Patients Guide

Cardiology

Who is at risk for heart disease?

Populations at Risk for Heart Disease:
There are several populations who have factors that put them at higher-risk for heart disease.
-The elderly, those over 65 years old,
-Males are generally more at risk than females. Gender plays a part in heart disease risk factor, however women are catching up with men in diagnosis of heart disease,
-Heredity, meaning heart disease can be genetic and can run in families.
-A person’s race
These factors are risk factors that cannot be controlled. If you are one of the people who would be considered high-risk, it is important that you work with your physician on ways to combat the disease.
Heart disease is often controllable or preventable, if a person has good medical care and an awareness of any risk factors in their lives.

Why is the elderly at risk for heart disease?

Cardiovascular disease is currently the leading cause of death in people over 65 years of age. Approximately 85 percent of people who die from coronary artery disease are over the age of 65.
The most common type of heart disease in the elderly population is coronary artery disease.
It is believed that the elderly are at higher-risk for heart disease because of their age and the fact that there may have been accumulated heart damage throughout a person’s lifetime.
For example, as a person grows older, his or her heart often changes. The muscles in an elderly persons heart may become less able to relax between beats. The end result of this is the chambers that pump the blood become stiff and do not work as well.
An elderly persons heart may not pump as well as it used to, which leads to the heart losing its effectiveness. These factors often leave an elderly person’s heart more susceptible to diseases.
It is also believed that as a person ages so does the person’s chances of developing high blood pressure. High blood pressure is often associated with heart failure, stroke, and heart attack.
It is important for the population, as it grows older, to have blood pressure checks regularly.
Women don’t have Heart?? Why Men are more prone to heart disease than Women??
Heart disease is not a picky disease. It can affect anyone, anywhere. However, there are those who more at risk due to their gender and age. Heart disease was considered a male-dominated disease for many years, because men tend to die earlier from it than women. Men still are more at risk for heart disease, but women’s risk for heart disease seem to be catching up with the men, just at a different age.
Men tend to have a higher risk for heart disease between the ages of 50 to 60. More men are diagnosed with heart disease at this age. However, women are being diagnosed more often between the ages of 65 to 70 years, thus resulting in almost a tie between the number of women and men who have heart disease.
The big difference is not the number of men and women who are susceptible to heart disease. The big difference is the age at when most develop the condition.
It is believed that women do not develop heart disease as early as men due to the estrogen a woman develops. This estrogen helps protect a woman’s body against certain factors that cause heart disease to develop.
When menopause occurs, the estrogen level is eliminated and the risk for heart disease heightens.
Both men and women of any age can make lifestyle changes that will lessen their chances of devloping heart disease.

Whether Smoking habit increases the chances of heart disease?

Smoking is a large contributor to heart disease. It is also the one contributor that is the most preventable. People who smoke run a risk that is two to four times greater than non-smokers of having a heart attack. This includes those who smoke cigarettes, cigars or pipes. Smokers run a much higher risk of sudden cardiac death than non-smokers. Even if you only smoke one to two cigarettes a day, the risk is still quite high that you may have a stroke or a heart attack.
People who smoke put others at risk, even non-smokers, for developing heart disease. Someone who is often subjected to a smoker’s second hand smoke is at a higher risk for developing heart disease.
Smoking is a contributing factor to heart disease. One easy way to eliminate this factor is to stop smoking

What is Coronary artery disease?

Coronary artery disease is the most common form of heart disease. Coronary artery disease is often referred to as CAD (coronary artery disease).
CAD occurs when the coronary arteries are clogged or narrowed with cholesterol or fat. This clogging or narrowing is commonly referred to as atherosclerosis. Coronary arteries supply our bodies with oxygen and nutrients.
When the arteries are narrowed or clogged due to coronary artery disease, the heart can’t get enough oxygen. When this occurs and the heart muscle is injured, a heart attack is often the end result.
CAD often has no symptoms associated with it. However, it can cause mild chest pains to more obvious chest pains. At times CAD can interfere with a person’s daily activities.
According the American Heart Association, the warning signs that someone may be experiencing CAD are the following:
-An uncomfortable feeling of pressure in the chest that may come and go.
-Pain that may spread to the shoulder, neck or arms.
-Feeling of discomfort in the chest that is present with light-headness or nausea.
CAD can also have less common warning signs such as: stomach pain, shortness of breath, trouble breathing, skin that pales, and cold sweats or palpitations.
If you experience any of the above symptoms, please consult with your doctor

How can high blood pressure contribute to heart disease?

Blood pressure is often called a “silent killer”, because many people are unaware they suffer from high blood pressure. High blood pressure can lead to stroke and heart attack. People need to have their blood pressure monitored on a regular basis by a physician.
High blood pressure often causes an increase pressure on the kidneys and the heart to work harder. This then increases the risk of heart attack, stroke and even kidney disease.
A normal blood pressure is considered to be 120/80 and lower. High blood pressure is considered to be 140/90 and higher.
Blood pressure can be controlled through exercise, weight loss and diet. There are times when medication is required to help decrease blood pressure. Reducing your blood pressure results in less chance of developing heart disease.

Which countries have the lowest rate of heart disease?

Countries with the highest rate of heart disease are: Soviet Union, Poland, Hungary and the Czech Republic.
Countries with the lowest rate of heart disease are: Japan, France, Spain, Switzerland and Canada

How much sodium intake should a healthy adult have daily?

Sodium intake can affect your body’s blood pressure. Often times, people who have a high sodium intake develop high blood pressure. High blood pressure can lead to heart disease.
It is important to watch your sodium intake. The American Heart Association recommends that adults who are healthy take in no more than 2,300 milligrams of sodium a day. This measures out to be approximately one teaspoon of salt a day.
To reduce sodium in your diet, you can make some simple lifestyle choices. Eat fresh vegetables. If you can’t choose fresh vegetables then choose frozen or canned vegetables that have no salt added. By simply choosing some easy changes, you can lower your risk of heart disease! When choosing dairy products, choose low-fat versions of milk, cheese, and yogurt. Cheese is also available in lower sodium versions. You can still enjoy your dairy, without all the extra sodium.
When cooking or baking try not using salt for flavor. Instead add delicious flavor by using spices or herbs. If you must use sodium-based spices, look for low-sodium versions of your favorites. They may cost a bit more, but are much better for you!

For advance information on Heart and Blood Vessels

Nephrology

Who is at risk for kidney disease?

Kidney problem symptoms generally develop over a period of years. Our kidneys perform many vital functions that help maintain overall health.
But if the blood vessels in the kidneys are damaged, the kidneys will not clean the blood properly and

Swelling around the face, eyes, feet and ankles
Pain or a burning sensation during urination
Fever
Need to urinate more frequently
Problems controlling urination
Blood in the urine

and salt than it should, leading to weight gain.
Here are common symptoms of kidney problems:

Here are some tips for helping support kidney health and avoiding kidney problem symptoms…

1. Drink Plenty of Liquids – you may already know that drinking 8 to 10 glasses of water each day is good for overall health. When you don’t drink enough liquids, toxins can build up in the body when there isn’t enough water pressure to push them through to the urinary tract for excretion (healthy bowel function also requires sufficient body liquids). The kidneys are designed to perform as a filter, removing undesirable substances from the body on an on-going basis. The best liquid to drink is pure, clear water that’s had the chlorine removed.

2. Reduce or Avoid Caffeine – a cup or two of coffee may not be bad for many people, but drinking coffee does not help your kidneys. Remember that caffeine is also found in many soft drinks and sports drinks. Caffeine acts as a diuretic which causes the body to lose fluids excessively. Being dehydrated results in your kidneys having to work harder to pump out fluid and toxins. Too much caffeine isn’t good for your body in many ways, and stressing the kidneys is one of them.

3. Cushion Your Body When Driving or Operating Equipment – road bumps, potholes and rough terrain transmit vibrations through the vehicle into the body, resulting in kidney bruising and damage. Occupations at risk for kidney damage include persons who regularly spend many hours absorbing road vibrations such as taxi drivers, truck drivers and mechanized equipment operators. Adding a quality seat cushion to the driver’s or operator’s vehicle seat can reduce the vibrations that the body receives.

4. Take Frequent Breaks – if you sit at work, get up often and move around. If you drive a lot for long periods of time, park your vehicle, get out and stretch your legs. Doing so is not only good for your kidneys, it’s great for general circulation and other organs. You’ll likely find getting out of the vehicle clears your head as well and how bad can that be!

5. When Nature Calls, Act Promptly – whether you need to urinate or have a bowel movement, when you need to go, don’t delay. Postponing elimination means the kidneys (or bowels) will begin reabsorbing the very toxins they’re trying to pass out of the body. Early kidney disease has no kidney problem symptoms, however, it can become kidney failure with little or no warning if left undetected. Kidney disease results from damage to the nephrons which are tiny structures inside the kidneys that filter blood. A kidney condition called nephrotoxicity occurs when the body is exposed to a toxin or drug that damages the kidneys. When kidney damage happens, you cannot rid your body of excess urine and wastes. Blood electrolytes such as potassium and magnesium become elevated and creatinine levels in the blood will also be elevated. Nephrotoxicity can be temporary due to dehydration or you may be developing kidney failure.

The two main causes of Kidney Failure: Diabetes and high blood pressure are two main causes of kidney failure. Many people know that they have these diseases, but they may not know that they are at risk for kidney disease. Usually the damage happens gradually over years and in both kidneys. Since there may not be obvious symptoms of kidney problems, you’re not aware it’s happening. In diabetes, the body doesn’t use glucose very well. If you have diabetes, you can prevent kidney disease by keeping your blood sugar levels under control. High blood pressure can damage the small blood vessels in your kidneys. When this happens, your kidneys cannot filter wastes from your blood very well.
Be kind to your kidneys by following the kidney health recommendations above. If you’re kind to your kidneys, they’ll be kind to you and perform without complaining for many years to come.

For advance information on Kidney / Genito-urinary

Gynecology

Pregnancy Calculator

Enter the mother’s pregnancy information into this calculator and it will provide an estimated conception date, birth due date, and an estimated current fetal age. Great for all those mothers-to-be!

Orthopedics

Protecting Your Bone Health
Consequences of Poor Bone Health

Poor bone health can result in osteoporosis, or the weakening of the bones. Many people who are healthy in most ways− eating right, exercising regularly and maintaining a healthy weight− are surprised to find themselves at risk for osteoporosis, because some of the most important preventative actions are not necessarily intuitive.

Osteoporosis literally means “porous bones” and is thus named because it is a condition in which the bones become porous, meaning the bones lack density and become fragile and brittle. When the bones are weakened, it makes you much more prone to bone fractures even when you perform simple activities like bending over to pick up an object or sneezing or coughing violently.

Who’s Most at Risk

Up until about age 30, most women’s bodies naturally produce more new bone tissue than it loses, so bone density is not usually a high concern. After age 30 however, women begin losing more bone tissue than their bodies can create to replace it, resulting in a severe deficiency if proper preventative measures are not taken.
Additionally, the hormone estrogen plays a role in preventing bone density loss and after the onset of menopause, estrogen production grinds to a halt. Thus, postmenopausal women are the most susceptible to developing osteoporosis.
If girls and young women do not get enough calcium and vitamin D or experience enough weight bearing exercise in their younger years (under age 30), their bones will not develop to their full density capacity, making them more susceptible to osteoporosis when they are older. Therefore it’s important to start building your bone health when you’re young, in order to prevent bone health problems later.
Other risk factors include smoking and being severely underweight as well as eating a diet that’s low in calcium and leading a sedentary lifestyle.

Steps You Can Take

Bone mineral density tests. If you are over 30, it’s a good idea to ask your doctor for a bone mineral density test at your next physical. Your doctor can tell you how your bone health is compared to other women your age and let you know if you need to change anything about your diet or exercise habits. He or she may even prescribe a medication for you to help increase your bone density if your bones are very porous. Eat right. Bone density is boosted by the intake of calcium. Most women do not gett enough calcium in their diets. Especially at risk are women who diet excessively and who do not consume dairy products.
The average woman over age 20 needs 1000 to 1200 mg of calcium every day for proper bone health. You will also need Vitamin D for your body to properly absorb the calcium.
Some excellent foods that are high in calcium are milk, cheese, puddings, yogurt, cottage cheese, broccoli and green leafy lettuces such as spinach, romaine lettuce or kale. You can also get calcium from fortified foods such as orange juice, cereals, tofu and breads.
Try adding nonfat, powdered milk into recipes to increase your calcium intake. A couple of tablespoons of nonfat powdered milk won’t change the taste or texture of most recipes, and yet it will add a whopping 200 mg of calcium to the meal.
You might also consider taking bone health supplements such as calcium and vitamin D (which helps your body absorb the calcium). Finally, don’t forget to spend some time in the sun each day to help your body synthesize the Vitamin D necessary for proper calcium absorption. Aim for 15 minutes each day, without sunscreen (even sun on the back of your hands or tops of your feet count).

Exercise to Improve Bone Health

You may think about exercising to tone muscle, reduce stress, ease anxiety and lose weight, but you should also know that weight-bearing exercises like strength training, walking, running and yoga help improve bone density in addition to providing all the other benefits associated with regular exercise.
It’s best if you can participate in some kind of weight-bearing activity for 30 minutes every day. Some forms of exercise to consider include:

Walking, jogging, running, hiking
Playing tennis, badminton, squash or racquetball
Floor or field hockey
Climbing your stairs
Jumping rope
Playing basketball
Dancing or dance aerobics
Step aerobics
Soccer
Strength training with weights

For advance information on Arthritic / Bone / Muscle

Diabetology

What is diabetes? 

Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn’t make enough insulin or can’t use its own insulin as well as it should. This causes sugar to build up in your blood.
Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations.

What are the symptoms of diabetes?

People who think they might have diabetes must visit a physician for diagnosis. They might have SOME or NONE of the following symptoms:

Frequent urination
Excessive thirst
Unexplained weight loss
Extreme hunger
Sudden vision changes
Tingling or numbness in hands or feet
Feeling very tired much of the time
Very dry skin
Sores that are slow to heal
More infections than usual.

Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of insulin-dependent diabetes, now called type 1 diabetes.

What are the types of diabetes? 
Type 1 diabetes, which was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, may account for 5% to 10% of all diagnosed cases of diabetes.
Type 2 diabetes, which was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, may account for about 90% to 95% of all diagnosed cases of diabetes. Gestational diabetes is a type of diabetes that only pregnant women get. If not treated, it can cause problems for mothers and babies. Gestational diabetes develops in 2% to 5% of all pregnancies but usually disappears when a pregnancy is over.
Other specific types of diabetes resulting from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses may account for 1% to 2% of all diagnosed cases of diabetes.

What are the risk factors for diabetes? 

Risk factors for type 2 diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity.
Risk factors are less well defined for type 1 diabetes than for type 2 diabetes, but autoimmune, genetic, and environmental factors are involved in developing this type of diabetes.
Gestational diabetes occurs more frequently in African Americans, Hispanic/Latino Americans, American Indians, and people with a family history of diabetes than in other groups. Obesity is also associated with higher risk. Women who have had gestational diabetes are at increased risk for later developing type 2 diabetes. In some studies, nearly 40% of women with a history of gestational diabetes developed diabetes in the future.
Other specific types of diabetes, which may account for 1% to 2% of all diagnosed cases, result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses.

What is the treatment for diabetes? 

Healthy eating, physical activity, and insulin injections are the basic therapies for type 1 diabetes. The amount of insulin taken must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose testing. Healthy eating, physical activity, and blood glucose testing are the basic therapies for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.
People with diabetes must take responsibility for their day-to-day care, and keep blood glucose levels from going too low or too high. People with diabetes should see a health care provider who will monitor their diabetes control and help them learn to manage their diabetes. In addition, people with diabetes may see endocrinologists, who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists for routine foot care; and dietitians and diabetes educators who teach the skills needed for daily diabetes management.

What causes type 1 diabetes? 

The causes of type 1 diabetes appear to be much different than those for type 2 diabetes, though the exact mechanisms for developing both diseases are unknown. The appearance of type 1 diabetes is suspected to follow exposure to an “environmental trigger,” such as an unidentified virus, stimulating an immune attack against the beta cells of the pancreas (that produce insulin) in some genetically predisposed people.

Can diabetes be prevented? 
A number of studies have shown that regular physical activity can significantly reduce the risk of developing type 2 diabetes. Type 2 diabetes also appears to be associated with obesity.
Researchers are making progress in identifying the exact genetics and “triggers” that predispose some individuals to develop type 1 diabetes, but prevention remains elusive.

Is there a cure for diabetes?

In response to the growing health burden of diabetes, the diabetes community has three choices: prevent diabetes; cure diabetes; and improve the quality of care of people with diabetes to prevent devastating complications.
Several approaches to “cure” diabetes are being pursued:

Pancreas transplantation
Islet cell transplantation (islet cells produce insulin)
Artificial pancreas development
Genetic manipulation (fat or muscle cells that don’t normally make insulin have a human insulin gene inserted — then these “pseudo” islet cells are transplanted into people with type 1 diabetes)

Each of these approaches still has a lot of challenges, such as preventing immune rejection; finding an adequate number of insulin cells; keeping cells alive; and others. But progress is being made in all areas.

For advance information on Diabetes

Gastroenterology

Your digestive system

Oesophagus
The oesophagus is a muscular tube, about 25cm long, with a sphincter (valve) at each end. Its function is to transport food and fluid, after being swallowed, from the mouth to the stomach. No absorption of nutrients takes place in the oesophagus. A mouthful of food which has been chewed and swallowed is called a bolus. This is propelled from the pharynx (throat) into the oesophagus, and is swept towards the stomach in peristaltic waves. These muscular contractions are involuntary, and cannot normally be felt. When food is not passing through, the oesophagus is folded in, or collapsed. The sphincters at either end of the oesophagus are normally closed, acting as valves. The upper one, below the pharynx, opens upon swallowing to allow entry into the oesophagus. The lower one, at the entrance to the stomach, also only opens to allow food and fluid to pass through. This one – the gastro-oesophageal or lower oesophageal sphincter – plays an important role in stopping reflux of acidic stomach contents back into the oesophagus. Although mucus is produced in the oesophagus, it is not as protective as mucus in the stomach, and so is more susceptible to damage by gastric juice.

Stomach

The stomach is a temporary storage organ for large quantities of food. It can easily hold 1.5 litres, with a maximum holding capacity of about 4 litres. Its three main compartments are called the fundus, the body and the antrum. The stomach is also an important site for mechanical and chemical breakdown of the food which enters it. Digestive juices are secreted from glands covering the entire stomach wall. When food is present, approximately every 20 seconds mixing waves combine the food with gastric juices to form chyme – a creamy, semi-fluid mass. This is gradually emptied into the small intestine through a narrowed region surrounded by a thick ring of muscle at the lower end of the stomach – the pyloric sphincter. Liquids empty from the stomach faster than solids, taking about 20 minutes. A mixed meal takes about 1.5 hours to be emptied.
The stomach is also a secretory organ. The cells and glands in its wall produce several important secretions. These include: digestive enzymes ; hormones ; hydrochloric acid ; and intrinsic factor (for vitamin B12 absorption). A sticky, alkaline mucous is also produced to protect the stomach from its own acidity.

Small intestine

The small intestine is the longest section of the digestive tract, with an average length of about 6 metres. Although only 2.5 cm in diameter – which is why it is called the small intestine – its surface area for absorption covers the size of a tennis court. This is due to the numerous folds on its surface, covered in tiny projections known as villi, which in turn are covered in even tinier projections known as microvilli.
Large quantities of nutrients and water can be absorbed in the small intestine. Daily, it is capable of absorbing: several kilograms of carbohydrate; up to 1 kg of fat; 500gms protein; and 20 litres of water.
The surface cells of the small intestine are highly specialised for digestion and absorption of nutrients. Almost all the body’s nutrient absorption occurs in the small intestine, along its three sub-divisions: the duodenum Þ jejunum Þ ileum. Sites for absorption of specific nutrients (eg: iron, vitamin.B12) are located in these divisions, but most absorption occurs in the jejunum (middle section). The specialised cells contain digestive enzymes, carrier proteins and other secretions. Blood vessels transport nutrients away from the intestine to the liver in the first instance.

Other features include: 

Intestinal Crypts –these secrete enzymes, hormones and mucus
Peyer’s Patches –lymph nodes preventing bacteria from entering the bloodstream
Brunner’s Glands – these produce an alkaline mucus which protects the intestinal wall from gastric acid

Liver and biliary system 

Hhe liver is the body’s largest organ, weighing about 1.5 kgs, or 2.5% of body weight. Major functions involve the uptake of nutrients and other substances from the intestine, processing (metabolising), storing or distributing these to blood and bile. The liver is also important in removing unwanted or harmful chemicals (detoxification) including chemicals produced in the body, unwanted chemicals taken into the body (eg carcinogens), and medications. The liver is the ‘powerhouse’ of the body.
Functionally, the liver is divided into lobes and segments, each with its own blood supply. It is like a large vascular ‘sponge’ with an extensive network of blood vessels. Blood entering the liver contains nutrients and other products which are extracted and processed. As a consequence, blood leaving the liver contains less of these substances. Liver cells – hepatocytes – are the liver’s main functional units. These produce bile, distribute nutrients from the blood, store fat-soluble vitamins, and play important roles in detoxification. The liver and biliary system produce bile and transport it to the small intestine, where it breaks up fats and other components of diet, and aids the digestion and absorption of these nutrients. About a litre of bile is produced daily. This leaves the liver via several ducts leading into the common hepatic duct, which joins the common bile duct (draining the gallbladder) and enters the small intestine. Excess bile is stored in the gallbladder, a green muscular sac approximately 10cm long attached to the lower part of the liver. If the gallbladder has been removed, bile is stored in the bile ducts which expand in size to hold the extra fluid.

Pancreas

The pancreas is a relatively small organ, which weighs around 100 grams and is about 15cm in length. It is the digestive system’s main enzyme producing organ, and can be likened to a factory. Most pancreatic cells produce millions of enzymes daily. The pancreas is subdivided into small lobes, with ducts entering into a main duct. Along with the bile duct, the pancreatic duct enters the small intestine to deliver fluid through a small hole in the wall of the second part of the duodenum known as the papilla. This fluid is known as pancreatic juice, of which approximately 1.5 litres is produced each day. It is a rich mixture, containing enzymes capable of digesting all food types – protein, fat and carbohydrate. These enzymes are activated in the small intestine as needed. Pancreatic juice is highly alkaline, to help neutralise the acidity of the food which has just left the stomach.
A variety of hormones are also produced in the pancreas. These are made by cell clusters – Islets of Langerhans – interspersed throughout the tissue. Two major hormones are insulin and glucagon, which regulate carbohydrate metabolism. Other hormones control the release of pancreatic juice.

Colon

he colon – also known as the large intestine – is the final organ of the digestive process. It is responsible for drying out indigestible food residues by absorbing fluid and producing solid waste (faeces) for elimination. Approximately 1.5 metres long, the colon has six distinct regions leading from the join with the small intestine (ileocaecal valve): caecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum.
As in the rest of the digestive tract, the colon wall is muscular, which is necessary to move waste along the colon. Propulsion along the colon is slower than the small intestine, movement taking days rather than hours. Movement is stimulated by food and exercise, but is diminished during sleep. Transit time in the colon is about 1cm per hour.
Billions of bacteria inhabit the colon, where they ferment dietary fibre and other unabsorbed substances. The colon acts as a storage organ, where mixing movements promote absorption of water, electrolytes and bacterial fermentation products. Mucus produced in the colon is important in easing the passage of waste products towards the rectum and anus.

For advance information on Gut / Bowel / Stomach

HANDLING YOUR BABY

Crying??
Do not hesitate to pick your child up when she cries. It is most important for a baby to have a feeling of security after birth. Crying is often a signal that she needs something. Don’t worry about disciplining the child at this stage. I am all for discipline, but let that come later, when the child is reassured that she is loved and wanted.

Sometimes, a baby who was quite at peace in hospital may start crying unduly on reaching home. Perhaps she needs time to adjust to her new surroundings. She will almost certainly settle in 2 to 3 days.

If you are worried that your baby is crying because you are not producing enough breast milk for her, watch the colour of her urine. If she is getting only your milk (without additional water), and keeps passing a light-coloured urine, that is a sure sign that she is getting enough milk. The crying is then due to other reasons .

Is Your Milk Suitable For Your Baby?

Your milk – thin, thick, yellowish, bluish or white – is always right for your baby. Breastfeeding is to be continued even if the mother is suffering from asthma, malaria, cold, typhoid or tuberculosis. It is important not to give any glucose water or any other milk for the first few days, because the first yellowish milk (colostrum) produced then, though small in amount, is enough to meet all the needs of the baby. Even if you have to work outside the home, it is dangerous to start bottle-feeding with the assumption that the baby should get used to it. Working mothers can breastfeed successfully without ever using a bottle.

You can feed in any position – lying down, sitting or reclining, as is convenient for you. The important point is that the position of the baby at the breast should be correct. This is based on the fact that breast milk collects in the dilated ducts that lie underneath the areola, the dark portion behind the nipple of the breast. The breast should be put into the baby’s mouth so that much of the areola – especially the portion below the nipple – is not visible while the baby is suckling. Let the baby keep suckling from one breast even if she seems to have fallen asleep and her eyes are closed. Offer the other breast only when the baby releases the first breast on her own. If the baby is satisfied with only one side, offer her the other breast at the next feed. If you have twins, milk from one breast is enough for one baby.

Some mothers’ breasts feel heavy or congested 3 to 4 days after delivery. This means that the mother is not feeding the baby enough. She should offer the baby frequent feeds or express the milk for the next 2 to 3 feeds. If the heaviness is allowed to remain, the mother will feel more discomfort and the baby will have difficulty in suckling.

If the baby starts sucking her fingers, do not jump to the conclusion that she is not getting enough milk from you. Observe the baby’s urine; its light colour indicates that the baby is getting her required quota of milk. Here, it may be mentioned that a baby may pass yellowish urine if she is given vitamins or if she sweats more because of heavy clothing.

10 Important Points For The Care Of Your Newborn

For advance information on Child Health

General Medicine

Oesophagus
Maintaining good health is very important to make your dreams come true. Vitality and energy are by products of good health and are needed to achieve career success and excellent relationships. There are no guarantees, but here are some ideas for increasing your odds of having a long and healthy life.

1. Drink plenty of water.

Much of our body and brain are made up of water. You need water to stay hydrated, to flush out toxins, to assimilate nutrients from food, and for your brain to function properly. Drinking plenty of water also keeps your skin from becoming dry and prematurely wrinkled from dehydration. Coffee, tea, and soda are not substitutes for water. They actually are dehydrating and if you drink them you will need more water. Even fruit juice is not a substitute for water because it comes from a food source and is not a true solvent.
Drinking tap water is better than not getting enough but it is best to drink water which has been purified naturally or through reverse osmosis or distillation. Only some of the bottled water meets these criteria.

2. You need a little sunshine.
It is true that you can get too much sun but we need some sunshine. Ten to twenty minutes of daily early morning or late evening sun is beneficial.
Sunshine gives you vitamin D which you need so your bones can absorb calcium. Without enough vitamin D our bones can become brittle and break. It is unnatural to spend all of our time indoors. We need fresh air and a little sunshine to maintain excellent health.

3. Exercise is important.
tOur bodies need movement and physical activity. Proper exercise slows down our physical deterioration.
We need three types of exercise: Flexibility, aerobic, and strength training.
A. Flexibility exercise.
As we age our bodies become stiffer. Yoga, swimming, tai chi, or just doing stretching helps us to maintain flexibility.
B. Aerobic or cardiovascular exercise.
Walking, biking, jogging, dancing, and sports which help you to stay in your working heart rate for 20-30 minutes are beneficial to your heart. Charts are available to determine the working heart rate for your age bracket.
C. Strength training exercise. This exercise keeps your muscles firm and strong. It also keeps your bones strong when combined with proper nutrition. This type of exercise includes weight lifting (it can be light weights), calisthenics, and machines which provide resistance.
Unless we are an athlete or compete in sports we do not need to spend a large amount of exercising. Like anything else it can be overdone and then the returns diminish. Moderation has its benefit.
If your diet is good, a mild to moderate exercise program is sufficient to stay fit.

4. Eat well.
Fresh fruits and vegetables are among the most important foods you can eat. The greater the variety of colors, the better because they contain different types of antioxidants. Antioxidants strengthen your immune system and slow the aging process. Fresh produce is best, frozen is second best, and the least nutritious are canned fruits and vegetables.
It is beneficial to eat some raw foods such as vegetables, fruits, nuts, and seeds. They contain enzymes which are frequently destroyed when the food is cooked. Enzymes help with digestion and increase our energy. Eating a salad with one or two meals a day is a great habit.
When you eat raw food, know your sources to avoid bacteria contamination. Whole grains, legumes, seeds, and nuts are beneficial. Raw nuts, seeds, fruit, and vegetables contain energy in addition to vitamins and minerals.

For advance information on General Health

Respiratory

What is tuberculosis?
Tuberculosis (TB) is an infectious disease caused by bacteria whose scientific name is Mycobacterium tuberculosis. It was first isolated in 1882 by a German physician named Robert Koch who received the Nobel prize for this discovery. TB most commonly affects the lungs but also can involve almost any organ of the body. Many years ago, this disease was referred to as “consumption” because without effective treatment, these patients often would waste away. Today, of course, tuberculosis usually can be treated successfully with antibiotics.
There is also a group of organisms referred to as atypical tuberculosis. These involve other types of bacteria that are in the Mycobacterium family. Often, these organisms do not cause disease and are referred to a “colonizers,” because they simply live alongside other bacteria in our bodies without causing damage. At times, these bacteria can cause an infection that is sometimes clinically like typical tuberculosis. When these atypical mycobacteria cause infection, they are often very difficult to cure. Often, drug therapy for these organisms must be administered for one and a half to two years and requires multiple medications.

How does a person get TB?

A person can become infected with tuberculosis bacteria when he or she inhales minute particles of infected sputum from the air. The bacteria get into the air when someone who has a tuberculosis lung infection coughs, sneezes, shouts, or spits (which is common in some cultures). People who are nearby can then possibly breathe the bacteria into their lungs. You don’t get TB by just touching the clothes or shaking the hands of someone who is infected. Tuberculosis is spread (transmitted) primarily from person to person by breathing infected air during close contact. There is a form of atypical tuberculosis, however, that is transmitted by drinking unpasteurized milk. Related bacteria, called Mycobacterium bovis, cause this form of TB. Previously, this type of bacteria was a major cause of TB in children, but it rarely causes TB now since most milk is pasteurized (undergoes a heating process that kills the bacteria)

What happens to the body when a person gets TB?
When the inhaled tuberculosis bacteria enter the lungs, they can multiply and cause a local lung infection (pneumonia). The local lymph nodes associated with the lungs may also become involved with the infection and usually become enlarged. The hilar lymph nodes (the lymph nodes adjacent to the heart in the central part of the chest) are often involved.
In addition, TB can spread to other parts of the body. The body’s immune (defense) system, however, can fight off the infection and stop the bacteria from spreading. The immune system does so ultimately by forming scar tissue around the TB bacteria and isolating it from the rest of the body. Tuberculosis that occurs after initial exposure to the bacteria is often referred to as primary TB. If the body is able to form scar tissue (fibrosis) around the TB bacteria, then the infection is contained in an inactive state. Such an individual typically has no symptoms and cannot spread TB to other people. The scar tissue and lymph nodes may eventually harden, like stone, due to the process of calcification of the scars (deposition of calcium from the bloodstream in the scar tissue). These scars often appear on x-rays and imaging studies like round marbles and are referred to as a granuloma. If these scars do not show any evidence of calcium on x-ray, they can be difficult to distinguish from cancer.
Sometimes, however, the body’s immune system becomes weakened, and the TB bacteria break through the scar tissue and can cause active disease, referred to as reactivation tuberculosis or secondary TB. For example, the immune system can be weakened by old age, the development of another infection or a cancer, or certain medications such as cortisone, anticancer drugs, or certain medications used to treatarthritis or inflammatory bowel disease. The breakthrough of bacteria can result in a recurrence of the pneumonia and a spread of TB to other locations in the body. The kidneys, bone, and lining of the brain and spinal cord (meninges) are the most common sites affected by the spread of TB beyond the lungs.

What is bronchitis?
Bronchitis is inflammation of the air passages within the lungs. It occurs when the trachea (windpipe) and the large and small bronchi (airways) within the lungs become inflamed because of infection or other causes.

What are the symptoms of bronchitis?
Some of the Symptoms include:

coughing up extra mucus, sometimes with blood
inflammation of the bronchi (branches of the airways below the trachea)
swelling (edema) of the bronchial walls
blockage of the alveoli
wheezing
difficulty breathing (due to above symptoms)
blocked/runny nose (may be associated with bronchitis of some causes but is not part of it).

What is Asthma?
Asthma is a chronic medical condition. It has been defined by the National Heart, Lung and Blood Institute of the United States of America as a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness (bronchospasm), and an underlying inflammation. The interaction of these features of asthma determines the clinical manifestations and severity of asthma and the response to treatment.
Public attention in the developed world has recently focused on asthma because of its rapidly increasing prevalence, affecting up to one in four urban children.

What are its signs and symptoms?
Because of the spectrum of severity within asthma, some asthmatics only rarely experience symptoms, usually in response to triggers, whereas other more severe asthmatics may have marked airflow obstruction at all times.
Asthma exists in two states: the steady-state of chronic asthma, and the acute state of an acute asthma exacerbation. The symptoms are different depending on what state the asthmatic is in.
Common symptoms of asthma in a steady-state include: nighttime coughing, shortness of breath with exertion but no dyspnea at rest, a chronic ‘throat-clearing’ type cough, and complaints of a tight feeling in the chest. Severity often correlates to an increase in symptoms. Symptoms can worsen gradually and rather insidiously, up to the point of an acute exacerbation of asthma. It is a common misconception that all asthmatics wheeze-some asthmatics never wheeze, and their disease may be confused with another Chronic obstructive pulmonary disease such as emphysema or chronic bronchitis.
An acute exacerbation of asthma is commonly referred to as an asthma attack. The cardinal symptoms of an attack are shortness of breath (dyspnea), wheezing and chest tightness. Although the former is “often regarded as the sine qua non of asthma. some patients present primarily with coughing, and in the late stages of an attack, air motion may be so impaired that no wheezing may be heard.When present the cough may sometimes produce clear sputum. The onset may be sudden, with a sense of constriction in the chest, breathing becomes difficult, and wheezing occurs (primarily upon expiration, but can be in bothrespiratory phases). It is important to note inspiratory stridor without expiratory wheeze however, as an upper airway obstruction may manifest with symptoms similar to an acute exacerbation of asthma, with stridor instead of wheezing, and will remain unresponsive to bronchodilators.
Signs of an asthmatic episode include wheezing, prolonged expiration, a rapid heart rate (tachycardia), and rhonchous lung sounds (audible through a stethoscope). During a serious asthma attack, the accessory muscles of respiration (sternocleidomastoid and scalene muscles of the neck) may be used, shown as in-drawing of tissues between the ribs and above the sternum and clavicles, and there may be the presence of a paradoxical pulse (a pulse that is weaker during inhalation and stronger during exhalation), and over-inflation of the chest.
During very severe attacks, an asthma sufferer can turn blue from lack of oxygen and can experience chest pain or even loss of consciousness. Just before loss of consciousness, there is a chance that the patient will feel numbness in the limbs and palms may start to sweat. The person’s feet may become cold. Severe asthma attacks which are not responsive to standard treatments, calledstatus asthmaticus, are life-threatening and may lead to respiratory arrest and death.
Though symptoms may be very severe during an acute exacerbation, between attacks an asthmatic may show few or even no signs of the disease

What is Lung abscess?
Lung abscess is necrosis of the pulmonary tissue and formation of cavities (more than 2 cm containing necrotic debris or fluid caused by microbial infection.
This pus-filled cavity is often caused by aspiration, which may occur during altered consciousness.Alcoholism is the most common condition predisposing to lung abscesses.
Lung Abscess is considered primary(60%) when it results from existing lung parenchymal process and is termed secondary when it complicates another process e.g. vascular emboli or follows rupture of extrapulmonary abscess into lung.

What are the signs and symptoms of Lung abscess?
Onset of symptoms is often gradual, but in necrotizing staphylococcal or gram-negative bacillary pneumonias patients can be acutely ill.Cough, fever with shivering and night sweats are often present. Cough can be productive with foul smelling purulent sputum (˜70%) or less frequently with blood (i.e. hemoptysis in one third cases). Affected individuals may also complaint chest pain, shortness of breath, lethargy and other features of chronic illness.
Patients are generallycachectic at presentation. Finger clubbing is present in one third of patients.Dental decay is common especially in alcoholics and children. On examination of chest there will be features of consolidation such as localised dullness on percussion,bronchial breath sound etc.

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ENT

What Is an ENT Specialist? 
Anear, nose and throat specialist (ENT) is a physician trained in the medical and surgical treatment of the ears, nose throat, and related structures of the head and neck. They have special expertise in managing diseases of the ears, nose and nasal passage sinuses, larynx (voice box), oral cavity and upper pharynx (mouth and throat), as well as structures of the neck and face.

The Ear

The unique domain of the ear; nose and throat specialist is treatment of ear disorders. This includes medical and surgical treatment for hearing disorders, ear infections, balance disorders, facial nerve or cranial nerve disorders, as well as management of congenital (birth) and cancerous disorders of the outer and inner ear

The Nose 
Care of the nasal cavity and sinuses is one of the primary skills of the ENT specialist. Management of disorders of the nasal cavity, paranasal sinuses, allergies, sense of smell, and nasal respiration (breathing), as well as the external appearance of the nose are part of an. ENT’s area of expertise.

The Throat 
Bronchitis iAlso specific to the ENT specialty is expertise in managing diseases of the larynx (voice box) and the upper aerodigestive tract or esophagus including disorders of the voice respiration (breathing), and swallowing.

The Head and Neck 
In the head and neck area, an ENT specialist is trained to treat infectious diseases, tumors (both benign and malignant/cancerous), facial trauma, and deformities of the face. ENT specialists perform both cosmetic plastic and reconstructive surgery. An ENT specialist may work with a team of doctors in other medical and surgical specialties. Common ground is shared with neurosurgery in treating skull base disorders; plastic surgery in correcting cosmetic and traumatic deformities; ophthalmology in treating structural abnormalities near the eye; oral surgery in treating jaw and dental trauma; allergy in managing sinus disease; dermatology in caring for skin cancers; oncology in managing head and neck cancers; and pediatrics and family practice in caring for common infectious, congenital, traumatic, and malignant (cancerous) diseases and disorders in the pediatric and general population.
Medical Services:
Some of the Clinical Services treated by the doctor include:

Allergy & immunotherapy
Image guided sinus surgery
Nose & Sinus disorders
Snoring & Sleep disorders
Paediatric ENT conditions
Ear & Hearing disorders
Implantable Hearing Aids
Tinnitus management
Head & Neck Cancers
Salivary Gland & Thyroid diseases
Dizziness & Balance disorders

Voice & Swallowing disorder

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Dermatology

Psoriasis
APsoriasis is a chronic, non-contagious autoimmune disease which affects the skin and joints. It commonly causes red scaly patches to appear on the skin. The scaly patches caused by psoriasis, called psoriatic plaques, are areas of inflammation and excessive skin production. Skin rapidly accumulates at these sites and takes on a silvery-white appearance. Plaques frequently occur on the skin of the elbows and knees, but can affect any area including the scalp and genitals. In contrast to eczema, psoriasis is more likely to be found on the extensor aspect of the joint.

The disorder is a chronic recurring condition which varies in severity from minor localized patches to complete body coverage. Fingernails and toenails are frequently affected (psoriatic nail dystrophy) and can be seen as an isolated finding. Psoriasis can also cause inflammation of the joints, which is known as psoriatic arthritis. Ten to fifteen percent of people with psoriasis have psoriatic arthritis.

The cause of psoriasis is not known, but it is believed to have a genetic component. Factors that may aggravate psoriasis include stress, withdrawal of systemic corticosteroid, excessive alcohol consumption, and smoking.[1] There are many treatments available, but because of its chronic recurrent nature psoriasis is a challenge to treat.

Types of Psoriasis:

The symptoms of psoriasis can manifest in a variety of forms. Variants include plaque, pustular, guttate and flexural psoriasis. This section describes each type ICD-10

Plaque psoriasis (psoriasis vulgaris) (L40.0) is the most common form of psoriasis. It affects 80 to 90% of people with psoriasis. Plaque psoriasis typically appears as raised areas of inflamed skin covered with silvery white scaly skin. These areas are called plaques.

Flexural psoriasis (inverse psoriasis) (L40.83-4) appears as smooth inflamed patches of skin. It occurs in skin folds, particularly around the genitals (between the thigh and groin), the armpits, under an overweight stomach (pannus), and under the breasts (inframammary fold). It is aggravated by friction and sweat, and is vulnerable tofungal infections.

Guttate psoriasis (L40.4) is characterized by numerous small round spots (differential diagnosis-pityriasis rosea-oval shape lesion). These numerous spots of psoriasis appear over large areas of the body, such as the trunk, limbs, and scalp. Guttate psoriasis is associated with streptococcal throat infection.

Pustular psoriasis (L40.1-3, L40.82) appears as raised bumps that are filled with non-infectious pus (pustules). The skin under and surrounding the pustules is red and tender. Pustular psoriasis can be localised, commonly to the hands and feet (palmoplantar pustulosis), or generalised with widespread patches occurring randomly on any part of the body.

Nail psoriasis (L40.86) produces a variety of changes in the appearance of finger and toe nails. These changes include discolouring under the nail plate, pitting of the nails, lines going across the nails, thickening of the skin under the nail, and the loosening (onycholysis) and crumbling of the nail.

Psoriatic arthritis (L40.5) involves joint and connective tissue inflammation. Psoriatic arthritis can affect any joint but is most common in the joints of the fingers and toes. This can result in a sausage-shaped swelling of the fingers and toes known as dactylitis. Psoriatic arthritis can also affect the hips, knees and spine (spondylitis). About 10-15% of people who have psoriasis also have psoriatic arthritis.

Erythrodermic psoriasis (L40.85) involves the widespread inflammation and exfoliation of the skin over most of the body surface. It may be accompanied by severe itching, swelling and pain. It is often the result of an exacerbation of unstable plaque psoriasis, particularly following the abrupt withdrawal of systemic treatment. This form of psoriasis can be fatal, as the extreme inflammation and exfoliation disrupt the body’s ability to regulate temperature and for the skin to perform barrier functions

Cause
Bronchitis The cause of psoriasis is not fully understood. There are two main hypotheses about the process that occurs in the development of the disease. The first considers psoriasis as primarily a disorder of excessive growth and reproduction of skin cells. The problem is simply seen as a fault of the epidermis and its keratinocytes. The second hypothesis sees the disease as being an immune-mediated disorder in which the excessive reproduction of skin cells is secondary to factors produced by the immune system. T cells (which normally help protect the body against infection) become active, migrate to the dermis and trigger the release of cytokines (tumor necrosis factor-alpha TNFa, in particular) which cause inflammation and the rapid production of skin cells. It is not known what initiates the activation of the T cells.

The immune-mediated model of psoriasis has been supported by the observation that immunosuppressant medications can clear psoriasis plaques. However, the role of the immune system is not fully understood, and it has recently been reported that an animal model of psoriasis can be triggered in mice lacking T cells. Animal models, however, reveal only a few aspects resembling human psoriasis. Compromised skin barrier function has a role in psoriasis susceptibility.

Psoriasis is a fairly idiosyncratic disease. The majority of people’s experience of psoriasis is one in which it may worsen or improve for no apparent reason. Studies of the factors associated with psoriasis tend to be based on small (usually hospital based) samples of individuals. These studies tend to suffer from representative issues, and an inability to tease out causal associations in the face of other (possibly unknown) intervening factors. Conflicting findings are often reported. Nevertheless, the first outbreak is sometimes reported following stress (physical and mental), skin injury, and streptococcal infection. Conditions that have been reported as accompanying a worsening of the disease include infections, stress, and changes in season and climate. Certain medicines, including lithium salt and beta blockers, have been reported to trigger or aggravate the disease. Excessive alcohol consumption, smoking and obesity may exacerbate psoriasis or make the management of the condition difficult.

Individuals suffering from the advanced effects of the Human immunodeficiency virus, or HIV, often exhibit psoriasis. This presents a paradox to researchers as traditional therapies that reduce T-cell counts generally cause psoriasis to improve. Yet, as CD4-T-cell counts decrease with the progression of HIV, psoriasis worsens. In addition, HIV is typically characterized by a strong Th2 cytokine profile, whereas psoriasis vulgaris is characterized by a strong Th1 secretion pattern. It’s hypothesized that the diminished CD4-T-Cell presence causes an over-activation of CD8-T-Cells, which are responsible for the exacerbation of psoriasis in HIV positive patients. It is important to remember that most individuals with psoriasis are otherwise healthy and the presence of HIV accounts for less than 1% of cases. The prevalence of psoriasis in the HIV positive population ranges from 1 to 6 percent, which is about 3 times higher than the normal population

Psoriasis occurs more likely in dry skin than oily or well-moisturized skin, and specifically after an external skin injury such as a scratch or cut. This is believed to be caused by an infection, in which the infecting organism thrives under dry skin conditions with minimal skin oil, which otherwise protects skin from infections. The case for psoriasis is opposite to the case of athlete’s foot, which occurs because of a fungus infection under wet conditions as opposed to dry in psoriasis. This infection induces inflammation, which causes the symptoms commonly associated with psoriasis, such as itching and rapid skin turnover, and leads to drier skin as the infecting organism absorbs the moisture that would otherwise go to the skin. To prevent dry skin and reduce psoriasis symptoms, it is advised to not use shower scrubs, as they not only damage skin by leaving tiny scratches, they also scrape off the naturally occurring skin oil. It is recommended to use talc powder after washing as that helps absorb excess moisture which would otherwise go to the infecting agent. Additionally, moisturizers can be applied to moisturize the skin, and lotions used to promote skin oil gland function

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