotics as prescribed. Always finish taking them as instructed, even if you feel better after a few days.

TREATMENT

Treatment depends in large part on how much damage has been done to the heart valves. In severe cases, treatment may include surgery to replace or repair a badly damaged valve.

The best treatment is to prevent rheumatic fever. Antibiotics can usually treat strep infections and keep rheumatic fever from developing. Anti-inflammatory drugs may be used to reduce inflammation and lower the risk of heart damage. Other medicines may be needed to manage heart failure.

People who have had rheumatic fever are often given daily or monthly antibiotic treatments, possibly for life, to prevent recurrent infections and lower the risk of further heart damage. To reduce inflammation, aspirin, steroids, or non-steroidal medicines may be given.

PHYSICAL THERAPY

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Medical rehabilitation, including physical and occupational therapy, can help you do daily activities while managing a rheumatic condition. A rehabilitation program tailored to your condition and needs allows you improve your strength and flexibility and the movement of your joints and muscles – all with less pain and stiffness. Such a program will not cure a rheumatic condition, but it can help you become better able to function and more independent.

Anyone who is experiencing pain, spasms, swelling or stiffness that is reducing the ability to function, the range of motion, strength or endurance, should consult a rehabilitation therapist. Seeing a physical or occupational therapist with special training in treating rheumatic diseases can be particularly helpful.

An appropriate rehabilitation program is essential for almost all persons with rheumatic diseases. It is most effective for conditions that involve the muscles or joints. The rheumatologists at Cedars-Sinai are well versed in the type of rehabilitation programs available and which ones best suit each patient and his or her condition.

A consultation with a rehabilitation therapist usually begins with an examination that will include:

• Touching or manipulating muscles that are having spasms
• Assessing range of movement, flexibility and strength
• Analyzing movement and gait

In the first stage of rehabilitation, tender areas of the body are treated with massage, stretching or other approaches as needed. This will be followed with a specific, individualized home program consisting of stretching, strength building, movement re-education and self-management of pain and swelling. You will also learn how to maintain good posture and use your body safely. Group programs can help you cope physically, emotionally and mentally with your condition, giving you a better sense of control and more confidence in your ability to function and lead a full, active life.

Occupational therapy can help you do daily activities without putting unnecessary strain on joints or causing you to become tired.

Physical therapy can help you maintain your strength and flexibility, help reduce pain and keep your mobility at its maximum. Physical therapy can also help reduce stiffness in joints.Rheumatic fever is the principal cause of heart disease from childhood well into adult life, but most persons with chronic rheumatic heart disease can be helped to enjoy productive lives by adequate total rehabilitation. The majority can be employed without any special concessions, after proper orientation and training, by matching the person’s mental and physical capacities with the requirements of the proposed job. Orientation and education of the patient and his family will help to produce a favorable environment free from undue tensions, so that a therapeutic balance between work, play, and rest can be achieved.

Aquatic therapy may be especially helpful to people who suffer with arthritis. Warm water helps to loosen tight joints and muscles while the resistance of the water improves muscle strength.

In some cases, physical therapy may involve splinting an area to keep it stable, applying moist heat or ice to reduce swelling and tenderness or exercise to strengthen muscles that protect a joint or enhance your ability to move and do daily activities.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com