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>A Simple Guide To Dental Caries

>A Simple Guide To Dental Caries
——————————–
What is Dental Caries?
————————
Dental caries is the decay of a tooth or teeth in the mouth.
The tooth decay is brought about by the acid erosion of tooth enamel.
What is the cause of Dental Caries?
———————————–
Dental caries is caused by the action of the bacteria that lives in plague, a sticky coating of saliva and food debris that forms on the surface of the teeth.
Plague can occur in the mouth:
1.in the pits or grooves in the back teeth
2.in between teeth
3.around dental fillings or bridgework
4.near the gum line
These plaque bacteria convert sugar and carbohydrates in the food particles into energy and in breaking them down produce acids.
These acids dissolves the calcium and phosphate minerals on the surface of the tooth eroding the enamel or creating cavities called dental caries.
If the process is unchecked the enamel and the dentin underneath is destroyed resulting in infection of the pulp and permanent damage to the nerves and the blood vessel it contains.
Early dental caries may be reversed if damage by the acid is stopped and the tooth is allowed to repair the damage naturally.
What are the Symptoms of Dental caries?
——————————————-
The early stages of decay do not cause any symptoms and only regular professional examinations can help detect the decay in early stages.
Once the dental caries is established,
1.sensitivity of the tooth to hot/ cold foods and drinks.
2.Pain occurs when the dentin is damaged.
3.Visble pits or holes appear on the enamel
Diagnosis
Dental caries is diagnosed by:
1.Dental examination .
2.X-rays if the dentist suspects hidden caries.
Treatment
1.scrape the teeth to remove plague
A flouride gel may be applied to protect the teeth from plague
2.If a cavity is present, the dental surgeon may fill the tooth with fillings made of dental amalgam in molars and premolars and composite resins for the front teeth.
3.in the case of a large cavity, the dentist will drill the decayed portion of the tooth, fill the cavity and cover the tooth with an artificial crown.
4.root canal treatment involves removal of the tooth’s pulp and replacing it with an inert material.
5.The entire tooth is taken out if the decay is very advanced
Preventing Decay
Tips for preventing caries include:
1.diet low in sugar
2.good oral hygiene:
a.Brushing teeth twice a day with fluoride toothpaste.
b.Cleaning between teeth daily with floss.
3.regular dental visits and assessment.
4.a protective plastic coating that can be applied to the chewing surfaces of the back teeth where decay often starts.

>A Simple Guide to Bedwetting (enuresis)

>A Simple Guide to Bedwetting (enuresis)
—————————————
What is Bedwetting?
___________________
Bedwetting or functional enuresis is the repeated involuntary voiding of urine during day or night at an age where continence or control of urine is expected.
Bedwetting or functional enuresis is common in children.
Prevalence of bedwetting:
5 years old – 7 per cent for boys and 3 per cent for girls
10 years old -3 per cent for boys and 2 per cent for girls
18 years old -1 per cent for boys and 0 per cent for girls
It usually occurs during non rapid-eye-movement (REM) sleep.
What are the causes of bedwetting?
————————————
1.family history of bedwetting often present
2.prevalence of emotional and mental disorder greater than in general population such as anxiety or rejection
3.slow physical development,
4.an overproduction of urine at night,
5.a lack of ability to recognise bladder filling when asleep
Symptoms
1.day or night involuntary voiding of urine after the age of 5 years at least twice a month or continuously.
2.In older children more than once a month
3.Somtimes a child develops bedwetting in responce to jealousy or reduced attention from parents or caretaker after a new child is born into the family
Complications:
Amount of urinary incontinenc is related to effect on the child’s emotional or psychological well being:
1.self esteem is affected
2.social ostracism by peers
3.anger at caretakers
4.rejection by caretakers
Diagnosis and treatment
1.an underlying condition such as urinary tract infection, developmental bladder abnormalities or nervous system disorders must be ruled out by tests conducted.
2.A “wait and see” approach is the preferred course of action. Record the days when the child is dry and give a reward as a form of motivation.
3.Regulate the amount of fluid taken before bedtime
4.Patient and family counseling will take out the anxiety and fear of rejection by the child
5.Use of urine sensitive device that detects wetness and activate auditory stimulus can help the child condition the response of waking up before he loses control of his bladder. This method is called behavioural conditioning.
6.Medicine such as antidressant can help to control bedwetting in children but only as as a short-term measure.
Prognosis:
Fairly good with counseling and motivation

>A Simple Guide to Amblyopia

>A Simple Guide to Amblyopia
——————————

What is Amblyopia?
———————

Amblyopia, commonly known as ‘lazy eye’, is reduced visual acuity in one eye that appears normal on examination.
It usually develop during early childhood.
If left untreated, amblyopia will usually continue into adulthood.

What are the Causes of Amblyopia?
———————————-

1. Squint

Squint or misalignment of the eyes occurs when one eye is looking straight and the other is looking in another direction.
The vision from the deviating eye is suppressed.
The part of the brain that receives the vision from the deviating eye does not develop normally.
Therefore there is a severe reduction of vision in the deviating eye.

2. Different refractive powers of the eyes

A significant difference in the degree of short-sightedness, long-sightedness or astigmatism between the two eyes may result in failure to form clear image in the eye with the greater refractive error resulting in Amblyopia.

3. Blurred vision in one eye

This occurs with:
1.An opaque cornea
2.Cataract
3.Drooping upper eyelids due to weakness of the muscles that lift the eyelids
4.Eye trauma or eye surgery
5.Toxic causes such as arsenic, lead, smoking,vitamin B1 and B12 deficiency
6.Neurological causes are chiasmal lesions in the brain
7.Amaurosis: complete loss of vision in one eye occurs in uremia, nephritis and eclampsia
8.Psychological causes like hysteria

Symptoms may include:
1.decreased vision in one eye
2.squint
3.drooping eyelid

Diagnosis and Early detection

1.Amblyopia in young children can only be discovered if vision in each eye is tested separately.

Treatment is usually more successful if amblyopia is detected early especially before the age of four.

2.regular eye and vision tests should be done by the family doctor, paediatrician or ophthalmologist.

Treatment

1.underlying conditions causing the ‘lazy eye’ such as refractive errors, drooping eye lid or squint should be treated.

2.The main purpose of treatment is to cause the part of the brain that reads images from the ‘lazy eye’ to work more harder to read images than the better eye.
The earlier the treatment is started, the better is the results.
Once the child is over 8 years of age, he/she may not respond well to treatment, resulting in permanently impaired vision.

Treatment can be given in two ways:
1.Eye Patch
 An opaque, adhesive patch is worn over the better eye for weeks to months. This treatment forces the child to use the weaker eye and stimulate the brain to read the images in the weaker eye.
The main problem with the eye patch is that no child likes to have his eye patched. Parents need to ensure that the eye patch is worn properly as advised by the eye doctor.

2.Atropine eye drops
In some cases where the child cannot tolerate eye patches, a drop of atropine is instilled in the stronger eye once a day to blur the vision temporarily in order that the child will prefer to use the ‘lazy eye’.

Prognosis:

Amblyopia if left untreated can lead to loss of vision in the ‘lazy eye’.

Even with treatment 1% – 2% of the population will remain amblyopic. This occurs especially if:
1.the amblyopic stimuli is excessive
2.detection of amblyopia is too late;
3.the child responds poorly to treatment.

Even with one good eye the child can go about his life provided he/she takes good care of the good eye and protect it from harm.

>A Simple Guide to Diarrhea

>A Simple Guide to Diarrhea
————————————-
What is Diarrhea?
—————————
Diarrhea is a symptom defined as an increase in the volume, water content and frequency of bowel movements.
What are the causes of Diarrhea?
——————————————–
Diarrhea is a symptom of many gastrointestinal disorders:
1.Infections:
Bacterial infections such as:
a.Shigella
b.Salmonella and typhoid
c.cholera
Viral infections such as:
a,enterovirus
b.rotavirus
Protozoan infections such as:
a.amoebic
b.giardia
2.Toxins from bacteria in contaminated food:
a.E.coli food poisoning (enterotoxins)
b.staphaloccal food poisoning (preformed toxins)
3.Antibiotic usage:
pseudomembraous enterocolitis
4.Food Intolerance
a.Lactose or sugar intolerance
b.Gluten sensitive enteropathy:
celiac disease, nontropical sprue
5.Inflammatory diseases of the intestine:
a.crohn’s disease or regional ileitis
b.ulcerative colitis
6.Malabsorption syndromes
a.malabsorption of bile acids
b.pancreatic steatorrhea
c.ileal resection
7.Cancers:
a.colon
b.rectal cancers
8.Tumors especially hormonal producing tumors:
a,gastrinoma
b.Zollinger-Ellison syndrome
c.glucaglonoma
d.carcinoid tumors
9.Drug induced:
a.excessive use of laxatives
b.magnesium antacids which absorbs water into intestine
c.stimulant cathartics
10.Rapid intestinal movement:
a.Irritable bowel syndrome
b.resection of bowels in tumors or fistula
c.vagotomy
d.other surgery of intestine
rhea with blood and mucus
How is Diarrhea investigated?
——————————————
1.full investigation of the possible underlying causes
2.Macroscopic and microscopic examination of the stools:
e.g rice water is typical of cholera
3.culture and sensitivity to antibiotic of the stools
4.Full blood count and electrolytes
How is Diarrhea treated?
————————————-
1.Because of the excessive fluid loss, correction of fluid and electrolyte balance is the most important part of treatment.
Prompt treatment may be needed to prevent dehydration which is the loss of fluids from the body. Important salts or minerals, known as electrolytes, can also be lost with the fluids. Dehydration can be caused by diarrhea, excessive urination, excessive sweating, or by not drinking enough fluids because of nausea, difficulty swallowing, or loss of appetite.
The symptoms of dehydration are
excessive thirst
dry mouth
little or no urine or dark yellow urine
sunken eyes
severe weakness or lethargy
dizziness or lightheadedness
Mild dehydration can be treated by drinking liquids.
Severe dehydration may require intravenous fluids and hospitalization.
Untreated severe dehydration can be life threatening especially in babies, young children and the elderly.
2.Specific treatment if available for underling conditions eg.antibiotic the choice of which depends on the sensitivity of bacteria to the antibiotic.
3.Relief of symptoms include an antispasmodic drug to stop abdominal cramps, medicine to harden the stools such as kaolin and slow down the intestinal movement (lomotil or loperamide).
The following steps may help relieve the symptoms of Diarrhea.
1.Allow your gastrointestinal tract to settle by not eating for a few hours.
2.Sip small amounts of clear liquids or suck on ice chips if vomiting is still a problem.
3.Give infants and children oral rehydration solutions to replace fluids and lost electrolytes. 4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Avoid dairy products, caffeine, and alcohol until recovery is complete.
6.Get plenty of rest.
Prognosis:
depends on the cause.
Usual outcome of acute diarrhea is excellent if treated early.
For chronic diarrhea, the underlying cause must be treated.
Outcome is usually excellent with appropriate treatment.
How is Diarrhea prevented?
—————————————-
You can avoid infection by:
1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers
2.washing your hands thoroughly for 20 seconds before eating
3.disinfecting contaminated surfaces such as counter tops and baby changing stations
4.Avoid eating or drinking foods or liquids that might be contaminated

>A Simple Guide to Down’s Syndrome

>A Simple Guide to Down’s Syndrome
———————————-
What is Down’s Syndrome?
——————————

Down syndrome is a genetic condition in which the affected person is born with mental disabilty and characteristic features.

These characteristic features have been called mongolism with:
1.obliquely set eyes
2.narrow palpebral fissures
3.epicanthyl folds
4.short stubby nose
5.flattened facies
6.short stature
7.generalized muscular hypotonia
8.dry skin
9.thin fine hair
10.underdeveloped genitalia

Most people with Down’s Syndrome are not able to look after themselves because of their mental diability.

But many of them have gentle and endearing personalities.

There is no medical cure for this condition.

What causes Down’s Syndrome?
———————————–

Chromsomes are tiny structures in our body cells which can seen only with a special microscope.
They contains the genes which determines the characteristics of a person.

Anormal person has 23 pairs of matching chromosomes in each cell.
Each pair is different and given a number except for the sex chromosomes which are named XY in the male and XX in the female.

A person with Down’s Syndrome has an extra chromosone no.21

What are the Types of Down Syndrome?
—————————————

There are  three genetic variations that can cause Down syndrome:
1.Trisomy 21 is the commonest type in which all the cells have an extra chromosome 21.Here something goes wrong during egg formation in the mother so that the mother has an abnormal egg with extra chromosomes no.21. The child will then get an extra chromosone no.21. The cause of this abnomal egg formation is unknown but occurs more frequency with the mother’s age.

2.Translocation Down syndrome happens when the extra chromosome 21  is attached to another chromosome. During cell division the embryo may get the attached chromosome and so have an extra chromosome no 21 and get Down’s Syndrome.

3.Mosaic Down syndrome is a another form of Down’s Syndrome in which only some cells have an extra chromosome 21.

What are the Risk factors of getting Down’s Syndrome?
——————————————————

Risk factors include:

1.maternal age above 35 years. Most cases of Down’s syndrome are born to women aged 35 and above. The risk of a woman above age 36 conceiving a child with Down syndrome is 1 in 350. The risk increases to 1 in 100 by the age of 40 and to 1 in 25 at the age of 45.
   
2.Mothers with one Down syndrome child have a 1 in 100 chance of having another child with Down syndrome.

3.Parents who are known to carry the translocated chromosome for Down syndrome can pass the abnormal gene to their offspring.

What are the Symptoms of Down’s Syndrome?
————————————————
Mongolian features:
1.distinct flat facial profile
2.Upward slanting eyes
3.Flat nose
4.Protruding tongue
5.Flat back of the head
6.Small statue
7.Poor muscle tone
8.Broad, short hands with short fingers and a single crease in the palm
9.dry skin
10.thin fine hair

Mental retardation
1.mental disability
2.unable to look after themselves

Congenital defects:
1.congenital heart disease
2.other birth defects

Screening tests are done for all pregnant women above 35 years of age and include:

1.Triple test – is a blood test done for older pregnant mothers above 35 years which measures specific proteins in the mother’s blood. This may indicates the possibility of Down’s Syndrome

2.Nuchal translucency test is an ultrasound scan of the embryo at 10-13 weeks of pregnancy. It measures the width of the spinal cord at the back of the baby’s neck.

If the screening tests suggest a possible high risk of Down syndrome, then the following diagnostic tests may be performed to determine or confirm whether the baby actually has Down syndrome:

1.Amniocentesis. A small amount of the amniotic fluid is obtained through a needle inserted into the mother’s womb after 16 weeks of pregnancy. This fluid contains cells shed from the baby and can be examined to see if the chromosomes are normal.

2.Chorionic Villous Sampling (CVS) involves obtaining some cells from the mother’s placenta to examine the baby’s chromosones.It is usually done around the 14th week of pregnancy.

3.Percutaneous umbilical blood sampling (PUBS) involves obtaining blood from a vein in the umbilical cord after 18 weeks of pregnancy. The blood cells are examined for chromosomal defects.

Complications of Down’s Syndrome are:

1.Heart defects.
2.Leukemia 
3.Infectious diseases such as pneumonia
4.Dementia often appear before age 40
5.intestinal obstruction,
6.thyroid problems,
7.hearing loss
8.poor vision.

Treatment of Down’s Syndrome:

There is no medical cure for Down syndrome.
However, children with Down syndrome do benefit from medical help and early interventions starting in infancy which improve the life expectancy and quality of life.

Prevention of Down’s Syndrome:

Down syndrome cannot be prevented.
1.genetic counselling in high risk translocation genetic group before considering pregnancy.

2.Coping and support from a team of doctors, teachers and therapists who can  provide the resources and support to  take better care of your child.

3.Joining a Down Syndrome support group and families who are dealing with the same problem

Prognosis:
1.A better understanding of Down syndrome and early interventions have improved the quality of life of children and adults with Down syndrome.

2.If there is no major complications such as heart disease and leukemia, a person with Down Syndrome may have a slightly shortened life span than a normal person.

>A Simple guide to Scarlet Fever

>

A Simple guide to Scarlet Fever
———————————————–

What is Scarlet Fever?
————————————
Scarlet Fever is an acute febrile infectious disease of the upper respiratory tract caused by the erythrogenic toxin associated with the bacillus Group A Streptococcus(GAS).

How is Scarlet Fever transmitted?
———————————————–


Scarlet Fever is transmitted through the air through
1.droplets from the infected tonsillar or pharyngeal area of infected patients.
2.infected articles or food,
3.infected wounds or
4.infected umbilical stumps of neonates 

It is highly infectious, being communicable from 24 hours before onset of symptoms to 2 to 3 weeks after onset of symptoms.

Asymptomatic carriers can also spread the disease.

Incubation period is 2 – 5 days.

The organism enters the blood from the throat and produce an erythrogenic toxin which causes  the symptoms of fever and rash.

The rash is the main symptom which gives rise to the scarlet appearance, hence the name Scarlet Fever.

The infections occur in persons of all ages but peak incidence is 5- 15 years. Males are affected equally as females.

Usually 1 attack will confer permanent immunity to the erythrogenic toxin of GAS streptococcus.

What are the Signs and Symptoms of Scarlet Fever ?
————————————————————————

Symptoms start off with:
1. sudden onset of headache

2. high fever 39-40 degrees centigrade

3. chills and rigors

4. sore throat(infected tonsils)

5. vomiting

6. cervical lymphadenopathy

Subsequent symptoms follows:
1.punctate erythrematous rash appearing 12 to 24 hours later after the fever, starting from the neck and chest then spreads rapidly.
The face is not affected.

2.Facial flushing and pale area around the mouth

3.Dark red lines along skin creases (Pastia’s lines)

4.Rash blanches when pressed

5.Tongue coated with white fur with occasional red papillae (white strawberry tongue) The white fur peels on the third day and becomes red by the fourth day (red strawberry tongue)

How to diagnose Scarlet Fever?
————————————————————-
1.Symptoms of fever and rash
2.ESR raised very high somtimes > 80
3.moderate leucytosis
4.Throat swab for culture and sensitivity

What are the complications of Scarlet Fever?
—————————————————————-

1.otitis media

2.rheumatic fever

3.glomerulonephritis

4.henoch-schonlein purpura

What is the Treatment of Scarlet Fever?
————————————————————

Isolation in hospital may be needed.
1.Antibiotics (penicillin or amoxicillin) are used in the treatment of Scarlet Fever. Treatment is for at least 10 days.
Alternatives are cephalosporins such as cephelexin in penicillin sensitive patients
2.Paracetamol is given for fever and pain
3.Bed rest , fluids and general supportive care

What is the Prevention for Scarlet Fever?
—————————————————

Avoiding infected patients
Recently there are new cases of Scarlet Fever in Hong Kong.

What is the Prognosis of Scarlet Fever?
————————————————-


In fact after the introduction of antibiotics, there is very few cases of Scarlet Fever.
Early therapy with antibiotics produce excellent recovery
In rare cases complications such as rheumatic fever and glomerulonephritis can occur

>A Simple Guide to Encephalitis

>

A Simple Guide to Encephalitis
———————————–

What is Encephalitis?
—————————

Encephalitis is a serious medical disease which causes inflammation and infection of the brain.

What are the causes of Encephalitis?
—————————————-

The causes of Encephalitis may be divided into:

Infections:
————
1.viral infections are the most common
(herpes simplex virus, mumps, measles, rubella, chickenpox, West Nile Encephalitis, Japanese Encephalitis, St Lious Encephalitis).

Of these viruses, herpes simplex virus is the most serious and can cause fatality.

2.bacterial infections such as meningoccocus(Neisseria meningitidis) and pneumococcus(Streptococcus pneumoniae) can be serious and fatal in some cases.

Meningococcal Encephalitis can cause outbreaks(spread easily).

3.fungi,
Cryptococcus neoformans is the most common cause of fungal Encephalitis

4.Parasitic
Examples are Toxoplasmosis, malaria, amoeba, Lyme Disease

What are Signs and symptoms of Encephalitis?
———————————————

The symptoms which often defines Encephalitis are:

1.Severe headache

2.Fever

3.Irritabilty

4.Confusion

5.Drowsiness and fatigue

Other symptoms are:

6.seizures and convulsions

7.vomiting

8.hallucinations

9.memory problems

10.tremors

11.weakness of the hands and legs

12.incontinence of urinary and bowel movement

How is the diagnosis of Encephalitis made?
——————————————

1.Typical symptoms of fever, headache, confusion .

2.Physical examination shows confusion ,drowsiness and signs of neck rigidity

3.blood tests (complete blood count, ESR and blood culture) 

4.cerebrospinal fluid analysis (CSF) via lumbar puncture is examined for increased white blood cells and protein content,  normal glucose level. Red blood cells may be present if there is bleeding. Sometimes the CSF may show the presence of micro-organisms.

This test should not be done if there is suspected cerebral mass lesion or raised intracranial pressure (head injury, localizing neurological signs, or signs of raised ICP).

5.CT or MRI of the brain and spine with MRI preferred over CT because it can detect more easily areas of cerebral edema,tumors, ischemia, and meningeal inflammation.

What are the complications of Encephalitis?
———————————————–

1.Neurological deficits

2.deafness

3.learning disorders in children

4.brain infarction,

5.septic shock,

6.adult respiratory distress syndrome 

7.seizures also more in children

8.pneumonia especially in the elderly

What is the treatment of Encephalitis?
————————————

1.Hospitalisation should be immediate as Encephalitis is an life threatening condition.

2.Antibiotics such as cephalosporin, ampicillin, chloramphenicol, intravenous vancomycin to be started even before doing lumbar puncture.

Acyclovir may be given for herpes virus infection

High dosages of antifungals may be given for Fungal Encephalitis for a prolonged period of time

3.corticosteroids is useful to reduce swelling and inflammation in the brain

4.Sedatives may be needed for irritabilty and restlessness

5.High-flow oxygen

6.intravenous fluids

What is the prognosis of Encephalitis?
——————————————

This depends on the severity and type of infection.

Viral infections except for herpes simplex usually recover quickly.

Bacterial infections such as meningococcus and pneumonia are more dangerous.

What are the Preventive measures taken for Encephalitis?
——————————————————–

Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of meningitis and encephalitis.

Mumps vaccination as part of Measles,mumps and rubella vaccine(MMR) has reduced the incidence of mumps related form of meningitis and encephalitis

>A Simple Guide to Tropical Sprue

>

A Simple Guide to Tropical Sprue

A Simple Guide to Tropical Sprue
————————————————–
What is Tropical Sprue?
—————————————
Tropical Sprue is a malabsoption disease of unknown etiology associated with temporary or permanent stay in the tropics and characterized by abnormalities in the lining of the small intestine.
The small bowel mucosa shows
1.villous atrophy
2.columnal to cuboidal changes in absorbing cells
3.infiltration of lamina propia with lymphocytes, plasma cells and eosinophils
Who is affected by Tropical Sprue? ———————————————————————————————-
Tropical Sprue cause is unknown but some possible causes are: 1.Nutritional deficiency
2.intestinal infection
There is a possibility of enzyme deficiency and abnormal immunological response.
Tropical Sprue can be found in all ages but are more common in the 10-30 years age group.
What are the Symptoms and signs of Tropical Sprue? ————————————————————————————-
Symptoms varies from mild to severe:
Early symptoms are:
1.fatigue
2.bulky stools
3.Weight loss despite good appetite and intake
After some months malnutrition is noted with evidence of malnutrition syndrome:
1.weight loss
2.glossitis
3.stomatitis
4.pigmentation
5.edema
5.diarrhea and steatorrhea
6.megaloblastic anemia
7.iron,folic acid and vitamin b12 deficiency
The Diagnosis of Tropical Sprue is confirmed by: ————————————————————————————
1.A history of abdominal pain , diarrhea and weight loss
2.small bowels radiology
a.thickening and coarsening of mucosal folds
b.dilatation of smaa intestinal lumen
c.flocculation and segmentation of barium
3.tests for malabsorption syndrome 4.fecal fat assessment
5.Jejunal biopsy
What are the complications of Tropical Sprue? ————————————————————————————-
1.weight loss
2.Nutrition: malabsorption and vitamin deficiency
What is the treatment of Tropical Sprue? —————————————————————————————————
Treatment is :
Control of Diet
1.Folic acid is given for at least 6 months
2.Vitamin B12 injection is given
3.food containing iron, folic acid and vitamin B12 are are given
4,Enough protein supplement
5.lots of fluids
Medication
1.Antispasmotic medication for abdominal pain
2.lomotil or imodium to suppress diarrhea
3.Tetracycline is given daily for at least 6 months
Start with high doses at first, followed by reduction of dosage.
4.Correction of anemia and nutritional deficiencies is important to enhance the immune system
What is the prognosis of Tropical Sprue? ———————————————————————————————-
The prognosis is usually very good Treatment is very effective in producing weight gain and correcting nutritional deficiency.
Abnomal morphology and bowel function may persist despite treatment
There may be spontaneous remission especially leaving the tropics.
What are preventive measures in Tropical Sprue? ————————————————————————–
A nutritious diet with vitamin supplements can strengthen the body resistance against illness.
Avoid the tropics.

>A Simple Guide to Photo Dermatitis

>

A Simple Guide to Photo Dermatitis
—————————————-

What is Photo Dermatitis?
————————————-

Photo Dermatitis is a common skin condition which presents as a erythematous or vesicular rash on face, neck, hands and other areas exposed to sunlight.

What causes Photo Dermatitis?
————————————-

The cause of Photo Dermatitis is related to the exposure of the skin to the sun.
However some possible triggers are:
1.Genetic

Genes play a part in Photo Dermatitis as the condition runs in families

2.External causes

Photo sensitivity:certain exogenous sensitizers play a part in the development of Photo Dermatitis.

a.drugs such as phenothiazines, thiazides and tetracycline

b.cosmetic such as lipstick, perfumes, soaps, shaving cream, antiseptic creams, even sun screening agents (especially if they contain coal tar)

c.irritating chemicals which exaggerated the photosensitzing effect of the sun

d.sunburn reaciion which aggarvated the skin to react as rashes.

e.Photo allergic rash which persist for years

f. injury by ultraviolet light

g.feeling too hot and/or sweating will cause an outbreak.

h.Stress can also sometimes aggravate an existing flare-up.

Photo Dermatitis affects both sexes equally.

What are the symptoms and signs of Photo Dermatitis?
———————————————————–

Typical features of Photo Dermatitis are:

1.vesicular or bubbles in areas most exposed to light

2.erythrematous or red rashes in areas most exposed to light

3.some occurs following severe sunburn

4.some are seasonal with recurrance in early spring and summer

5.actinoid reticuloid skin rash affecting the face and hands are also seen in chronic photo dermatitis patients

How is Photo Dermatitis diagnosed?
——————————————-

1.History and appearance of the rash

2.Photo patch testing

3.Determination of light wavelength causing photo dermatitis

How can Photo Dermatitis be treated?
——————————————

Treatment of an Photo Dermatitis treatment routine is:

1. Avoid ultraviolet light especially long wave ultraviolet light

2. application of lotions or creams to protect the skin against the sun

3.chloroquine sulphate 200mg daily may be useful for some patients over short periods

4.application of nonprescription corticosteroid creams and ointments to reduce inflammation
if the condition persists, worsens, or does not improve satisfactorily.

Hydrocotisone cream and ointment are preferred to prevent side effects such as skin thinning.

5.For severe flare-ups, your doctor may prescribe oral corticosteroids (this treatment is not recommended for long-term use).

6.sedative antihistamines are sometimes used to reduce the itch

Prognosis:

1.good to excellent in most cases with phot toxic eruptions

2.good to fair with photo allergic reactions

3.Some patients reacts persistently to light without exposure to an antigen.

How can Photo Dermatitis be prevented?
———————————————

Photo Dermatitis outbreaks can usually be avoided with some simple precautions.

The following suggestions may help to reduce the severity and frequency of flare-ups when exposed to the sun:

1.use sun screen

2.Avoid drugs or cosmetics which can trigger off photo dermatitis

3.Avoid sweating or overheating

4.Reduce stress

5.Avoid harsh soaps, detergents, and solvents

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

7.Be aware of any foods that may cause an outbreak and avoid those foods

>A Simple Guide to Giardiasis

>

A Simple Guide to Giardiasis
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What is Giardiasis?
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Giardiasis is an acute infectious illness caused by the single celled parasite Giardia lamblia
What is the cause of Giardiasis?
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The bacteria which causes Giardiasis is the Giardia lamblia
which is an extremely hardy parasite able to live in  polluted water, contaminated food and soiled clothes.
Giardiasis infections occur most common in the small intestines.
The parasite can cling to folds of the lining of the small intestine and absorbs nutrients from the fluid in the intestines.
In this way the child may suffer from malnutrition.
What are symptoms of Giardiasis?
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The main symptoms of Giardiasis are
1. Many people with E.histolytica in stools are passive carrier
2. Invasive bowel disease begins 1-6 months after infection sometimes later
3. abdominal pain especially at the sides
4. altered bowel habit
5.diarrhea with blood or mucus in stools
6.foul stools
7.adominal bloating or gas
8.tenderness on palpation at caecum or sigmoid colon regions
Severe cases may have:
1.more severe symptoms as above
2.bloody stools
3.fever
4.weight loss
5.liver enlargement and tenderness on palpation
6.dehydration and its effects such as delirium and disorientation
7. lassitude and tiredness
8. convulsions
9.tender abdominal mass with obstruction
How is the diagnosis of Giardiasis made?
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Doctors generally diagnose Giardiasis based on:
1. stool cultures.
2.blood tests
3.colonoscopy
4.liver scan and ultrasound
What are the complications of Giardiasis?
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Giardiasis is a disease which can kill espcially through its complications:
1.Perforation of bowel leading to peritonitis or inta-abdominal abscesses
2.Severe hemorrhage uncommon but can cause death
3.Intussusception or insertion of part of colon into another part of colon is rare but can follow amebic ulceration and may cause intestinal obstruction
4.irritable bowel syndrome may persist for some months
5.Lung and pericardial involvement rare but can pose danger
6. cutaneous amebiasis cause deep painful and rapidly spreading ulceration
7.Liver infection can cause damage to liver and result in cirrhosis
8.Liver abscess may perforate and cause peritonitis or produce lung abscess or amebic pericarditis
9.Amebic brain abscess are rare but can occur.
How is Giardiasis treated?
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Giardiasis is an infectious disease which can spread to other people through contaminated food and water.
1.Anti-parasitic medicines like metronidazole 750mg three times a day for 10 days should work for mild to moderate disease.
2.Metronidazole 750mg three times a day for 10 days and chloroquine or diiodohydroquin (1000mg for 2 days followed by 500mg per day up to 3 weeks) for hepatic amebiosis
3.Emetine hydrochloride 1mg pere kg per day by intramuscular injections for 5 days in acute amebic dysenery
4.tetracycline 250mg four times a day for 10 days my be needed for some with invasive intestinal disease.
5.Diloxanide furoate 500mg three a day for 10 days for asymptomatic amebic cyst carrier
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 Giardiasis prevented?
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Prevention of Giardiasis can be by:
1.boil drinking and cooking water for 5 minutes
2.Proper filtration of water
3.Examination of stools of food handlers
4.Avoid eating or drinking foods or liquids that might be contaminated especially by flies
5.Good food hygience and hand washing
What is the prognosis of Giardiasis?
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Prognosis depends on the stage of disease
It is excellent with prompt treatment of amebic infection.
Luminal disease or dysentery usually respond well to treatment.
In refractory cases chloroquine may be added to metronidazole.
Surgery is rarely necessary.
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