Importance of vitamin B1

           Importance of vitamin B1 & Lack of vitamin B1

Vitamin B1 (Thiamine)

Vitamin B1  is a water-soluble vitamin and plays a very important role in energy metabolism, and helps protect our body's tissues against advanced oxidative stress.

It is from B complex family and also known as thiamine; it is not stored in our body, so we have to take it through proper diet.

 It is found in wheat ,brown rice,vegetables,fruits,cereals,beef and beef liver,eggs ,nuts,yeast chicken,fortified grains etc.

Vitamin B1 is a very important vitamin for our body,co-factor for proper enzymatic functioning, it provides energy to the brain and increases the efficiency of the heart muscles .lack of vitamin B1 can lead to many complications in the body.

A severe chronic form of this vitamin B1 deficiency leads to beriberi, which there are to major types, wet beriberi, dry beriberi.

 1. Wet beriberi, in this type of vitamin B1 deficiency complication cardiovascular system, is involved with cardiomyopathy, congestive heart failure, palpitation, pulmonary oedema, breathlessness.

2. Dry beriberi, mainly nervous system is involved. Peripheral nerve involvement is typically asymmetric by both motor and sensory neuropathy and loss of reflexes.commonly in dry beriberi lags are more affected than the arms, also decreased sensation. Central nervous system involvement results in Wernicke-Korsakoff syndrome. Wernicke-Korsakoff encephalopathy thy consists of nystagmus progressing to ophthalmoplegia, truncal ataxia and confusion.   

Signs and symptoms of vitamin B1 deficiency

If anyone has a vitamin B1 deficiency, they should treat it immediately. The importance of vitamin B1 can be gauged by the fact that its deficiency in the body affects the entire system of our body, in the advanced stage, this vitamin B1 deficiency becomes more dangerous. The following are the common signs and symptoms of vitamin B1 deficiency,

• Confuse personality  

• Irritability 

• Memory loss 

• Shortness of breathing 

• Anorexia 

• Oedema (especially swelling of legs) 

• Fast heartbeat 

• Body pain and muscle cramps   

• Numbness of feet 

Causes of vitamin B1 deficiency

Vitamin B1 deficiency is mainly seen in alcoholic people and people who take carbohydrate-rich food over along time, as we know carbohydrate-rich food like white bread and white rice, carbonated drinks are low in vitamin B1.

Nowadays, alcohol is the biggest reason for vitamin B1 deficiency, alcoholism prevents vitamin B1 uptake in the duodenum and leads to fatty liver .and, therefore, less vitamin B1storage in the liver. There are several causes of B1 deficiency, some causes are below,  

• Alcoholism  

• Metabolism 

• Pregnancy and lactation 

•  Poor dietary intake    

• Dialysis

•  HIV 

• GI surgery 

• Excess carbohydrate 

Laboratory investigations

Most vitamin B1 deficiency patient is diagnosed by a doctor after physical examination., but in some severe cases, the doctor usually measures the vitamin B1 level by measuring RBC transketolase activity and also urine B1 excretion. A transketolase activity coefficient > 15-20% suggests vitamin B1 deficiency. In addition, thyroid function tests may be performed.

Treatment of Vitamin B1 deficiency

If vitamin B1 deficiency is not severe, this deficiency can be compensated by eating foods containing vitamin B1, but where vitamin B1 deficiency is severe, they may be given vitamin B injections, tablets or syrup.

In emergency conditions like anorexia nervosa, GI surgery, AIDS, an infusion of vitamin B1 300mg to 500mg  can be given slowly and the doctor also prescribes some medicines orally. 

The daily requirement for adults:1.1 to 1.5 mg per day, Children,0.5-1.4 mg per day, this requirement increases slightly during pregnancy 1.4 mg per day.

You may be surprised to know that every year many people die of vitamin B1 deficiency without treatment. Most importantly, never take any vitamin without consulting a doctor.

 

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life threatening anorexia

                            life-threatening anorexia nervosa 

                                                         

Anorexia nervosa 

Anorexia nervosa is a complicated eating disorder, In a simple world, we call it a loss of appetite. This anorexia nervosa disorder can occur at any age, especially common in adolescents and young adults. Anorexia nervosa is more common in young females.

Excessive dieting and exercise can lead to a life-threatening anorexia nervosa. Patients of anorexia nervosa always think that they are overweight, and thus they try to keep the weight as low as possible.

There are two major types of anorexia nervosa.

1. Restricting anorexia nervosa 

2. Purging anorexia nervosa 

1. Restricting anorexia nervosa, In it, people force themselves to stay away from eating, and even if they do eat, they eat very little.

2. Purging anorexia nervosa, this disorder is very strange, because affected people eat food but later they try to expel the food out of the stomach by any means, so they put their fingers in their mouth and try to vomit.

Signs and symptoms 

People who have anorexia nervosa will always say," I'm not hungry, "whenever you tell them to eat. The signs and symptoms of anorexia nervosa are very clear, sometimes it could be emotional and sometimes could be physical, some of them are following,

•  Dizziness  

• Lack of appetite & thin body  

• Insomnia  

• Weakness 

• More active and exercising  

• Nausea   

• skin and hair  disorders

• Constipation  

• Dehydration  

• Abdominal pain 

• Menstrual irregularity 

• Infertility 

Other symptoms include hypotension, oedema, memory loss, cold intolerance, etc.

Causes of anorexia nervosa 

The exact cause of the anorexia nervosa have not been identified yet, but it has often been observed that people with nervous weakness have this anorexia nervosa. 

People face life-threatening anorexia nervosa, because of their desire to look beautiful and attractive, but it can lead to mental health crises, which lead to depression. Even anorexia nervosa sufferers commit suicide due to depression.

Mostly actors, actresses, athletes, people associated with the modelling industry have anorexia nervosa because thin people are more valuable in these fields. 

It simply means to control the natural process artificially. People with this disorder are sometimes very hungry but can't eat. I would call it a feeling of inferiority or fear. The causes of anorexia nervosa are as follows,

• Fear of obesity  

• Genetic  

• Depression  

• Cultural factors 

• Exercise excessively 

• Usage of laxatives.  

Complications, I call it life-threatening anorexia, because it causes a lot of dangerous complications such as,

• Heart diseases  

• Osteoporosis 

• Kidney problems 

• Liver problems 

Laboratory investigations

Anorexia nervosa patients also have complications with blood test such as anaemia, high cholesterol levels, endocrine abnormalities, etc.

Treatment of anorexia nervosa 

As we all know there is no medication for anorexia nervosa, but if anyone has an anorexia nervosa, they should first consult a primary care physician to find out the reasons for anorexia nervosa. The physician can ask questions about your eating habit. 

In addition, the physician recommends some tests to rule out certain diseases because there are many similarities between anorexia and these diseases, such as inflammatory bowel disease (IBS), hypothyroidism, diabetes, cancer. Such people are also in dire need of counselling.

It is very important to know body mass index ( BMI ) in anorexia nervosa.To find out the BMI, usually, doctors first determine the weight in kilograms and height in meters and then divide the weight by meters squared, normal BMI should be from 18.5-24.9, less than that will call underweight, and more than that normal BMI  will be called obesity.BMI should be based on your age. 

Depending on the severity of your weight loss, In some cases, antidepressants are very effective, but some people who are facing anorexia nervosa are also hospitalized because their BMI is much lower than normal BMI. If someone has severely dehydrated, so they are put on intravenous fluids.

Nutritionist: In this eating disorder, you will need a nutritionist who will tell you what to eat and what not to eat. A nutritionist will tell you the benefits of a balanced diet and may advise you to use a certain type of nutritional supplements.

We commonly observe that patients with this eating disorder are unwilling to admit that they have anorexia nervosa.In such cases, it is the duty of the family to support and take special care of their diet.

 

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optimal folate levels

                              Folic acid deficiency in the elderly,

                                 optimal folate levels

Folate   (Folic Acid)

Folate is a type of vitamin B9, which is a water-soluble vitamin. Folate and vitamin B12 work together, folate is necessary for the formation of RBC (Red blood cells) and nerve function. Folate is a water-soluble vitamin. It helps the body to restore cells, and formation of DNA and RNA. Lack of folate and B12 causes anaemia, which we call macrocytic anaemia.

Normalization of folate is very important for fetal development. The major problem of folate deficiency is in pregnancy, because of folate deficiency can cause neural tube defects, like spine Bifida  (Incomplete closure of the vertebrae and membranes of the spinal cord) and anencephaly (Absence of the main portion of the brain)  the fetus.

Folate levels must be normal in the body, its deficiency also affects the skin, nail, hair and muscles.

Causes of folate deficiency

Folate deficiency is a clinical condition, because of the low level of folate. Most people are folate deficient because of the unbalancing diet, especially they eat junk and processed foods a lot, and didn't eat enough green leafy vegetables, fruits, pulses, nuts and seeds.

We should confirm the megaloblastic anaemia of folate deficiency from vitamin B-12 deficiency by the finding of a normal vitamin B 12  level and a decreased red blood cell folate or serum folate level. In megaloblastic anaemia, physical growth slows down.

Mostly folate deficiency is caused by increased demand for folate through pregnancy or sickle cell disease. The most common reasons for folate deficiency are:

• Poor diet, if someone not eating folate-rich foods like leafy green vegetables, beans, citrus fruits, rice and fortified cereals. Folate deficiency anaemia can occur because of a poor diet.

•   Pregnancy,  Folate requirements are increased in pregnancy because fetus uses quality levels of folate and received from mother.

• Consumption of excess alcohol,   Alcoholic persons decreased folic acid absorption is rarely seen, since absorption occurs from the entire gastrointestinal tract, alcohol increases folate excretion through the urine.

• Old age, inadequate food intake in old age is the biggest reason for folate deficiency.  

• Medications, Drugs such as phenytoin, trimethoprim-sulfamethoxazole, methotrexate or sulfasalazine, carbamazepine may interfere with its absorption. Folic acid absorption is poor in some patients with vitamin B,, deficiency because of mucosal disruption from that missing nutrient.

• Diseases, that affect absorption in the gastrointestinal tract can cause folate deficiency, diseases such as celiac disease, several kinds of cancers, kidney problem especially when requiring dialysis etc.

Symptoms of folate deficiency

 The features are like those of vitamin B,, deficiency because of anaemia and megaloblastic changes in the mucosa. Although, there are none of the neurologic abnormalities related to vitamin B,, deficiency. Patients with folate deficiency have the following signs and symptoms, 

• Weakness  

• Pale look    

• Chest  pain  

• Diarrhoea 

• Nausea 

• Difficulty in-breath and swallowing   

• Dizziness  

• Canker sores  

• Low Red blood cells (RBC ) and platelet.

Folate deficiency  side effects and complications 

If someone is folate deficient, so it should be treated by a doctor, as folate deficiency seems to be a minor problem, but its deficiency can lead to many dangerous complications. Some complications that can be caused by folate deficiency are listed below,

• Heart problems  

• Stroke     

• Hypothyroidism   

• Hair loss  

• Lead to anaemia & leukopenia 

•  Premature or low birth weight 

• Infertility 

Laboratory  investigations 

Folate normal value for adults is 2-20 ng/mL. 5-21 ng /mL is for children and for infants  14-51 ng/mL,(Serum normal optimal folate levels 7.2 to 17.ng/mL)..... Megaloblastic anaemia is identical to anaemia resulting from vitamin B,, deficiency. A red blood cell folate  level of < 150 ng/mL (< 340 nmol/L) is diagnostic of folate deficiency. 

The red blood cell folate level is preferred over the serum folate level because the former reflect body stores over the life span of the red blood cell, while the latter reflects immediate labile serum levels rather than body stores. 

Usually, the serum vitamin B 12 level is normal and should always be measured when folate deficiency is suspected. In some instances, folate deficiency is a consequence of the gastrointestinal mucosal disturbances from vitamin B-12  deficiency.

Bone marrow is sometimes studied to determine folate deficiency. 

Dietary options 

A folate deficiency is usually easy to curable with oral supplements. Folate supplements amazingly decrease the risk of congenital heart defects. Folate is present in most fruits and vegetables, and daily requirements of 50-100 mcg are mostly met in the diet. 

If you eat a proper diet on a daily basis, you will never suffer from folate deficiency, and in that case, medicine will not be needed. The following foods can help reduce folate deficiency, 

• Citrus fruits 

• Eggs 

• Leafy green vegetables  

• Broccoli  

• Peas 

•  Avocado 

• Nuts 

• Beef liver  

• Milk

Treatment of folate deficiency 

Total body stores of folate are about  5 mg, enough to supply requirements for 2-3 months. The woman who wants to conceive should start taking folate supplements before they conceive, because it protects the baby against diseases and birth defects .400 mg to 600 mg of folate should be taken daily during or before pregnancy, especially in the first trimester.

Folate deficient should receive supplementation with 1 mg daily of folate. The response is similar to that seen in the treatment of vitamin B,, deficiency, with rapid improvement and a sense of well-being, reticulocytosis in 5-7 days, and total correction of hematologic abnormalities within 2 months.

Large doses of folic acid may produce hematologic responses in cases of vitamin B,, deficiency, but will allow neurologic damage to progress, hence the importance of knowing the vitamin B 12 status in suspected folic acid deficiency.

Remember that folate acid medications should never be taken without doctor's advice as it can have many harmful side effects, such as skin rashes, poor appetite, nausea, breathing problems, etc.

                     

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management of sleep apnea

                                     Management of sleep apnea

Sleep apnea

Sleep apnea means when a person suddenly stops breathing again and again during sleeping. Basically, it is a serious and common sleep disorder. If someone snores loudly and feel tired, every time, and unknowingly stop breathing again and again throughout the sleep, these are the indications of sleep apnea.

If the respiratory arrest for more than 10 seconds or 10 seconds, we call it a sleep apnea Snoring is considered a main symptom of sleep apnea, and risk factors are age, family history and obesity With each episode of sleep apnea blood pressure, cholesterol and sugar level increase. Oxygen in the brain begins to decrease.

Sleep apnea affects about 100 million people worldwide,20% of women and 30% of men, it can occur at any age. There are mainly  two types of sleep apnea,

1. Obstructive sleep apnea (OSA)   2. Central sleep apnea (CSA)

1. The obstructive sleep apnea is the most common and prevalent type, and is characterized by a blockage of airflow because of tongue and tissue collapsed during deep sleeping.

2. Central sleep apnea is a very serious type of sleep apnea, the nervous system fails to signals the muscles to breathe.In a result of this, the brain and the rest of the body may not get oxygen.

Symptoms of sleep apnea

The patient may appear sleepy or even fall asleep during the evaluation. The oropharynx is frequently found to be narrowed by excessive soft tissue folds, large tonsils, pendulous uvula, or prominent tongue. 

Nasal obstruction by a deviated nasal septum, poor nasal airflow, and a nasal twang to the speech may be observed. Below are some more basic signs and symptoms  of sleep apnea,

• Loud snoring  

• Restless sleep  

• Sudden breathing obstruction during the sleep  

• Fatigue   

• Bull neck appearance

• Depression  

• Morning headache  

• Irritability  

• Mood swings 

• Day time sleepiness  

• poor  memory & poor concentration   

• Impotence

Causes of sleep apnea 

Sleep apnea is mainly caused by the blockage of the throat and upper trachea, caused by soft excess tissues around the neck and throat. Most of these can be treated by removal, especially by losing weight. 

Sleep apnea a sleep disorder, patients stop breathing during sleeping, there  are some of the common reasons given below,

• Obesity  

• Big neck  

• Hypothyroidism 

• Drinking alcohol & smoking  

• High blood pressure  

• Enlarged tonsils 

Side Effects of sleep apnea

Sleep apnea is very dangerous, if left untreated, maybe lead to complications, some severe complications of sleep apnea are below,

• Stroke  

•  Anxiety  

• High blood pressure 

• Heart attack   

• Arrhythmia 

• Premature death 

• Lack of concentration  

• Diabetes 

Laboratory investigations

Mostly pulmonologists or ENT specialists diagnosis based on physical examination, but in some cases some tests are necessary. 

Erythrocytosis ( increase in red blood cell) is common. Thyroid function tests (serum, TSH, FT) should be collected to eliminate hypothyroidism.

Treatment 

Sadly to say, there is no cure for sleep apnea, although there is the treatment for the symptoms. Patient with sleep apnea is admitted in a hospital for a night for a sleep study, after the sleep study, the patient's treatment is decided according to what kind of treatment needs. Nowadays continuous positive airway pressure (CPAP) therapy is a frontline and common treatment for sleep apnea patients, it is highly effective.

In this (CPAP) method uses a mask that fits over nose and mouth, the machine slowly blows oxygen into your throat. The pressure from the air helps keep the airway open during sleep.

Nasal continuous positive airway pressure (nasal CPAP) at night is curative in many patients. Polysomnography is frequently necessary to determine the level of CPAP (usually 5-15 cm H, O) necessary to abolish obstructive apneas.

 For mild or moderate obstructive sleep apnea, Polysomnography is important to evaluate the effects of oxygen therapy. Mechanical devices inserted into the mouth at bedtime to hold the jaw forward and prevent pharyngeal occlusion have modest effectiveness in relieving apnea; however, patient compliance is not optimal. 

Uvulopalatopharyngoplasty (UPPP), is a procedure containing of surgery of pharyngeal soft tissue and removal of approximately 15 mm of the free edge of the soft palate and uvula, is helpful in about  50% of selected patients. It is more effective in evaluating snoring than apneic episodes.

Surgery: Mostly surgery is effective in treating snoring, but less effective in obstructive sleep apnea. Children with snoring or sleep apnea have enlarged tonsils & adenoids or both. In 80% of these cases, surgical of these tissues cures sleep-breathing problem  

Management of sleep apnea 

Sleep apnea can't be cured completely but can be controlled using different useful therapies. Lifestyle modifications are important to normaling breathing. People can control sleep apnea through changes in lifestyle. Patients with sleep apnea should avoid antidepressants and sleeping pills, and sleep on the side .

Avoid smoking and alcohol. Daily exercise and yoga are very important, regular exercise can increase energy level strengthen heart, don't sleep immediately after dinner.

Lose weight if someone is overweight, try to maintain healthy body weight by measuring BMI. Live a positive life, stay away from worries. You may have heard many people say that if we are sleeping with snoring then it is a sign of restful sleep, this is wrong, such people must consult a doctor once.

 

 

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how do.you get scabies

                                                 How to do. you get scabies

 Scabies

Scabies is caused by a mite Sarcoptes scabiei hominis, the word scabies is derived from the Latins word, which means scratching. Scabies is a contagious skin disease.

Most people get scabies in a place where there are a lot of people and can spread quickly through close physical contact in a family, school class, nursing home and public transport. 

Mites reproduce on the surface of the skin and burrow into it and the females lay eggs under the skin. Especially at night and on warmer days Sarcoptes scabiei lay eggs, therefore, itching at night more severe than a day. 

After 21 days hatch the larvae once hatched, the larvae move to the skin surface and spread across the body. Between 15 -20 mites are involved in an infection. Some people will say that they are itching because of their bites, that is not true.

The itching is an autoimmune response to the mites living underneath patient skin. Because of itching, red rash to form on the skin. Scabies affects people of all ages, race, and gender.

There are two types of scabies 1. Classic scabies  2.Crusted  scabies 

1. Classic scabies is a common type of contagious disease. Usually severe and worse at night. Axillae, areola, webs of fingers and genitalia are the affected areas of the body .

2. Crusted scabies, is a less common type but more severe form of scabies, also known as Norwegian scabies. Usually occurs in a poor immune system older people, HIV patients or cancer patients .we can see higher mites burden in these kinds of patients. Crusted scabies targets scalp, hand and feet.

Symptoms 

Severe itching is almost always present worse at night and can be quite severe. A rash of tiny red bumps that sometimes form in a straight line. 

The lesions consist of more or less generalized excoriations with small pruritic vesicles, pustules, and "burrows" in the web Spaces and on the heels of the palms, around fingernails, buttocks, wrists, elbows, around the axillae, knees and on the breasts of women. In infants, the site of infestation may include other parts of the body e.g scalp, palms, neck and face.

The feet are a good place to identify burrows, since they may have been scratched off in other locations. The burrow appears as a short irregular mark, 2-3 mm long and the width of a hair. 

Causes

Scabies commonly occurs in people in crowded living conditions, it is most often spread during a long period of direct skin contact with an infected person, such as during shake hands, hugging, during sex or living together.

Scabies can also be spread by sharing bed, cloth or furniture infested with mites. When these patients are hospitalized, hospital-based epidemics can occur. These epidemics are difficult to eradicate since many health care workers become infected and spread the infestation to other patients.

Diagnosis 

The scabies mites are very small and usually not directly seen. A dermatologist can usually diagnose based on patient symptoms and by looking at rashes Sometimes the doctor will scrape one or two bumps open. In the situation where the diagnoses are difficult polymerases, chain reaction testing is possible.

The diagnosis should be confirmed by microscopic demonstration of the organism, ova, or faeces in a mounted Specimen, examined with tap water. Best results are obtained when multiple lesions are scraped, choosing the best un excoriated lesions from interdigital webs, wrists, elbows, or feet.

 Patients with crusted/hyperkeratotic scabies must be evaluated for immunosuppression (especially HIV and HTLV-1 infections) if no iatrogenic cause of immunosuppression is present.

Treatment 

Treatment is aimed at killing scabies mites and controlling dermatitis, which can stay for months after effective eradication of the mites.  

 Permethrin 5% cream is highly effective and safe in the management of scabies. Permethrin 5% cream once for 12 hours-or 5% or 6% sulfur in petrolatum applied thinly thoroughly behind the ears and neck down over the entire body after showered with neem soap at nightly for 3 nights, permethrin cream is to be removed with warm water and soap after 10 hours. Each of the family members should apply it.

Patients will continue to itch for several weeks after treatment. Antihistamines such as diphenhydramine hydrochloride (Benadryl ) or hydroxyzine hydrochloride (Atarax) and calamine lotion may be used to relieve itching. Calamine lotion must be applied head to toe and scalp, especially before bed and after you have showered.

A single oral dose of Ivermectin is also very effective .Ivermectin is not recommended for pregnant women and children. Pregnant patients should be treated only if they have documented scabies themselves.

 Use of triamcinolone 0.1% cream will help resolve dermatitis. If secondary pyoderma is present, it is treated with systemic antibiotics.

 In areas where nephritogenic streptococcal strains are prevalent, infestation with scabies or exposure to scabies-infested dogs may be followed by acute post-streptococcal glomerulonephritis.

Persistent pruritic postscabietic papules may be treated with mid- to high-potency corticosteroids or with intralesional triamcinolone acetonide (2.5-5 mg/mL). )Because of the contagious nature of scabies, a dermatologist often recommends treatment for all family members at once.

Neem has antibacterial and antifungal properties, neem oil, soap can be a useful alternative treatment for scabies.

Prevention 

Maintain hygiene. Naver touch rashes without medical gloves, avoid scratching itchy skin. Daily Vacuum carpet and your furniture, then empty outside. Mop with soap and hot water.

To prevent reinfestation, Wash all clothes, bath towel carpets, bedsheets, sofa covers should be laundered or cleaned or set aside for 14 days in plastic bags.

These mites usually only can survive for three days without a host. Don't share clothes & towel. Preventative care after the treatment is the best.

 

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prevention of bronchiectasis

                                   Prevention of bronchiectasis

Bronchiectasis

Bronchiectasis is one of the most common problems especially in developing and undeveloped countries When a cough becomes chronic plus productive, lower infections became occurring often, so we call it bronchiectasis. Bronchiectasis disease is dilated airways. 

Airways become condensed with viscous mucous including inflammatory pathogens and mediators. This leads to breathing difficulty known as exacerbations. Bronchiectasis is a disorder that especially affects older individuals, about 2/3 of bronchiectasis patients are females.

Causes of  bronchiectasis

As we know that bronchiectasis is a progressive disease and causes serious respiratory complications. Bronchiectasis mostly arises as a complication of other diseases or from environmental exposures.

 It has several causes, some of them are the following : 

• Whooping cough   

• Sinusitis   

• Cystic fibrosis   (Cystic fibrosis causes about half of all cases of bronchiectasis.)

• Primer tuberculosis  

• Lung abscess  

• Cigarette smoking

•  Measles  

• Pneumonia 

• Fungal infections 

• Congenial 

Symptoms of  bronchiectasis 

The most common symptom of bronchiectasis is a cough with production of the profuse quantity of sputum. Obstructive pulmonary dysfunction with hypoxemia is seen in moderate or severe disease

• Low-grade fever   

• Anaemia

• Chronic cough   

• Pleuritic chest pain  

• Purulent sputum  

• Weight  loss 

• Anorexia 

Laboratory investigations for bronchiectasis

Diagnosis is based on a physical examination, history, radiographic testing, starting with a chest x-ray.  Here are four basic methods to help diagnose bronchiectasis,

• Sputum  culture  

• CBC 

• Chest X-ray  

• CT scan of the chest is more sensitive.

Imaging 

Radiographic abnormalities include dilated and thickened bronchi that may appear as "tram-tracks" or as ring-like markings on chest radiograph. 

 Microbiology 

Haemophilus influenza is the most common organism recovered from non-cystic fibrosis patients with bronchiectasis. P aeruginosa, S pneumoniae, and Staphylococcus aureus are commonly identified. Nontuberculous mycobacteria are seen less commonly.

Treatment for bronchiectasis

Treatment depends on what stage of the disease patient is, Early detection and treatment of bronchial 

obstruction can also reduce the chance of bronchiectasis.

Treatment of acute exacerbations consists of antibiotics, daily chest physiotherapy (5-10 minutes twice a day ) with postural drainage and chest percussion, and inhaled bronchodilators.

Antibiotic therapy should be guided by sputum smears 'and cultures. If a specific bacterial pathogen cannot be isolated, then empiric oral antibiotic therapy for 10-14 days is appropriate. 

Common regimens include amoxicillin or amoxicillin-clavulanate (500mg every 8 hours), ampicillin or tetracycline (250-500 mg four times daily), trimethoprim-sulfamethoxazole (160/800 mg every 12 hours), or ciprofloxacin (500-750 mg twice daily). 

Prolonged macrolide therapy (azithromycin 500 mg three times a week) has been found to decrease the frequency of exacerbation when taken for 6 months compared to placebo.

In surgical treatment doctor excision of bronchiectasis area, Surgical resection is reserved for the few patients with localized bronchiectasis and adequate pulmonary function in whom conservative management fails. Annual vaccination against influenza and vaccination against pneumonia after every 5 years is important.

Prevention of bronchiectasis

If someone has any lung disease, the chances of meteorological disease increase. Bronchiectasis patients should drink warm water to avoid cold water, cold drinks, ice cream and full-fat dairy products etc. Steam daily. Eat fresh food don't eat refrigerated food.

Avoid smoking, and if possible, use a mask when you go out. Perform breathing exercise as directed by the pulmonologist.

If a person has a cough for a long time, he must consult to a pulmonologist. If the disease is diagnosed in time, then treatment can be done quickly and easily.

Home remedy for bronchiectasis

1 tablespoon turmeric powder + 1 tablespoon cinnamon powder. Mix well and store in a jar.

To make 1 cup of ginger tea, add 1 teaspoon honey and 1 teaspoon lemon juice, use a half teaspoon of the (turmeric+cinnamon) above mixture. Effective in hot water, you can take this tea in the morning and evening. It will start giving results after a week.

 

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painful knee

                                     Painful knee &its treatment 

Knee pain 

Knee pain is a very common disease, especially in overweight people and age. The largest joint in our body is the knee joint and is sensitive to injury from infection, inflammation, trauma, and degenerative changes. The first step in knee pain is to look at the type of pain.

Knee pain can sometimes be caused by sitting with too much-bending legs or walking to fast. This type of pain usually heals quickly after taking a pain killer.  Our knee joints a soft surface, as we call cartilage. In fact, cartilage is present in every joint. This cartilage needs to be normal for normal movement.

 Cartilage weakens with age. Separating and protecting these bony surfaces is the lateral and medial meniscal cartilage, which works as a shock absorber throughout weight-bearing, protecting the articular cartilage. 

The patella is a large sesamoid bone anterior to the joint. It is placed in the quadriceps tendon, and it articulates with the trochlear channel of the femur Poor patellar following in the trochlear groove is a common source of knee pain especially when the cause is atraumatic in nature.

 The knee is supported by the collateral ligaments against varus (lateral collateral ligament) and valgus (medial collateral ligament) stresses. 

The tibia is limited in its anterior movement by the anterior cruciate ligament (ACL) and in its posterior movement by the posterior cruciate ligament (PCL). The bursae of the knee are detected between the skin and bony importance. 

They are sac-like structures with a synovial lining. They work to decrease the friction of tendons and muscles as they move over adjacent bony structures. To much external pressure or friction can lead to swelling and pain of the bursae. 

The prepatellar bursae located between the skin and patella, and the pes anserine bursa (which is medial and inferior to the patella, just below the tibial plateau) are most commonly affected. 

Other structures that susceptible to overuse injury and may cause knee pain following mind-numbing activity include the patellofemoral joint and the iliotibial band. 

Osteoarthritis of the knees is common after 50 years of age and can develop due to earlier trauma, ageing, activities, alignment issues, and genetic predisposition.

Signs and symptoms of knee pain 

Assessment of knee pain should begin with general questions concerning period and immediacy of symptom inception and the mechanism of injury or irritating symptoms. Overworked or degenerative problems can arise with stress or compression from sports, hobbies, or occupation.

 Symptoms of infection (fever, recent bacterial infections, risk factors for Sexually transmitted infections [such as gonorrhoea] or other bacterial infections (such as staphylococcal infection) should always be elicited.

Some of common symptoms and  complaints are :

1. Existence of clicking, grinding or cracking with bending, may be indicative of osteoarthritis of the patellofemoral syndrome.

2. Jamming " or "catching" when walking suggests an internal derangement, such as meniscal injury or a loose body in the knee.

3. Pain that occurs when rising after prolonged sitting suggests a problem with tracking of the patella.

Causes of knee pain

The knee is so much exposed, therefore easily injured. The knee is weight-bearing and for his reason is at a higher risk when the patient is obese.

 Not all knee pain is the same, each has a different cause. There are many reasons for knee pain, like torn ligaments or torn cartilage, dislocated and arthritis. Common causes include,

* Mechanical dysfunction or disruption:

1. Internal derangement of the knee: injury to the menisci or ligaments. 

2. Degenerative changes caused by osteoarthritis.

 3. Dynamic dysfunction or misalignment of the patella Fracture as a result of trauma. 

* Intra-articular inflammation or increased pressure :

1. Internal derangement of the knee: injury to the menisci or ligaments. 

2. Inflammation or infection of the knee joint. 

3.Ruptured popliteal (Baker) cyst. 

* Periarticular inflammation :

1. Internal derangement of the knee: injury to the menisci or ligaments

2. Prepatellar or anserine bursitis

3. Ligamentous sprain.

*  Common causes of knee pain and locations  :

* Medial knee pain :

1.Medial compartment osteoarthritis. 

2. Medial collateral ligament strain. 

3. Medial meniscal injury. 

4. Anserine bursitis (pain over the proximal medial tibial plateau)

*  Anterior knee pain :

1. Patellofemoral syndrome (often bilateral) Osteoarthritis. 

2. Prepatellar bursitis (associated with swelling anterior to the

patella). 

 3. Gout (buildup uric acid ) or other inflammatory disorder. 

* Lateral knee pain :

1.Lateral meniscal injury.

2. Iliotibial band syndrome (pain superficially along with the distal

iliotibial band near lateral femoral condyle or lateral tibial

insertion). 

3. Lateral collateral ligament sprain (rare). 

* Posterior knee pain :

1. Popliteal cyst. 

2. Osteoarthritis. 

3. Meniscal tears. 

4. Hamstring or calf tendinopathy.

Investigations for knee pain  

Laboratory  investigations :

Laboratory testing of aspirated joint fluid leads to a definitive diagnosis in most patients. 

Imagings:

Knee pain is evaluated with plain (weight-bearing) radiographs and MRI most commonly. Plain radiographs are usually negative in anterior cruciate ligament injury tears but are useful to rule out fractures.

 If a plain X-ray doesn't accurately diagnose a patient's knee pain, then MRI is the best choice.MRI is used to diagnose PCL and other related injuries.

MRI of the knee is the best diagnostic option for meniscal injuries. In osteoarthritis, MRI is most likely unneeded unless another pathology is suspected, like ischemic osteonecrosis.

Treatment of knee pain 

The treatment of painful knee depends on what the underlying diagnosis is, The most important thing to do is find the cause, especially if activities such as walking fast or jogging have just begun to run. Many people who exercise with sideways movements have symptoms of knee pain. 

But after these activities are stopped for approximately 2-6 weeks, the symptoms of knee pain will disappear slowly.

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help deal with inflammation (swelling or redness) and pain. 

These drugs can cause stomach problems and are recommended to take after eating. People who suffer from ulcer disease or gastric inflammation are advised to see a doctor before using these drugs.

Pain in the kneecap can usually be treated with physical therapy to strengthen the quadriceps muscle (quadriceps) and stretch the hamstring muscles (hamstrings) and calf muscles (lower legs). Sprained ligaments often heal on their own as time passes and adequate rest. 

Ligaments that are torn around the knee sometimes require immobilization and are followed by active physical therapy. If the pain in the knee does not decrease or worsen as the treatment progresses, a surgeon will recommend an operation (arthroscopy) to repair the damage.

After the symptoms have been successfully cured, previous activities can be carried out slowly, as usual, starting with activities such as walking or cycling.

Anterior Cruciate Ligament Injury treatment 

Most young and active patients will require surgical reconstruction of the ACL. Common surgical techniques use the patient's own tissues, usually the patellar or hamstring ten-dons (autograft) or a cadaver graft (allograft) to arthroscopically reconstruct the torn ACL.

Collateral Ligament Injury treatment 

The majority of MCL injuries can be treated with protected weight-bearing and physical therapy. For grade 1 and 2 injuries, the patient can usually bear weight as tolerated with a full range of motion. A hinged knee brace can be given to patients with grade 2 MCL tears to provide stability.

Posterior Cruciate Ligament Injury treatment 

PCL injuries can be treated nonoperatively. Acute injuries are usually immobilized using a knee brace with the knee extension; the patient uses crutches tor ambulation.

 Meniscus Injuries treatment 

Conservative treatment can be used for degenerative tears in older patients. The treatment is similar for patients with mild knee osteoarthritis, including analgesics and physical therapy for strengthening and core stability. Acute tears in young and active patients can be best treated arthroscopically with meniscus repair or debridement.

Patellofemoral Pain treatment 

For symptomatic relief, use of local modalities such as ice and anti-inflammatory medications can be beneficial. If the patient has signs of patellar hypermobility, physical therapy exercises are useful to strengthen the quadriceps to help stabilize the patella and improve tracking. Support for the patellofemoral joint can be provided by the use of a patellar stabilizer brace or special taping techniques.

*Osteoarthritis treatment 

Knee braces provide Some improvement in subjective pain symptoms most likely due to improvements in neuromuscular function. 

The initial drugs of choice for the treatment of pain in knee osteoarthritis are oral acetaminophen and topical capsaicin. Knee joint corticosteroid injections are options to help reduce pain and inflammation and can provide short-term pain relief, usually lasting about 5-10 weeks.

*Surgical treatment 

Joint replacement surgeries are effective and cost-effective for patients with significant symptoms or functional limitations, providing improvements in pain, function, and quality of life. 

Knee realignment surgery, such as high tibial osteotomy or partial knee replacement surgery, is indicated in patients younger than age 60 with unicompartmental osteoarthritis, who would benefit from delaying total knee replacement. 

Knee joint replacement surgery has been very successful in improving outcomes for a patient with end-stage osteoarthritis.

A physical therapist or certified trainer can always help you with proper knee movements and make you know your limits.

Many people are afraid of knee replacement surgery, while surgery is definitely the last option it is also the best way to get rid of knee pain. A knee replacement patient can lead a normal life after 3 to 4 weeks of treatment.

                                                               

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