A Simple Guide to Cystitis

A Simple Guide to Cystitis
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What is Cystitis?
----------------------

Cystitis is an acute or chronic infection of the urinary bladder.

What are the causes of Cystitis?
------------------------------

Cystitis is usually caused by the following:

1. ascending infection of the urinary bladder from the urethra.

2. in females frequently associated with sexual activity eg. honeymoon cystitis

3.In males with enlargement of the prostate or infection of the prostate

4. In children, the bacteria E.coli of the same type as the child's bowels

5.More frequently present in Diabetic patients

6.procedures such as urinary catheterisation

7.cystitis is more common in the female,especially those on contraceptive pills or with intrauterine contraceptive devices.

8. may be associated with congenital abnormalities of the urinary tract such as bladder neck obstruction,urethral reflux,neurogenic bladder,and urinary incontinence.

What are the symptoms and signs of Cystitis?
-------------------------------------

Persons who has Acute Cystitis has the following symptoms:

1.frequency of urination and nocturia

2.painful urination

3.suprapubic discomfort

4.cloudy and unpleasant smelling urine, sometimes blood in the urine

5.fever and chills especially in children

Signs:
Tenderness on palpation in the suprapubic region

How do you diagnose Cystitis?
--------------------------------

Diagnosis can usually be made by :

1.History of frequency of urination, painful urination

2.Urine test shows the presence of pus cells, leucocyte, red blood cells and micro-organisms

3.Urine culture will determine the micro-organism involved and the antibiotic most appropriate for it.

4. cystoscopy may be necessary to exclude tumours of the bladder

What are the complications of Cystitis?
-------------------------------------

Upward infections from the bladder can lead to infections of the kidneys and kidney failure.

What is the treatment of Cystitis?
-------------------------------------

Analgesic or antispasmodic medicine

Antibiotics for infections especially after urine bacterial culture

Lots of fluids

What is the prognosis of Cystitis?
----------------------------------------

Prognosis is usually good with medication.

Recurrence is quite common.

cystitis,frequency,painful,nocturia,sexual activity,antibiotics,analgesic, cystoscopy, urine test, bacteria culture,prostate

A Simple Guide to Cholera

A Simple Guide to Cholera
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What is Cholera?
---------------------------

Cholera is an acute infectious illness caused by the Vibrio cholorae bacteria.

What is the cause of Cholera?
----------------------------------

The bacteria which causes Cholera is the Vibrio cholorae which is an extremely hardy bacteria able to live in polluted water and contaminated food.

There are 2 main types of cholera bacteria:

1.the Classic short slightly curved Gram negative aerobic rods

2.The El Tor strain which is hardier,persists longer in nature and is more likely to cause carrier states in humans.

Incubation period is 12 hours to 6 days.

What are symptoms of Cholera?
----------------------------------------------

The main symptoms of Cholera are

1. Vomiting after 12 hours of ingestion of bacteria

2. abrupt painless rice water diarrhoea

3. abdominal pain

4. prostration and muscle cramps

Severe cases may have dehydration leading to:

1.hypotension

2.cardiovascular collapse

3.tachycardia

4.difficulty in breathing and cyanosis

5.weak peripheral pulses

6.delirium and disorientation

7.lassitude and tiredness

8.convulsions in small children

Symptoms usually appear within 12 hours after exposure to the germ and last up to 1 week.

How is Cholera transmitted?
------------------------------------------

Most epidemics are water borne espcially after severe flooding.
The germs can also be transmitted by food handlers.

How is the diagnosis of Cholera made?
-----------------------------------------------------

Doctors generally diagnose Cholera based on the symptoms and a physical examination.
Confirmation is by blood tests and stool cultures.

What are the complications of Cholera?
-------------------------------------------

Cholera is a disease which can kill espcially through its complications:

1.Severe dehydration especially in young children and the very old patients

2.Hypovolemic shock

3.uncompensated metabolic acidosis

4.renal failure

How is Cholera treated?
-------------------------------------

Cholera is an infectious disease which can spread to other people through contaminated food and water.
It is therefore advisable to quarantine the patient in hospitals.

1.The most important complication in Cholera is dehydration so prompt replacement of fluids and electrolytes intravenously is necessary.

WHO diarrhea treatment solution consists of
a.4gms of sodium chloride
b.6.5gms of sodium acetate
c.1 gm of potassium chloride
d.10gms of glucose
in 1 liter of sterile distilled water.

Where intravenous administration of diarrhea solution is not available, isotonic drinks and even coconut water may act as replacements.

2. Careful monitoring of the patient as 1 liter of fluid may be lost in the stools in one hour.

3.Antibiotics is the main treatment against cholera.
The best antibiotic is tetracycline or deoxycline.

Symptomatic treatment includes:

1.Paracetamol for relief of fever and headache

2.antispasmodic drug to stop abdominal cramps

3.medicine to harden the stools such as kaolin

4.slow down the intestinal movement (lomotil or loperamide).

Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.

Get plenty of rest.

How is Cholera prevented?
----------------------------------------

Prevention of Cholera can be by vaccination with the cholera vaccine.
However the success rate of immunisation against Cholera is only 20-30% so most doctors do not recommended it.

You can avoid infection by:
Avoid eating or drinking foods or liquids that might be contaminated
Good food hygience

What is the prognosis of Cholera?
-------------------------------------

Prognosis is excellent with prompt treatment of rehydration treatment.
After replacement symptoms usually clear within 48 hours with tetracycline treatment.

A Simple Guide to Cervical Spondylosis

A Simple Guide to Cervical Spondylosis
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What is Cervical Spondylosis?
----------------------------------

Cervical Spondylosis is a degenerative disease of the joints of the cervical spine(neck), causing pain in the neck and nerve root irritation.

Who get Cervical Spondylosis?
-------------------------------------

Every one can get Cervical Spondylosis.
The age of onset is usually in the late 40 or early 50.
It is also more common in men than women.
It is worst in the lower cervical spine.

What are the causes of Cervical Spondylosis?
-----------------------------------------------

The causes of Cervical Spondylosis are:

1.Age Degeneration of the cervical spine due to usage such as bending the head to read or write.
The weight of the skull also serves to compress the vertebrae of the cervical spine as well as the intervertebral discs causing narrowing of disc space and bone protrusions called osteophytes which becomes worse with age.

2.Trauma and injury such as whip lash injury, head injuries can also indirectly injure the vertebra of the neck and cause intervertebral disc protrusions.

3. Congenital abnormality of the cervical spine such as incomplete formation of the vertebra and disc.

What are the Symptoms of Cervical Spondylosis?
-------------------------------------------------------

1.The onset is usually gradual with occasional neck pain over weeks or months.

2.There may be a history of trauma to the neck or prolonged neck strain.

3.Early morning neck stiffness and pain may occur,then wears off during the day.

4.The pain may radiate to the shoulder or upper limb.
Pain can be persistent in some cases.

5.Numbness, paresthesia even weakness of the arm and hands may occur due to compression of the neck nerve root.

6.Headaches may be common due to pressure on the neck muscles giving rise to pain to the occiptal region.

7.Neck movements may be restricted in all directions. There may be creaking sounds of the neck on movement.

8.Muscle weakness of the upper and/or lower limb with muscle wasting

Pain may be aggravated by stress, poor general health, prolonged period of the neck in one position.

How is Cervical Spondylosis diagnosed?
-----------------------------------------

Confirmation is usually by an xray of the cervical spine which may show:
Typical cervical vertebra degeneration,
Disc space narrowing
Osteophytic changes
Narrowing of the exit foramina
Subluxations of the vertebra
Sclerosis of the vertebral margins
Lordosis of the spine

How to treat Cervical Spondylosis?
------------------------------------

Not every patient suffer the same degree of symptoms

1. mild requiring only exercises or mild pain killers.

2. more severe require:

a.Neck collars

b.physiotherapy -cervical traction, shortwave diathermy, neck exercises

c.NSAIDs painkillers

d.surgery for cord compression,intractable root symptoms,vertebral artery compression,weakness of arms or legs

3. All cases require:

protection of neck from muscle strain

avoidance of excessive bending and turning of neck

maintenance of good posture

avoidance of emotional stress

What is the prognosis of Cervical Spondylosis?
------------------------------------------------

Symptoms comes and go.

With exercise and NSAIDS, pain is reduced and flexibility of the spine is improved especially with regular exercise and proper posture.

Injury and stress can aggravate the condition.

There is no cure.

A Simple Guide to Urticaria

A Simple Guide to Urticaria
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What is Urticaria?
----------------------

Urticaria is an itchy rash that occurs rapidly anywhere on the body.
The rash may occur often simultaneously at multiple sites.
It is usually temporary disappearing after 24 hours although new rashes may occur at other sites.

What causes Urticaria?
---------------------------

Urticaria is usually due to known mast cell stimulants although in the majority of cases the cause is unknown.


Urticaria is not contagious and for most patients the condition may be managed well with treatment and avoidance of mast cell stimulants:

1. Certain foods: eggs, nuts, fruits,shellfish, fish, chocolates

2. Certain drugs: antibiotics, NSAIDs

3. Physical stimulants: pressure, sweating, cold temperature, sunlight

4. Infections: viral, bacteria

5. Others: flowers, pollen, beestings, animal furs, soaps

What are the symptoms and signs of Urticaria?
-------------------------------------------------------

The rash is typically itchy and appear rapidly as localised red swelling on the skin measuring a few mm to more than 10 cm in size in different shapes.

The swelling can also occur on eyelids, lips, palms and soles.

Urticaria is usually harmless and disappear within a few days or week.

However because it can involve very extensive areas of the body, it can cause a lot of irritation and a lot of anxiety.

Very rarely the urticaria can lasts months to years causing disruption to work and social life.

What makes patients with Urticaria itch?
----------------------------------------------------

In people with Urticaria, the mast cell stimulant can cause histamine release from mast cells.

The histamine is the predominant chemical which is responsible for the inflammatory response which leads to changes of the blood vessels of the skin.

This leads to more blood flow to the affected skin and excessive fluid moving into the surrounding tissues , causing itching and swelling.

How can Urticaria be treated?
------------------------------------

One of the most important part of treatment is to to try to identify the substance or underlying medical condtion which may cause the Urticaria.
Avoidance of the causative substance or treatment of the underlying medical conditions such as infections will lead to the resolution of the urticaria.

One of the most important components of an Urticaria treatment routine is to prevent scratching.

Cold compresses applied directly to itchy skin can also help relieve itching.

Antihistamine tablets will usually relieve the itch and suppress the eruption of the rash.
The antihistamine need to be taken regularly for long as the urticaria is active.

If the condition persists, worsens, or does not improve satisfactorily, another effective treatment is the application of nonprescription corticosteroid creams and ointments to reduce itch.

Corticosteroid tablets may be prescribed if necessary.

How can Urticaria be prevented?
----------------------------------------

Find the causative agent and avoid it.

Avoid sudden changes in temperature or humidity

Avoid sweating or overheating

Avoid certain foods (e.g.,eggs, nuts, seafood, chocolates)

Avoid harsh soaps, detergents, and solvents

Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)

A Simple Guide to Varicose Veins

A Simple Guide to Varicose Veins
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What are Varicose Veins?
----------------------------

Varicose Veins are swollen veins in the legs which has ballooned up over time.
They are more common in women than in men.

What are the causes of Varicose Veins?
----------------------------------------

The cause of the Varicose Vein is due to the accumulation and stagnation of blood in the veins over time.
From the heart blood flows easily downwards to the legs into the capillaries to supply nutrient and oxygen to the foot.
From the foot the blood is then pushed up though the veins right up to the heart.
Movement of the blood in the veins is assisted by the contraction of muscles pushing the blood upwards.
When the muscle relaxes, the blood in the veins gravitates downwards but is prevented from going down by valves in the veins.
If the valve in the vein fails, blood begins to accumulates and stagnate in the veins causing ballooning and dilation of the veins.
The distended veins are then called Varicose Veins.

Causes for the failure of the valves in the veins are:
1.Hereditary - some people are born with inherent weakness of the valve of the veins.

2.Prolonged standing -causes gravitation of the blood down the veins

3.Pregnancy - the veins may be partially blocked by weight of the foetus causing stagnation of blood

4.Obesity - the weight of the body causes the blood to slow down and gravitates down wards in the veins.

5.pelvic tumours like ovarian cysts can partially block the blood flow up the veins.

6.Tight stockings- constricts the blood vessels mechanically

7.Smoking- constricts the blood vessel through its chemicals

What are the complications of Varicose Veins?
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Varicose Veins reduces the blood flow in the legs and can give rise to
complications:

1.Phlebitis-
inflmmation of the varicose vein is due to a blood clot stucked in the vein forming a thrombosis.
The skin over the inflammed vein becomes hot, red, swollen and tender.
A thrombosis in the superficial veins are usually not dangerous but a deep vein thrombosis can become detached and lodged in the lungs causing pulmonary embolism.

2.Haemorrhage-
bleeding may occur when a swollen varicose vein with thinned walls burst.
Blood will then flow out.
Trauma or injury of the swollen varicose vein can also cause bleeding.

3.varicose ulcers may occur when the swollen venous wall gradually stretched and breaks without bleeding.
The break may slowly develop into a ulcer becoming larger unless treated.

4.varicose pigmentation results from skin discoloration from an iron containing pigment called hemosiderin from broken down red blood cells stucked in the varicose veins.

What are the symptoms of Varicose Veins?
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1. Swollen blood vessels in the legs
2. Varicose pigmentation
3. Varicose ulcers
4. Phlebitis

What are the investigations needed in assessment of varicose veins?
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The type, size, location and depth of the varicose vein problem can be determined by various non-invasive diagnostic tests:

1.venous doppler,

2.PPG, and

3.color duplex ultrasound.

What is the treatment for Varicose Veins?
-------------------------------------------

1. No treatment if condition is mild

2. Elastic stocking- support stockings and pressure bandaging compress the valves of the veins together to prevent backflow and prevent dilation of the veins.
Once the stockings are in place, you should exercise by walking as much as possible. When sitting raise the legs.
While sleeping do not use the stockings.
Raise the bottom of bed or put legs on pillows to elevate the legs.
While stockings can slow down the natural course of the disease and reduce the painful symptoms. they WILL NOT CURE the disease.

3. Medical treatment:

Injection of veins-

a.Traditional Sclerotherapy
Here the veins are injected with a small amount of a solution causing them to collapse and disappear.

b.Ultrasound Guided Sclerotheraphy
By using a Doppler/Duplex Ultrasound system the doctor can get a x-ray-like picture of the deeper vein and inject at strategic locations of the vein.

c.Foam Sclerotherapy
Similar to traditional sclerotherapy, but using a foaming agent, making it more suitable for larger veins.

d.IPL Laser Therapy used mostly for the smallest spider veins.
In this method a light beam is pulsed onto the veins to seal them.

4. Surgical treatment:

a.tying of veins-
The simplest treatment consist of tying the superficial vein in the upper thigh preventing the flow of blood in the superficial vein and deflecting it into the deeper vein.

b.stripping of veins
this consist of removal of the long superficial vein using a instrument called the stripper.
After the removal of the vein, firm pressure is applied to the leg.

c.Ambulatory Phlebectomy
Parts of the vein is removed through tiny incisions leaving only small puncture marks and requires no stitches.

d.Closure(Radiofrequency Occlusion)
A super-thin catheter is inserted in the vein and when removed it closes the vein behind it by the use of radio frequency waves.

e.Endovenous Laser Treatment -same as the Closure Procedure, except the catheter emits laser rays instead of radio frequency waves

How can Varicose Veins be prevented?
---------------------------------------

1.Reduce weight

2.Exercise

3.Aviod prolonged standing

4.Put your feet up

A Simple Guide to Obesity Part 2

A Simple Guide to Obesity Part 2
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What is the Treatment of Obesity?
----------------------------------------

Motivation:
---------------

Motivation is the key to weight control.

Knowing the dangers of obesity will help to motivate a person to lose weight.

Set realistic goals for losing weight eg. reduce 10% in 6 months
Gradually reduce weight and maintain it at a healthy weight.

Even if you fail to reach your targeted healthy weight, any reduction helps your health and prevents diseases associated with obesity.

Regular Exercise:
-------------

Regular exercise daily, or at least three times a week is good for the body.
It helps to improve blood circulation and breathing.

Start with a regime of walking or cycling or swimming.
Slowly increase the level of activity to more intense physical exercise like jogging.

Lead an active lifestyle.
Do not sit and watch TV all the time.

Diet Control:
-------------

Choose a healthy diet with with reduced calories and which is nutritionally balanced

Take plenty of vegetables and fruits.
Eat less food which is high in fat and sugar

Low Fat and high carbohydrate diets may reduce the weight but may have long term bad effect on your health.

A combination of diet and exercise is more effective in reducing than either one alone.

Medication:
-----------------

Two main types of medications are available to help control weight:

1.Appetite suppressants:
-----------------------------
help promote weight loss by reducing appetite or increase the sensation of being full.
They increase serotonin or catecholamine - brain chemicals that affect mood and appetite.

They also help by increasing metabolism thus burning away the fat.
They may have limited effect on weight loss as the patient's weight loss level off after 4 to 6 months.

They have the side effects of irritability, insomnia, palpitations and tachycardia.
They should be avoided in heart disease, anxiety, insomnia, pregnency.

They should be used for short term (6-12 months) as there is also a danger of dependency.

2.Fat absorption suppressant:
------------------------------------
prevents the absorption of fats by interfering with the enzymes which dissolves the fat and absorbs the fat into the body.

Instead the fat is not absorbed into the body and passes out in the stools undigested.
The fat in the body is then used up to provide energy and production of hormones.
Less fat is available for putting on weight.

They should be avoided in malabsorrption syndrome, liver disease or pregnancy.
The side effects of these medicines are usually diarrhoea due to the fat passed out in the stools.

They can be taken for a longer peroid of 2 years.

Surgery:
-----------

Surgical treatment may be required for the severely obese (those with a BMI of 40 or greater) or with other health problems.

Surgery should be used only drug therapy, diet, exercise have failed.

Minor surgery may involve liposuction (sucking out the fats in the abdominal wall,under the chin, buttocks and other obvious parts of the body.

Lapband surgery is done for the very obese when other methods have failed and there is a risk of obesity related disease.
A band is placed over the middle of the stomach making it narrow and not capable of taking much food.

Surgery has some complications such as infections.

How do you prevent recurrence of Obesity?
---------------------------------------------------

Many studies showed that most people will regain weight within 5 years.

You can maintain your weight by
1.eating a low calorie diet, low in fats

2.maintaining a healthy exercise regime

3.maintaining motivation and self esteem

4.monitoring your weight food intake and exercise

A Simple Guide to Obesity

A Simple Guide to Obesity
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What is obesity?
--------------------

Obesity is defined as having a weight 20% above the desirable weight which is having a BMI (Body Mass Index) of 22 or less.
It is a chronic medical condition where fat accumulates in the body due to excess calories.
Obesity is harmful to the person's health and well being.

What causes obesity?
--------------------------

Many factors contributes to obesity:

Genetic factors
-------------------

Obesity runs in the family and is hereditary.
Family members who share the same diet and lifestyle may have the same overweight condition.

Environmental factors
---------------------------

The environment is an important factor in determining obesity.
1.Overeating -
many people have an increased craving for food.
It has found that these people lack a hormone called serotonin in the brain which acts to decreased appetite.

2.low metabolism -
some people has a lower metabolic rate tends to accumulate the excess energy from food as fats in the body.
Classic example is hypothyroidism where the low thyroid hormone reduce the capacity of the body to burn off energy so they become lethargic and fat.

3.lack of exercise -
Exercise helps to burn up calories.
People who tend to have a sedentary life without exercise tends to be overweight

4.Certain medications:
some medications like corticosteroids, female hormones aand antidepressants tends to cause increased appetite and water retention and contributes to weight gain.

Psychological factors
---------------------

Psychological factors may be the cause of tendency to overindulge in food.
Some people eats more out of boredom, sadness, or anger.
Others overeat as a way of dealing with stress or depression.

Rare illnesses:
------------------

Some rare illnesses like hypothyroidism, Cushing's syndrome, depression, and certain neurological problems can lead to overeating.
These conditions are believed to be responsible for only about one percent of all obesity cases.

What is the criteria for diagnosis of Obesity?
------------------------------------------------

The most widely used method is the body mass index (BMI).
BMI is the gauge of the amount of body fat in adults.

BMI = Your Weight (kg)
---------------------
Height (metres) x Height (metres)

The risk of developing heart disease and diabetes begins at BMI values of 23 kg/m2 and above.
BMI (kg/m2) (for adults):
Risk of Heart Disease and Diabetes

27.5 and above
High Risk

23.0 - 27.4
Moderate Risk

18.5 - 22.9
Low Risk (healthy range)

Less than 18.5
Risk of nutritional deficiency diseases and osteoporosis

Knowing your BMI will motivate you to lower your weight.

What are the Complications from obesity?
----------------------------------------

Health hazards
------------------

Obesity is not just a cosmetic problem.
Many serious medical conditions are associated with it:
--------------------------------------------------------------------------

1.High blood pressure

2.High blood cholesterol

3.Diabetes

4.Coronary heart disease

5.Stroke

6.Gallbladder disease

7.Liver disease

8.Degenerative joint disease

9.Cancer (colon, uterine, breast and other cancers).

10.Gout,caused by high levels of uric acid in the blood from the high purine
proteins consumed.

11.Sleep apnoea

Emotional effects:
------------------

1.Feelings of rejection, shame, or depression

2.Feeling undesirable compared with a slim person.

3.Some face prejudice or discrimination.

4.Some may be seen as lazy or lacking in self-control.

Treatment of Obesity will follow in A Simple Guide to Obesity Part 2

A Simple Guide to Coronary Heart Disease Part 2

A Simple Guide to Coronary Heart Disease Part 2
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What is the treatment of Coronary Heart Disease?
-----------------------------------------------------------

Any heart attack is an EMERGENCY!
Immediate treatment is urgent!

While waiting for the ambulance, lie the patient in a slightly inclined position.
Give nitroglycerin tablet under the tongue if available.
Admit to hospital as an emergency.

Severe cases are admitted to Cornary care unit(CCU) for constant monitoring of the heart, blood pressure and abnormal rhythm of heart rate.

Risk factors for Coronary heart disease like hypertension, high cholesterol, diabetes must be treated.

Medicine:
-----------

Anticoagulants such as warfarin, aspirin, Plavix,should be given to
prevent blood clots .

Vasodilators like isorbide are given to help dilate the artery to the heart

Any abnormal rhythm of the heart must also be treated with medications or pacemaker if severe as damage to heart may affect the conduction of the electrical impulse of the heart to the cardiac muscles.

Because of the psychological effect of a heart attack on the patient, sometimes antidepressant or tranquilliser may be necessary.

Interventional Procedures:
--------------------------

Once stable the patient may be requred to have a ballooning of the narrowed artery or a stent inserted in the narrowed artery.
This can be done during the cardiac catheterisation.

1.balloon angioplasty
balloon is inflated to compress fatty matter to the wall of narrowed artery and open the blood vessel

2.Stent:
balloon angioplasty is performed in combination with placement of a stent which is a small, metal mesh tube that provide support inside the coronary artery.

3.Drug eluting stents (DES):
Drug-eluting stents contain a medication that is actively released at the stent implantation site to prevent recurrence of narrowing of the artery

4.Rotablation
The Rotoblation special catheter, with an acorn-shaped, diamond-coated tip, spins around at a high speed and grinds away the heavily calcified plaque on the arterial walls.

5.cutting balloon
The cutting balloon catheter has a balloon tip with small blades which are activated when the ballon is inflated. The small blades remove the plaque and the balloon compresses the fatty matter into the arterial wall.

Surgery :
-------------

If the narrowing involved too many arteries, then a coronary artery bypass graft (CABG) surgery will have to be done.

Stay in Hospital and Rehabilation:
---------------------------------

Usually a heart attack patient stays in hospital for 2-4 weeks depending on the severity of his condition.

Mild exercise is started once his condition is stable.
Exercise is good for the patient because it helps the blood circulation.

However strenous exercise including sexual inercourse should start until at least 4-6 weeks later.

Most patients should be able to drive or fly after 2 months.

What can I do to prevent Coronary Heart Disease?
---------------------------------------------------

Prevention of a heart attack is the same as prevention of a stroke as both involve the avoiding the blockage of a major artery to the brain or heart.

1.Control the Blood Pressure
Have your blood pressure checked at least once a year from the age of 40 years.
If there is high blood pressure, lifelong treatment with monthly checkups will keep it under control.

2.Control the Diabetes
Check for diabetes starting from the age of 40 years. If there are risk factors for diabetes, screening should start earlier.
If there is diabetes, take the medicine or injections regularly.
Monitor the sugar levels daily.
Control the diet.
Check with the doctor regularly.

3.Watch Your Diet
Reduce consumption of fat, high-cholesterol food, sugar and salt.
Take more fruit, vegetables and moderate servings of carbohydrates.
Eat more beancurd, dried peas, dried beans, fish and chicken instead of red meat.
Drink low-fat milk.
Avoid full cream milk.
Avoid alcohol.
Drink less coffee, tea and cola drinks.

4.Don't Smoke
Stop smoking immediately.
Don't start smoking if you are not a smoker.

5.Physical Activity
Regular exercise is good for you.
Do moderate intensity physical activity for 30 minutes such that you sweat and breathe deeply without getting breathless.
Examples include brisk walking, swimming, cycling.

6.Learn To Relax
Have adequate rest especially when you feel tense or tired.
Take up a hobby.
Do relaxation exercises such as yoga or deep breathing exercises.
Time management is important.

What is the prognosis of Coronary Heart Disease?
---------------------------------------------------

The outlook following a coronary heart attack is generally good.
About 80% of patients are alive after 3 years and 70% after 6 years.

The outlook varies depending on the age of the patient and severity of the heart attack.

However with new treatment and a healthy lifestyle, the prognosis has improved tremendously.

Medication such as Aspirin or warfarin may have to be taken permanently to prevent a recurrent attack.

A Simple Guide to Coronary Heart Disease

A Simple Guide to Coronary Heart Disease
---------------------------------------------------

What is Coronary Heart Disease?
--------------------------------------

Coronary Heart Disease occurs when the coronary arteries become blocked. The blood supply to the part of the heart cannot provide the oxygen and nutrients to the muscles of the heart.
The cells in that part of the heart died off and that part of the heart is unable to function properly.
This is called a heart attack.

Coronary Heart Disease can lead to sudden death.

What causes Coronary Heart Disease?
-----------------------------------

Coronary Heart Disease occurs when

1.there is a blockage of an artery in the heart by a blood clot, piece of fat or air bubble travelling in the blood from another part of the body.
This leads to lack of supply of oxygen and nutrients to the heart muscle.
As a result the heart cells died leading to loss of function of the part of the heart.

2.narrowing of the blood vessel due to fat deposit in the walls of the artery supplying blood to the heart.
This reduce the blood supply of oxygen and nutrients to the heart muscles cells and affects its function.

What are the risk factors in Coronary Heart Disease:
----------------------------------------------------------

1.High Blood pressure-
Hypertension narrows the arteries of the heart and causes blockage

2.High cholesterol-
Cholesterol deposit thickens the walls of the arteries, making them narrow and reducing blood flow.

3.Diabetes mellitus
The high blood sugar level thickens the arteries and make the blood thick so that less blood is able to flow through them.

4.Obesity
A BMI of 23.0kg/m² and above increases the risk of getting high blood pressure, diabetes and heart attack.

5.Smoking
Tobacco smoke narrows arteries and reduces oxygen supply to the heart.

6.Drinking of Alcohol
Alcohol can cause liver and kidney damage. increase blood pressure and affect diabetes

7.Stress
Repeated stress, if poorly controlled, can lead to high blood pressure.

What is a Angina Pectoris?
--------------------------------------------------------------

It is a early warning sign of a ischemic heart disease.
Angina occurs when the blood supply of the heart is partially blocked by narrowing of the blood vessel.

1.It occurs during exertion when the supply of the blood to the heart is insufficient to keep up with the increase demands of the heart muscles.

2.It can also occurs when anger or fear causes the heart muscles to pump faster to supply the body with oxygen.

3.Stress can also causes spasm of the cornonary arteries reducing oxygen to the heart tissues.

4.Smoking can also constrict the blood arteries to the heart.

The symptoms of Angina Pectoris are:
1. Crushing heavy pain in the sternal area of the chest or chest discomfort lasting 2-10 mins

2.It occurs during exertion, anger or stress

3.It is relieved by rest or taking sublingual
nitroglycerin.

4. The major sign is ST depression in the ECG (electrocardiogram) during the attack which becomes normal after the attack.

5.Threadmill examination can spark off an attack of angina because of the exertion involved in doing the threadmill so it is not advisable to do a threadmill at this stage.

What are the symptoms of Coronary Heart Disease?
----------------------------------------------------

The symptoms of Coronary Heart Disease are :

1.Crushing heavy (not sharp) chest pains in the mid sternal region of the chest which may radiate to the Left jaw, neck, shoulder and down the inside of the left arm and hand.
This pain occurs when not enough oxygen is supplied to the heart muscles.
The pain is usually not relieved by rest or nitroglycerin.

2.Breathing difficulty is usually associated with the chest pain due to the lack of oxygen being pumped from the heart to the lungs. The patient finds difficulty in lying flat and needs to sit up or in a inclined position.

3.Cold sweats may also be associated with the chest pain

4.Paleness of the face due to poor flow of blood from the heart

5.Fatique and tiredness

6.Confusion, dizziness, depression,

7. Difficulty in movement and speaking

How is the diagnosis of Coronary Heart Disease done?
----------------------------------------------------

Diagnosis of coronary heart disease is usually confirmed by:
1.History of chest pain and physical examination of the heart and blood pressure

2.ECG(electrocardiogram)shows typical features of depression in Q wave, ST segment and raised RS segment.
A 12 leads ECG may showed the presence of Coronary heart disease more clearly

3.Threadmill -Features of ECG is enhanced during exertion on the threadmill

4.CAT scan of the heart- a new technology where the complete scan of the heart with the movement of dye through the coronary ateries can show presence of narrowing or blockage of the arteries.

5.Angiogram( cardiac catheterisation)- a small catheter is entered into the artery at the groin.
The catheter is guided through the blood vessel to the coronary arteries with the aid of a special x-ray machine.
A radio-opaque dye is injected into the artery and its passage is recorded on a screen.
Occlusion or narrowing of any of the coronary arteries can be seen.

6.intravascular ultrasound (IVUS) and fractional flow reserve (FFR), may be performed together with cardiac catheterization to obtain more detailed images of the walls of the blood vessels.

7.Blood cardiac enzymes and ESR may be raised.

All acute Coronary Heart Disease attacks are Emergencies and should be admitted to hospital as soon as possible for proper treatment.

The treatment of Coronary Heart Disease will be discussed in the Simple Treatment of Coronary Heart Disease Part 2.

A Simple Guide to Stroke 2

A Simple Guide to Stroke 2
--------------------------------

What is the treatment of Stroke?
--------------------------------

Stroke is an emergency.

Purpose of treatment is to:

1. preserve life

2. limit the amount of brain damage

3. lessen the extent of disability and deformity

4. prevent recurrence of a stroke.

Admission to hospital is necessary to determine

1. the cause of the stroke

2. the extent of damage to the brain using MRI of the brain

3. immediate treatment with medicines(usually anticoagulant,blood circulation,nerve vitamins).

4. whether Surgery is necessary to stop bleeding or remove a blood clot

5. risk factors for stroke are investigated and treated (diabetes, high blood pressure etc)

During the acute phase of stroke:
1. A clear airway must be maintained

2. Sufficient fluid and electrolyte intake must be maintained

3. Adequate nutrition in the form of glucose, proteins and calories must be given

4. Adequate nursing care is provided to prevent bed sores etc

5. Proper medicines are given

Once the stroke is stable:
The stroke patient is started on a rehabilitation programme.

This will include
a.exercises to strenthen his muscles,

b.speech training for patients with dysphasia (difficulty in talking)

c.training on how to carry out his daily activities.

d.advice about his diet

Immediate care improves the chance of a complete recovery.

How to care for a Stroke Patients?
----------------------------------------

A stroke can be very devastating and depressing for a patient.

He will feel that part of his body and brain function is incapacitated.

Therefore he need all the support from everyone involved in the treatment of his condition:
1.doctors,
2.nurses,
3.physiotherapist,
4.speech therapist
5.occupational therapists
6.family members and friends

Family members can provide the most important means of support.
They should be familiar with his disabilities and help him accordingly:

Please do:
--------------
1.be understanding and patient.

2. keep the patient cheerful and hopeful

3.learn how to help him with the diet, daily exercises and other care necessary for him

4.allow the person more time to do any task

5.encourage and praise the patient to do as much as possible for himself at his own pace.

6.involve the person in family discussions and activities.

7.be encouraging and praise his daily efforts.

8.encourage the person to look at, touch, and move his affected limbs.

Do not:
----------
1.ignore him or treat him like a child .

2.encourage the person to do things using the good side only.

3.pull on the affected arm or leg as it can be extremely painful.

4.interrupt or speak up for him.

5.make discouraging remarks.

6.allow the person to squeeze rubber balls as this may tighten his hand muscles.

7.let him be depressed

8.let him develop bed sores. Try to turn his body regularly.

In order to help the person be as independent as possible, there are
special aids(such as tripod walking cane) and
appliances(wheelchairs) which can be used to help him with his daily activities.

There are also special clothes and shoes which uses velcro instead of buttons or zips.

Make the home a safe place with non-slipmats and grab bars

How to Prevent Stroke?
----------------------

Prevention of a stroke is the same as the prevention of a heart attack as both involve the avoiding the blockage or bleeding of a major artery to the brain or heart.

1.Control the Blood Pressure
Have your blood pressure checked at least once a year from the age of 40 years.
If there is high blood pressure, lifelong treatment with monthly checkups will keep it under control.

2.Control the Diabetes
Check for diabetes starting from the age of 40 years.
If there are risk factors for diabetes, screening should start earlier.
If there is diabetes, take the medicine or injections regularly.
Monitor the sugar levels daily.
Control the diet.
Check with the doctor regularly.

2.Watch Your Diet
Reduce consumption of fat, high-cholesterol food, sugar and salt.
Take more fruit, vegetables and moderate servings of carbohydrates.
Eat more beancurd, dried peas, dried beans, fish and chicken instead of red meat.
Drink low-fat milk.
Avoid full cream milk.
Avoid alcohol.
Drink less coffee, tea and cola drinks.

3.Don't Smoke
Stop smoking immediately.
Don't start smoking if you are not a smoker.

4.Physical Activity
Regular exercise is good for you.
Do moderate intensity physical activity for 30 minutes such that you sweat and breathe deeply without getting breathless.
Examples include brisk walking, swimming, cycling.

6.Learn To Relax
Have adequate rest especially when you feel tense or tired.
Take up a hobby.
Do relaxation exercises such as yoga or deep breathing exercises.
Time management is important.

A Simple Guide to Stroke

A Simple Guide to Stroke
-------------------------------

What is a Stroke?
---------------------

A stroke is also known as a cerebrovascular accident(CVA).
It happens when the blood vessel to a part of the brain is blocked(due to a blood clot) or burst.
The brain cells in that part cannot get the oxygen and nutrients so they are damaged and unable to function.

What Causes Stroke?
-------------------

A stroke occurs when:

1.there is a blockage of an artery in the brain by a blood clot, piece of fat or air bubble travelling in the blood from another part of the body.
This leads to lack of supply of oxygen and nutrients to the brain cells.
As a result the brain cells died leading to loss of function of the part of the body controlled by the brain cells.

2.there is a rupture of an artery in the brain leading to internal bleeding and damage to the brain cells.
This can be caused by high blood pressure, head injury or a weak artery wall from birth(aneurym).

3.there is compression by a brain tumour or tightening of the artery wall.

What are the risk factors in Stroke:
-------------------------------------

1.High Blood pressure-
Hypertension damages the arteries of the brain by causing bleeding or blockage

2.High cholesterol-
Cholesterol deposit thickens the walls of the arteries, making them narrow and reducing blood flow.

3.Diabetes mellitus
The high blood sugar level thickens the arteries hard and make the blood thick so that less blood is able to flow through them.

4.Heart disease
People with heart disease are more likely to have poor blood flow to the brain.
Some heart disease like atrial fibrillation can throw out blood clots which can block the blood supply of the brain

5.Obesity
A BMI of 23.0kg/m² and above increases the risk of getting high blood pressure, diabetes and stroke.
6.Smoking
Tobacco smoke narrows arteries and reduces oxygen supply to the brain.

7.Drinking of Alcohol
Alcohol can cause liver and kidney damage. increase blood pressure and affect diabetes

8.Cerebral aneurysm, tumour,cancer metastasis,
These can cause blockage and bleeding in the arteries of the brain

9.Trauma or surgery of the brain
These can cause bleeding or form blood clots in the arteries of the brain

10.Stress
Repeated stress, if poorly controlled, can lead to high blood pressure.

What is a temporary Stroke or Transient ischaemic attack(TIA)?
--------------------------------------------------------------

It is a early warning sign of a stroke .
TIA occurs when blood supply to a part of the brain is temporarily cut off causing slight damage to the brain cell.

It may last seconds to up to 24 hours.

The symptoms of a TIA are often vague and temporary:

1.temporary numbness or weakness occurring suddenly in one arm or leg or on one side of the face

2.temporary difficulty in speaking or slurring of speech

3.sudden difficulty in seeing or 'blackout' in one eye

4.temporary dizziness or fainting or loss of balance

5.Temporary confusion, poor coordination or understanding

6.unexplained headaches or a change in the usual headache pattern

Early treatment of a TIA can help prevent a stroke from occurring in the future.

What are the symptoms and signs of a Stroke?
--------------------------------------------

The affected person may have:

1.sudden numbness or weakness, usually on one side of the body,often with loss of feeling

2.difficulty in speaking or understanding

3.difficulty in swallowing

4.loss of concentration and memory

5.sudden difficulty walking

6.loss of control of passing urine or passing motion

7.behaviour changes such as laughing or crying at the wrong time, feeling depressed or showing bad temper.

8.sudden severe giddiness, loss of balance and coordination

9.sudden severe headache with no known cause

10.sudden vision loss in one eye

Treatment and caring for stroke patient will be in the Simple Guide to Stroke 2.

A Simple Guide to Hepatitis - Update

A Simple Guide to Hepatitis - Update
----------------------------------------

Hepatitis Update:
--------------------

There are now 7 types of Hepatitis viruses: A, B, C, D, E, F, G.

The most common are Type A, B and C.

All hepatitis viruses can cause acute hepatitis.

Viral hepatitis types B, C, and D can cause chronic hepatitis.

Hepatitis B together with D has been found to cause more complications in patients than Hepatitis B alone.

New drugs like
lamivudine,
adefovir,
entecavir and
telbivudine
has been approved by FDa for treatment of hepatitis B.

Hepatitis C is now curable with the new drugs.

There are also many drugs on trial at the moment which can potentially cure HBV and HCV

A Simple Guide to Cholecystitis

A Simple Guide to Cholecystitis
--------------------------------------

What is Cholecystitis?
--------------------------

Cholecystitis is an acute or chronic inflammation of the gallbldder.

What are the causes of Cholecystitis?
--------------------------------------------

Cholecystitis is usually caused by the following:

1. obstruction of the cystic duct by a gallstone -most common cause 80-90% of cases

2. bacterial infection following obstruction in 50% of cases

3. bacterial or viral infection following gastroenteritis-
germs from gut going up the cystic duct into gallbladder.

4. chronic disease follows attacks of acute infection.

Cholecystitis is more common in
the female,
>forty years of age,
fat,
flatulent person.

What are the symptoms and signs of Cholecystitis?
------------------------------------------------------------

Persons who has Acute Cholecystitis has the following symptoms:

1.gradual onset of abdominal pain starting from the epigastrium,
moving to the right subcostal area,
may be felt in the back at the subscapular region.

2.nausea and vomiting

3.loss of appetite

4.mild fever and bodyaches

5.slight jaundice

Signs:

1.Tenderness at the right subcostal area with involuntary muscle spasm

2.Murphy Sign positive: sharp increase of tenderness at the subcostal area on palpation with thumbs pressed inwards below the ribs when the patient is asked to breathe deeply

3.Gallbladder may sometimes be felt(palpable)

In chronic Cholecystitis, there may recurrent biliary colic which may be mistaken for signs of gastritis.

How do you diagnose Cholecystitis?
-------------------------------------------

Diagnosis can usually be made by :
1.Physical examination -a positive Murphy's sign suggest Cholecystitis.

2.Plain X-rays can show the presence of gallstones in 10-15%

3.Oral cholecystogram is 95% accurate if the liver and intestinal functions are normal but may unreliable during the acute attack.

4.Ultrasound is highly reliable in showing up the presence of gallstones

5.Intravenous,transhepatic and endoscopic retrograde cholangiography may be more accurate in diagnosing the gallbladder function and stones

What is the complications of Cholecystitis?
---------------------------------------------------

1.gangrene of the gallbladder due to obstruction of blood supply

2.perforation of the gallbladder due to obstruction of the cystic duct

3.cholangitis - infection of the bile duct which can lead to hepatitis and intestinal infection

What is the treatment of Cholecystitis?
-----------------------------------------------

Acute Cholecystitis:
----------------------
Admission to hospital

Gastric suction and fluid replacement

Analgesic or antispasmodic medicine usually by injection

Antibiotics for infections

Cholecystectomy -surgical removal of the gallbladder and stones now usually done through 4 holes in the abdomen.

Chronic Cholecystitis:
--------------------------
Cholecystectomy

What is the prognosis of Cholecystitis?
---------------------------------------------

Prognosis is usually good after surgery.

However some pain may persists after surgery due to scar tissue.

A Simple Guide to Burns & Scalds

A Simple Guide to Burns & Scalds
--------------------------------

What are burns and scalds?
------------------------------

A burn is skin which is damaged most commonly by

1.fire or heat.
2.chemicals,
3.electricity
4.light including sunlight
5.radiation.

A scald is a burn caused by hot liquids or steam.

How do you determine the severity of the burn?
------------------------------------------------------

The following are considered when determining the severity of the burn:

1.Degree of burn

2.Extent of the burn

3.Age of patient

4.Body region burned

5.Other illnesses and injuries

What are the degree of burns and scalds?
--------------------------------------------

First degree Burn:
----------------------

superficial injury only affecting the epidermis
The skin is red, hot and painful.
Damage is superficial and temporary.
There is no blisters.

Second degree burn:
------------------------

first layer of skin is burned through, second layer is damaged
The underlying tissues are not damaged..
The skin is red, hot, swoolen and intensely painful and there is blister formation.

Third degree Burn:
-----------------------

The full thickness of the skin is damaged including sometimes the underlying tissues.
The skin may appear pale and leathery or charred.
Because the nerves are damaged, there may not be pain.

How do you estimate the extent of the Burn or scald?
-----------------------------------------------------

The rule of nines give a rough estimate of the extent of the burn:
Each of the following represents 9% of body surface:
head and neck
each upper limb
the front of each lower limb
the back of each lower limb
the chest
the abdomen
the upper back
the lower back and buttocks

These constitute 99% of the body surface.
The remainder 1% is assigned to the genitals.

Age of the Patient:
----------------------

The infant and young child have a surface area greater in proportion to the whole body compared with a older child or adult. There is therefore more body fluid loss and more danger.

An older adult above 55 years has less ability for his tissues to heal from any burns as compared to an younger adult.

Region of body burned
----------------------

Face- burn to the face is serious because it may involve the airway or injury to the eyes.
Hands and feet - burns are also of special concern because scarring may mean loss of movement of the fingers and toes.
Groins,buttocks- burns here are particularly prone to bacterial infection
Circumferential burns- encircle the body or body part and can block circulation to the tissues distal to the burn.

Other illnesses and injuries
----------------------------

Illness such as those below can aggravate the severity of the burns and affect the healing:

Respiratory diseases
Diabetes
Heart disease
Injuries like fractures

The source of the Burn-
is also important.
A minor burn caused by nuclear radiation is more dangerous than one caused by heat.
Chemical burns are particularly more serious because the chemicals may remain on the skin and burn for hours and may enter the bloodstream causing toxic reactions.

What is the treatment for burns and scalds?
---------------------------------------------------

Superficial(first degree) burns and scalds, and partial-thickness(2nd degree) ones which does not involve an area smaller than that of the victim's palm can be treated at home:
1.Remove all jewelry and clothing at the burn area

2.Put the injured part under cold running water for a few minutes to ease the pain.
Dry by patting with a clean cloth.

3.Apply a soothing cream or lotion for scalds and burns.

4.Try not to break a blister. If a blister is already broken, apply an antiseptic lotion.

5.Painkillers may be necessary for pain.

More severe cases should be treated in a hospital:

1.the burn or scald is full-thickness (3rd degree).

2.the mouth or throat, eyes, ears, entire face or genital area is involved .

3.chemical or any corrosive substance burns.

4.electric current or lightning burns .

5.thick smoke or hot air inhalation with breathing difficulty

6.the burn or scald gets infected(fever, pus formation and increasing pain, redness and swelling).

7.partial-thickness burn affects an area larger than the victim's palm.

8.medical illnesses such as diabetes, heart attack and stroke are present