Diagnosis of Tuberculosis

Any person with cough for more than three weeks should undergo for an investigation for tuberculosis.

Bacteriological examination of sputum is a rule and only by which a tuberculosis can be confirmed. At least three sputum samples should be collected and examined by microscopy in a designated laboratory or at RNTCP centres. Either the sputum or the patient himself can be sent to the microscopy centre for sputum examination. It is absolutely free and most reliable at Revised National Tuberculosis Control Program (RNTCP) Centres.

Diagnosis By Radiological Examination

Diagnosis by chest X-Ray is un reliable as many other disease may resemble that of tuberculosis in chest X-Ray. It can be done only after sputum examination is negative as sputum examination itself confirms the diagnosis.

Smear Positive Pulmonary cases of Tuberculosis

This category includes patint with at least 2 sputum samples positive for Acid fast bacilli by microscopy and those with one sputum sample positive with consistent radiological abnormalities with active TB.

Smear Negative Pulmonary Cases

This category includes at least 3 sputum sample negative but radiological abnormalities is evident along with clinical evidence of active tuberculosis and it depends upon physicians secesion to start a full course of TB.

Extra Pulmonary Tuberculosis

These are patients with history and/or clinical evidence consistent with active TB resulting in the decesion by a physician to treat with a full course of anti-tuberculosis drugs.
Extra pulmonary TB can affect any part of the body including pleura, lumph nodes, bones and joints, genito-urinary tract and Central nervous system(Tuberculous meningitis).
Diagnosis is often difficult and sometimes require specialized techniques like Fine needle aspiration cytology(FNAC) or biopsy.
Though extra pulmonary tuberculosis rarely, if ever spread the disease to other healthy person.

Paediatric Tuberculosis

In children as the sputum cannot be obtained so diagnosis is a bit diffcult, even if it is obtained it is often negative.Thus diagnosis depends upon clinical history, history of contact with infectious patient, X-Ray and Tuberculin test which is also called Mantoux test.

All patients with cough of 3 weeks or more should have their sputum examined at RNTCP microscopy centers.

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Inflammatory bowel disease- Ulcerative Colitis and Crohn's disease

Inflammatory bowel disease encompasses spectrum of Ulcerative colitis (UC),Crohn's disease(CD) and indeterminate colitis (IC), which may evolve later into any of the two. Incidence and prevalence are much lower in developing world compared to the West, which partly was beleived due to under detection but even with recent availability and use of modern equipments for better diagnosis, the statistics remain the same albeit showing a trend to increase in this world compared to the 1980s. This is due to rapid Westernisation of lifestyle, diet and environment here. Typical example is India and Asia Pacific region where reported incidence and prevalence have been 4.5 to 10.8/million and 4.6 to 44.8/million for Ulcerative colitis and 0.5 to 2.3/million and 1.8 to 5.2/million for Crohn's disease respectively.

Factors responsible for Inflammatory bowel disease

The main pathogenetic factors are susceptible genetic background ( positive family history, NOD gene) on which a number on environmental factors act to manifest the disease e.g. smoking (nicotine), high sugar consumption, appendicectomy and change of intestinal flora due to frequent antibiotic use. Intestinal parasitic infestation is found to be protective.

Clinical features of Inflammatory bowel disease

The main clinical features of Ulcerative colitis are bloody diarrhea which can be life threatening at times and that od Crohn's disease are diarrhea with or without blood, weight loss, oral ulcers, recurrent anal fissure, intestinal fistula and obstruction.

Extraintestinal manifestation in both case are cutaneous (pyoderma gangrenosum, erythema nodosum), arthritis, liver (primary sclerosing cholangitis, cholangiocarcinoma), blood ( increased coagulbility) and eye (uveitis, scleritis).

Treatment of inflammatory bowel disease

Mainstay treatment are aminosalycilate drugs ( Mesalamine, Pentasa, Balsalazide) and steroids (hydrocortisone, budesonide) as oral tablets or enemas. Later on immunosuppressive drugs (Azithioprine) can be added.

A recurrent advancement to treatment has been infliximab which is a TNF alpha blocker. Fulminant ulcerative colitis may need cyclosporine, infliximab or colectomy. Severe fistulising and perianal Crohn's disease may need infliximab and intestinal obstruction may need judicious surgery.
Treatment may need to be continued life long

More public awareness of these diseases are needed as early diagnosis may prevent complication and need of toxic drugs and surgery.

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Treatment of Tuberculosis

As per RNTCP the patients of TB has been categorized on the basis of sputum examination and the treatment modality varies for each caregories.
Here is the brief description of treatmnet of TB based on the category.

Category I TB

All new cases of of TB who are sputum-positive, or seriously ill patients eith smear negative or seriously ill extra-pulmonary tuberculosis.

Treatment of Category I TB

Treatment is given in two phases. The intensive phase consist of Isoniazid, Rifampicin, Pyrazinamide and Ethambutol given under direct observation(DOTS) thrice weekly on alternate days and lasts for 2 months ie 24 doses in total.
This is immediately followed by the continuation phase, which consist of 4 months(18 weeks, 54 doses) of Isoniazid and Rifampicin given thrice weekly on alternate days, the first dose each week is directly observed.
If the sputum smear is positive after 2 months of treatment, the 4 intensive phase drugs are continued for another one month(12 doses) before starting the 4 months of continuation phase.
Total duration of treatment is thus of 6 months in normal circumstances.

Category II TB

This category consist of retreatment cases including patients with relapse, failure and those who return after default. Such patients are generally sputum positive and have longest duration of treatment.

Treatment of Category II TB

Treatment is given in two phases. The intensive phase consist of two months (24 doses)of Isoniazid, Rifampicin, Pyrazinamide, Ethambutol and injection Streptomycin followed by one month (12 doses) of Isoniazid, Rifampicin, Pyrazinamide and Ethambutol all given under direct observation thrice weekly on alternate days. In total the intensive phase in category II is 3 months.
This is immediately followed by continuation phase, which consist of 5 months(22 weeks, 66 doses) of isoniazid, rifampicin and Ethambutol given thrice daily on alternate days, the first dose each week directly observed.
If the sputum smear is positive after 3 months of treatment, the 4 oral intensive phase drugs are continued for another one month(12 doses) before starting 5 months of continuation phase.
In normal circumstances total duration of treatment is of 8 months.

Category III TB

This consist of patients who are sputum negative, or who have extra pulmonary TB and not seriously ill, like TB of pleura, TB lymph nodes etc.

Treatment of Category III TB

Treatment is given in two phases. The intensive phase consist of Isoniazid, Rifampicin and Pyrazinamide given under direct observation(DOTS) thrice weekly on alternate days and lasts for 2 months ie 24 doses in total.
This is immediately followed by the continuation phase, which consist of 4 months(18 weeks, 54 doses) of Isoniazid and Rifampicin given thrice weekly on alternate days, the first dose each week is directly observed.
*If the sputum smear is positive after 2 months of treatment, the patient is considered as a treatment failure and should begin afresh on Category II.*
Total duration of treatment is thus of 6 months in normal circumstances.

Drugs are supplied in patient-wise boxes containing the full course of treatment, and packaged in blister packs. For the intensive phase, each blister contains one day medication. For the continuation phase, each blister pack contains one weeks supply of medicine.The combipack drugs for extension of the intensive phase are supplied separately.

To know about How to diagnose Tuberculosis please see Diagnosis of Tuberculosis

To know more about the TB program in India (Revised National Tuberculosis Control Program) please see RNTCP

To know more about the DOTS please see DOTS

To know about TB in AIDS patients please see TB in AIDS

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Treatment of Atopic Eczema

The use of emolients for skin care and topical corticosteroids for controlling exacerbation is the mainstay of treatment of Atopic eczema.

Topical steroids for atopic eczema

Hydrocortisone a low potency corticosteroid is available over the counter at pharmacies and is used in treatment of small inflammatory conditions. A moderately potent steroid clobetasone has been made available in some Countries over the counter but it has some limitations in its use that it can't be used in children under 12 and on sensitive skin areas including face and neck, anogenital region, groin or flexures which are more frequent sites for atopic dermatitis.

The local side effects of less potent topical steroids like purpura, erythema and rosacea and systemic side effects of more potent steroids and its limitations to use in children and sensitive skin areas had led to under treatment of atopic eczema.

Alternative treatment of Atopic eczema

Though efficacy has not been outstanding but there are various alternative treatment for atopic eczema apart from topical corticosteroids, these are :-
Antihistaminics
Antihistaminics by blocking the histamine receptors may help in controlling itching and the allergic factors of the disease. Sedation is a common side effect.
Antimicrobials and antiseptics
Though the reason is unclear but the association of bacteria Staphylococcus aureus has been seen with patients with atopic eczema, thus topical antibiotic like Fusidic acid may be helpful in atopic eczema. But there is no consistent evidence of their use in infection free skin in atopic eczema.
Ultravoilet light therapy
Standard UVB treatment may be adequate to control mild atopic eczema, but combined UVA and UVB therapy may be required in moderate to severe cases.
Ultravoilet light therapy is reserved for patients refractory to other treatment regimens. It can be expensive and time consuming and may have association with skin ageing and carcinogenic effect.
Anti asthamatic agents
Some anti asthamaticx agent are used in atopic eczema. Nothing much is known for the rationality.
Immunosuppressive drugs
Cyclosporin A a cyclopeptide which is a potent inhibitor of T lymphocyte dependent immune response has been found to be effective in treatment of atopic eczema and psoriasis as well when given orally. Its potential side effects like renal toxicity and hypertension has restricted its use in refractory cases. Topical cyclosporin is ineffective.
Tacrolimus which is a macrolactams has actionsimilar to cyclosporin A and now a days topical tacrolimus is found to be effective in treating atopic eczema, thus side effects like renal toxicity and hypertension is avoided which may occur while given orally.

To know details about atopic eczema refer to the links given.

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Atopic Eczema- A disease overview

Atopic eczema or atopic dermatitis is an inflammatory condition of skin characterized by features like erythema, papulation and infilteration of the skin. Oozing and crushing may even be apparent in severe cases.

The word eczema is derived from Greek word eczein meaning 'to boil over'.
The main symptom is pruritis which worsen by scratching the affected area. Atopic eczema is characterized by increase in serum immunoglobulin E(IgE) which may confer a predisposition to the development of allergies. It may even be associated with other allergic condition like allergic asthama or allergic rhinitis.

Epidemiology of atopic eczema

Researches confer tat prevalence of atopic eczema is marked in industrialized Countries. As per allergy statistics published in 1998 by US National institute of health, the prevalence of Atopic eczema was 9% and was rising and became 15% in reports of 2000.

There are several factors linked with the onset of the disease.
Environmental factors being the main factor which include pollen, house dust, mites, pets, dander, tobacco smoke and traffic pollution. The effect of these factor may be amplified by modern living standard with the use of air condition, central heating, double glazing and carpets which increases indoor allergies and irritants.

Apart from environmental factors studies in monozygotic twins reveals contribution of genetic factors as well. Other factors may be associated are cell-mediated dysfunction, autonomic nervous system dysregulation and psychosomatic influences.

Pathology of Atopic Eczema

The skin has its own immune system, which comprises Langerhans' cells, Keratinocytes, Mast cells, Endothelial cells etc. Atopic eczema is exaggerated cutaneous immune response to environmental antigens. Histologically, edema and pruritis in both chronic and acute lesions are associated with epidermal infilteration by activated T cells and macrophages.

IgE also has a role in pathogenesis of atopic eczema. It can bind to receptor of dendritic cells which can be detected in dermis and epidermis of the patient.

Diagnosis of Atopic Eczema

Diagnosis is based on clinical observation. There is not any predictive or diagnostic test or marker of the disease. The first sign is development of red, scaly and oozing plaques on the forehead and face which may spread to the neck, hands and flexural areas. In severe cases it may extend to whole body. The skin becomes dry and there is extreme itchiness and scratching worsen the condition by predisposing to secondary bacterial infection due to breakage in cell lining.

Burden on life due to Atopic eczema

Atopic eczema is such a disturbing disease that it severely impairs the quality of life of patients, families and carers. Sleep disturbance is the most common hazard seen in about 90% of the patient with atopic eczema. Tiredness, lack of concentration and irritability is often noticed which in turn lead to underachievement in learning abilities and even inability to participate in any activity. A social cut off is most often seen and depression on panic attack may even occur at times.

A proper management helps in improving not only the sign and symptoms of disease but also improves the quality of life. For management of atopic eczema please see "Management of Atopic eczema"

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Celebrities with Obsessive Compulsive Disorders

If you are sometimes frustated with your obsessive thoughts and compulsive behaviours and at times isolating yourself from society to hide them, dont do that because this may aggravate your symptoms and remember you are not only one with this disorder as 1 out of every 30 persons suffers with obsessive compulsive disorders.
Not only the common man but there are some great celebreties too in your group having some obsessive compulsive disorders.

Here are some Celebrities having obsessive compulsive disorders.

1. David Beckham -There are many people obsessed with David Beckham but do you know for what he is obsessed, football is the common answer, apart from football the other obsession is that he can't resist himself from counting the cans of cola in his fridge and he has to make sure that the count should be in even number.

2.Actress Jeniffer Love Hewitt -Even the air condition may be out of order, climate may be hot and humid but this actress cannot go to sleep unless any cabinet or closet doors are left open.

3. Paul Gascoigne - This retired footballer is obsessed with cleaning and he always make sure that his home is spotless. He also have an obsession to check repeatedly that the doors are locked before he leave home.

4. Actress Jane Horrocks - There was a time when this actress went on actively blinking and swallowing all the time.

5. Cameron Diaz - This highest paid hollywood actress has an obsessive thought of fear from contamination and she always use her elbows to open a door to avoid germs.

There may be many more in the list and most of us may think these acts as celebs quirks but they are actually having obsessive compulsive disrders of different range of severity.

To know more about OCD and how to deal with OCD. Please look at Obsessive Compulsive Disorders

To know about common obsessive thoughts and behaviour please see Common obsessive thoughts and behaviour in Obsessive Compulsive Disorders

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Common Obsessive thoughts and behaviours

Though obsession can be of any thing depending upon the individual, genetic and enviromental factors but here the common obsessive thoughs and behaviours seen in a person with Obsessive Compulsive Disorders.

Common obsessive thoughts in Obsessive Compulsive Disorders.

1. Fear of being contaminated by germs.
The thought sometimes becomes such that many persons always use elbow to open the doors and windows.

2. Sexually explicit thoughts as well as images.
This type of obsessive thought in tender age is very common and not considered as a disorder but in some individual the thoughts may lead to a compulsion of performing such act which may lead to severe distress and excessive suffering both physically and mentally.

3. Fear of loosing people that you love and care for.
This occurs in person who lost their close relatives or one love and care at very tender age and at times their obsession turns to such an extent that it ends up by calling or seeing all thier beloved ones every hourly to check that they are perfectly okay.

4. Extreme superstitions.
This is due to psychosocial factors and some past experience of some good or bad incidences and sometimes the obsession turns into causing serious impact in normal daily routine.

5. Relegious thoughts.
Though every individuals may be relegious but not obsessed, but in Obsessive Compulsive Disorders the thoughts are in extreme leading to compulsion of performing such act which may cause severe hinderence in normal day to day life.

Common obsessive and coppulsive behaviours in Obsessive Compulsive Disorders.

1. Checking locks and switches repeatedly while leaving the house is most common obsessive compulsive behaviour in OCDs. Other common behaviours are-

2. Counting or repeating certain words or doing senseless things like stepping sideways or walking in same colored tiles at home or excessive nail biting to reduce anxiety.

3. Spending a lot of time in washing or cleaning due to fear of germs.

4. Praying excessively.

The most important thing in OCD patients are that they use to hide or act differently in order to hide their compulsive acts or may try to prove it right.

To know more about OCD and how to deal with OCD. Please look at Obsessive Compulsive Disorders

To know about some celebreties having OCD please look at Celebreties having Obsessive Compulsive Disorders

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Obsessive Compulsive Neurosis

Obsession is somewhat present in every individual and rarely may end up compulsive at times and this may not be a thing to panic as it does not interfere any way to lead a normal healthy life.
But there are obsession towards many thoughts and behaviour which becomes a compulsion in the part of life, not only causing distress but also interfere with day to day work, normal relationship, jobs and social interaction. At this stage it is called Obsessive compulsive disorders or OCDs
In short when obsession leads to cumpulsion to perform some act is called OCDs.

Factors responsible for Obsessive Compulsive Disorders

Factors giving way to OCDs may be biological, genetic and psychosocial.
The biological blame is on Serotonin a neurotransmitter in brain which is considered as a cause of Obsessive Compulsive disorders.
The family history or the condition of the family is the genetic factor and research has proven that the incidence of OCD is more in one having family history than the other with no family history.
Psychosocial factor includes some past incidence, bad experience etc. for example a person losing one very near and close friend or relative may develop a fear of loosing another one which in turn can convert into OCDs.

How to deal with Obsessive Compulsive Disorders

1. To hide the obsessive act never isolate your self from society, because social isolation can aggravate your Obsessive Compulsive disorders.

2. Meditation for at least half an hour every day, deep breathing, jogging and practising yoga like Sukhasan, Kapalbhati and Shabasan.

3. If still the problem persist, never hesitate to consult a psychiatrist as there is chances that in mild Obsessive Compulsive Disorders only few session may do the deed. Just remember sooner the better.

To know about common obsessive thoughts and behaviour please see Common obsessive thoughts and behaviour in Obsessive Compulsive Disorders

To know about some celebreties having OCD please look at Celebreties having Obsessive Compulsive Disorders

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What should diabetics eat

There are a lots fuss regarding diet in diabetic patients, with incomplete knowledge a diabetic person usually reduce their diet to such an extent that it may lead to extreme weakness and even depression due to starvation.
Here are the detailed lists of food which can be taken and which should be avoided in diabetes.

Foods that can be taken in diabetes

Vegetables
Drumstick, Ladies finger, Papaya, Bitter gourd(Karela), Cucumber, Turnip, French bean, Brinjal, Cabbage, Green tomato, Fig, Small onion, Garlic, Ginger, Capsicum, Plantain stem and flower, Snake gourd, Spinaches and other leaves even of radish and all other green vegetables not present in the list.

Pulses and Legumes
All types of pulses preferably with husk, Bengal gram, Roasted Bengal gram, Soyabeen, Rajma and gota moong.

Meat/Fish
Chicken, Fish preferably small fish and egg without yolk. Mutton should be avoided.

Fruits
Oranges, Sweet lime, Black berry, Rose apple, Lemon, Ripe papaya, Coconut water(Dab water), Amla, Watermelon, Guava, Plum lemon.

Drinks
Water, Dab water, Lemon water, Butter milk without cream, light soup, Tomato (green) soup.

Cereals
Red flour with husk, Dalia, Rice preferably puffed rice.

Others
Cream cracker or any other sweetened diabetic biscuits can be taken. Skimmed milk, double toned milk and its product, cow and buffalo’s milk without cream.

Foods to be avoided in diabetes

Vegetables
Potato, Sweet potato, Jimikhand(Ol), Green banana, Radish, Beet root, Carrot, Red pumpkin, Jackfruit, Water cashew nut and arvi.

Fruits
Banana, Apple, Pine apple, Wood apple, Pear, Custard apple, Ripe mango, Grapes, Litchi, Wild olive.
Dry fruits and nuts like Dates, Pista, Kismis, Coconut and its product should be avoided.

Others
All kinds of sweets, sugar, honey, jaggery, Ice cream, chocolates, Pastries, Glucose, Mutton..
To add in the list all kind of fried snacks and oily products like Paratha, Puri, Cutlets and chops, Burgers and Patties.
Cows and buffalo’s milk (whole) and its products and their products like ghee, butter, sweet curd, cheese etc.
Not only alcoholic beverages but also carbonated beverages like colas and nutritional drinks which are readily available in market should be avoided.

Note: The above lists are based the product available in a particular region and other physiological and pathological conditions are not considered, hence advice of your dietician or physician should be taken before following it.

How you can know that you are diabetic or not, or is it necessary to consult a doctor, to know details look at How to find if I am Diabetic?

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Know about Hypertension

Apart from diabetes, Hypertension is another common and dangerous disease which very commonly prevalent in our country. Incidences are increasing day by day and people are ignorant as it initially doesnt show any symptoms.
Normal blood pressure ideally should be 120/80 (upper systolic and lower diastolic).If the pressure is above this value we may call it high blood pressure or hypertension.

Causes of Hypertension

Not going in medical details it can be simply explained as the blood flow in a tubular structure arteries and veins and if the diameter of these tubes is narrowed ultimately the pressure of the flow will increase.The diameter is reduced due to the deposition of plaques mainly composed of cholesterol.

Symptoms of Hypertension

Giddiness, Mild sweating may be the initial symptoms but in majority of cases it shows no symptoms initially.

Complications of Hypertension

1.One can simply understand when there is more pressure in a balloon or a pipe it ultimately burst. Similarly if blood pressure increase enormously they may lead to haemorrhage.
2.When the normal rhythm of the blood is disturbed the flow becomes turbulent leading to formation of clots called as thrombus. This thrombus may flow with blood (emboli)and after reaching narrower blood vessels get stuck there blocking the blood flow. If this embolus block the blood vessels supplying brain it may lead to stroke or what we say cerebro vascular accidents(CVA). If it blocks coronary artwery it may lead to heart attack what we say myocardial infarction.

Some common misunderstandings about hypertension.

a. Sometimes a person having pressure of 100/70 get tensed as they feel that they are suffering from loew blood pressure or hypotension. But the fact is that in athletes, sportsman etc we may witness this pressure and is absolutely normal.
b. Earlier it was thought that diastolic pressure is more dangerous but this is not the fact. Systolic pressure is much more dangerous than diastolic pressure.
c. General thinking is in older age pressure upto 150/90 is considered as normal, but the fact is any level above 140/90 needs serious attention and precaution for better and healthy life.

Prevention Measures for Hypertension

1. Get your lipid profile checked as cholesterol is the common culprit as I mentioned above.
2. Restrict salt intake as Sodium has a major role in hypertension.
3. Restrict fat intake to avoid cholesterol and triglycerides.
4. Do moderate exercise, streneous excercise should be avoided.

Any queries regarding hypertension or any disease can be asked. I will feel honoured and happy if I will be able to help a single person with my knowledge sharing.

Regards.

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How to know that I am diabetic

Diabetes and Hypertension are often termed as silent killer as there is no obvious sign and symptoms present which can cause a concern to the patient.
An initial diagnosis of diabetes not only helps in keeping a check in sugar level but also very effective in controlling its complications.
Though periodic check up is of great value but it may not be feesible for every individual.
Then

How will you realize that you are suffering from diabetes?

There are parameters given below for which points has been alloted.

1. Increased frequency of urination : Points-4
2. Increased appetite : Points-2
3. Increased feeling of thirstiness : Points-4
4. Increased feeling of fatigue or tiredness : Points-2
5. Prone to infection : Points-2
6. Sexual impairment : Points-2
7. Unexplained loss of weight : Points-2
8. Family History : Points-2
9. Obesity : Points-3
10.Tingling and numbness of lower extremity : Points-2
11.Impairment of vision : Points-2

You ask yourself the above questions . If 'yes' then start counting of alloted points. If the total points crosses 7, then you may be suffering from diabetes.

In this case immediate go for your blood sugar estimation and advice of doctor is needed for further diagnosis and management

Soon I will be coming up with more details about diabetes mellitus.

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Common facts about Pimples or Acne

The young generation suffer from a very common skin problem called Acne or in simple words Pimples. There are several myths regarding its cause and some of them are far from truth.

Here are some common myths and the truth related to it

Acne is a result of poor deit

Myth is that Acne occurs due to comsumption of choclate, sugar, greasy food etc.
Truth
Multiple conflicting points of view exist regarding diet and acne. Recent data suggest a positive association exist between intake of whole or skim milk and acne, it has been proposed that statistical association may not reflect causal relationship, specially when other confounding variable are not taken in account like heredity, Nationality and socio-economic status.
Diet induces release of insulin and this hyperinsulinemia has been a factor in keratinocyte proliferation and androgen mediated sebum production.
High concentration of dietary omega-6-polyunsaturated fatty acids has been implicated in the overproduction of inflammatory cytokines.

Though dietary relationship with acne is still a hypothesis and numerous well controlled experiment is required to confirm these hypotheses.

Acne is a result of poor hygiene and frequent washing will decrease acne

Truth
This beleif may cause patients to overwash their skin(scrubbing)which can increase local inflammation and can exacerbate acne. According to recent study there is no difference seen in washing face once, twice, three times or four times daily with a cleanser.

However twice daily washing has shown a significant improvement and is recommended. In India due to more pollution and dust thrice washing is suggested depending upon the patients profile

Stress causes Acne

Truth
Though stress directly is not a causative factor of acne but evidence shows that increased stress level may be associated with increase the severity of acne.

Acne treatment is unnecessary because patients will simply outgrow their acne

Truth
Not all adolescents outgrow their acne ; there is a significant amount of adult acne specially in women and treatmentis very well required. The impact of acne, includding scarring and psychosocial effect may persist beyond the acne itself.

You can judge acne medication effectiveness immediately

Truth
Objectively, while a number of treatments probably do start working immediately, it may take weeks to months to see clinically appreciable difference.

Shortly we will be giving the link for treatment of acne.

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Healthy food-Mustard oil beneficial for health

After several research it is now clear that mustard oil in our diet is as beneficial as olive oil for prevention of heart diseases and several other diseases.

Though its use has been restricted at times due to rumor that it can cause heart diseases but research has proven that mustard oil not only prevents heart disease but also beneficial for controlling blood sugar in diabetics and also have some anti-oxidant properties thus helpful in preventing several abdominal diseases as well as some cancers.
It is also a cheaper alternative as edible oil and makes the food more tastier.

How Mustard Oil is Healthy food

Mustard oil contains 70% mono unsaturated fatty acids, apart from that it contains a very useful fat called omega 3 fatty acid in abundance which confirms that mustard oil prevents heart disease by decreasing dangerous lipids like LDL and increases level of useful lipid HDL. It contains very less amount of saturated fatty acid which is a responsible factor fo causing hypertension.

It is now a days considered as best edible oil for health point and is not only cheap but also have various other beneficial effects and negligible side effects in comparison to other edible oil.
Famous Cardiologist of Apollo hospital Dr Manchanda always recommend to use mustard oil as edible oil.

Benefits of Mustard oil

Mustard oil has been considered as better choice among all edible oil due to several positive benefits and some of them are :-

1. It is helpful in preventing many gastrointestinal diseases as well as gastrointestinal cancers.

2. It diminishes the dangerous effect of many cardiovascular diseases as it has negligible amount of saturated fatty acids which is responsible for forming plaques in the arteries thus decreasing the diameter and causing hypertension and other dangerous diseases like myocardial infarction(heart attack) and pulmonary embolism.

3. It decreases fats from blood thus prevents formation of thrombus. It also contains omega 3 fatty acid and other anti oxidants like Vitamin E which helps to fight against dangerous free radicals responsible for many diseases of skin and cardiovascular system.

4. It is also considered useful for disease like asthama, arthritis and other degenerative diseases.

Thus conclusion is that we dont need to stay away from oily foods and have the boring diet. Mustard oil is the answer which not only makes our food more palatable but it is also cheap and risk free and even useful for our body.

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Phytolacca Berry for Treatment of Obesity

Obesity An Epidemic Problem

The data and report as per National Family Health Statistics indicates that in India approximately 13 percent women is suffering from a problem of increasing weight or obesity. Out of that about 10 percent are overweight and 3percent as frank obese. The problem is increasing day by day and is seen mainly in an age group 15-49 years and in married female.

The report showed 11 percent obesity data in National Family Health Statistics- 2 which increased to 15 percent in National Family Health Statistics -3. Out of these one fourth of them have Body Mass Index(BMI)of 25 or more and 5-10 percent with BMI 30 or more.

As per study report the tendency of obesity in Indians are much more. The deposition of fat specially occurs at abdominal and hip region and taking proper step at proper time is necessary to counter them.

Effect of Obesity

Obesity is not at all a good indicator of health, it can lead to various heart diseases, hypertension, hyperlipidemia, Gout, Diabetes, Gall stone, Osteoarthritis, some metabolic disorders and even may lead to severe metabolic disorders.

Obeisty is a very stubborn problem and once affected, to get rid of it is an uphill task even after reducing diet and until and unless proper measure with proper diet is taken.

Phytolacca Berry For obesity

Phytolacca berry is a recent remedy for obesity in homeopathy, in the form of tablet. It is made of fresh American yoke berries which constitutes fat decreasing elements. This medicine along with some weight reducing excercise is a very effective mode to reduce weight.

Phytolacca berry is available in market, this medicine provides balanced nutrition to our body and intake of this medicine for 1-2 months may reduce the weight upto 5 Kg without any side effect. During the course of the medicine regular excercise and proper and balanced diet is necessary and following this the result may be much more better.

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Cervical Cancer vaccine

Cancer Cervix is the most common cause of death in females due to cancer in India and second most mommon in World after breast cancer. In India it is estimated that 8 deaths occur every hour due to cancer cervix and about 74000 deaths every year.

Etiology of Cancer Cervix
Though there are several factors involved for the cause of cancer cervix like multiple sex partner, frequent intercourse, early age of 1st intercourse and multiparity.
But the main cause of cancer cervix is a virus called Human papilloma virus. The four serotypes of HPV(human papilloma virus) 6,11,16 and 18 are responsible for causing genital warts, precancerous lesion and ultimately frank cancer cervix.

Vaccine for Cervical Cancer
HPV is also the most common cause of sexually transmitted disease in USA, It is estimated that 6.2 million women gets infected from HPV in America. On average, there are 9,710 new cases of cervical cancer and 3,700 deaths attributed to it in the United States each year.
E-Merck the pharmaceutical company came with a recombinant vaccine for HPV which ismmunizes against all serotypes, initially vaccine was effective for serotype 16 and 18 only but now but studies suggested that it protects from all serotypes of HPV.
E-Merck came with this vaccine as a trade name Gardasil. In India it has also been launched by MSD an Indian unit of E-Merck.

Gardasil
Gardasil is a recombinant vaccine that doesnt contain virus. It protects against most of the serotypes of Human papilloma virus but it does not confer protection for less common type of infections thus a regular pap-smear is still indicated. For females already infected by HPV it does not provide full protection.
Study reports suggested that Gardasil gives nearly 100 % protection against all common types of HPV. It is given as three injections over a six-month period.
According to Jesse Goodman, MD, MPH, Director of FDA's Center for Biologics Evaluation and Research "This is the first vaccine licensed specifically to prevent cervical cancer. Its rapid approval underscores FDA's commitment to help make safe and effective vaccines available as quickly as possible. Not only have vaccines dramatically reduced the toll of diseases in infants and children, like polio and measles, but they are playing an increasing role protecting and improving the lives of adolescents and adults,"
Side effects of Gardasil includes mild or moderate local reactions, such as pain or tenderness at the site of injection.
Research are going on for the pregnancy outcomes of women who receive Gardasil while unknowingly pregnant. Evaluations are being done for males too getting infected by human papilloma virus which is a cause of genital wart in males.

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Lycopene for Skin Care

Lycopene is a carotenoid which is present in colored fruits like tomatoes, guava, watermelon etc. It is a strong anti-oxidant and is useful for various ill effects caused to to unwanted free radicals in our body.

Uses of Lycopene

Lycopene is an anti oxidant and is useful in preventing a very common eye disorder nyctalopia or night blindness. It is also useful is other ophthalmic disorders like conjunctival xerosis, keratitis and others caused due to deficiency of Vitamin A.

Apart from that there are some study reports suggesting that Lycopene can be useful in preventing various heart diseases, diabetes and other degenerative diseases due to its anti-oxidant properties.

Lycopene is also useful in combating various types of cancers.

Lycopene is very much useful in skin disorders which is described in detail below.

Sources of Lycopene

As mentioned above the colored fruits and vegetables are very important source of Lycopene. Tomatoes consist of significant amount of lycopene. Other sources include Guava, Watermelon, Grapes, Turnip and pumpkins.

Lycopene for Skin Care

Lycopene has a great role in skin care as it prevents skin from the ill effects of Sun ray which can be a very common reason for some skin cancers. It helps in holding oxygen to our skin. It also reduces the problem of pigmentation, uneven complexion and tanning of skin. It prevents the release of free radicals which occurs due to melanin (a skin pigment) metabolism.

For skin problems lycopene may not be sufficient in our food, therefore sometimes extra lycopene is required which is available is several anti-oxidant capsules and tablets.

For skin lycopene cream is also available and can be applied 2-3 times a day.

Overall lycopene is a useful substance not only for skin diseases but also for beauty conscious persons.

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Tuberculosis in AIDS patients

The most common infection in HIV positive or AIDS patients has been tuberculosis, and in patients with HIV positive, tuberculosis has been a tedious but important job to diagnose and treat.
Patients with HIV infection are much more susceptible to infections called oppurtunistic infection and tuberculosis being the most common and most serious one in India in HIV positive cases. In patients infected with both HIV and TB, the lifetime risk of developing the disease has been estimated to be at least 60%, compared to approximately 10% in persons infected with TB who do not have HIV infection.

Diagnosis of Tuberculosis in patients with HIV

For diagnosis of Tuberculosis in patients without AIDS or HIV negative please see Diagnosis of TuberculosisThe diagnosis of tuberculosis in patients with AIDS or HIV is more difficult than in those without HIV for three reasons stated below :-
** Direct sputum smear examination is specific test, but is not a sensitive test for the diagnosis of tuberculosis. The sensitivity of sputum microscopy as a diagnostic tool is further reduced in HIV-infected patients. Of HIV-negative patients with pulmonary tuberculosis, 50-80% will have positive sputum smears, compared to approximately 30-50% of HIV-positive patients with pulmonary TB.
** X-Ray abnormalities, which are not specific for TB in HIV-negative patients, are even more non specific in HIV-infected patients. In AIDS(HIV infected patients), TB may be present with only minor abnormalities on chest X-Ray or with abnormalities which do not look like classic TB. This may result in under diagnosis of pulmonary TB.
** Patients infected with HIV have frequent pulmonary infections. Because chest x-ray is a non-specific diagnostic too for pulmonary TB, the frequent occurence of pulmonary infections other than TB like infection with Pneumocystis carni may result in over diagnosis of TB among HIV positive patients.

Important step of management in HIV with pulmonary infection

When patients with HIV infection have chest symptoms, they should have 3 sputum examinations for Acid fast bacilli(AFB), if all the three sputum examinations are negative, they should receive treatment for bacterial pneumonia, which is also common in AIDS patients. If routine antibiotics do not releive the symptoms, then based on the result of appropriate diagnostic studies (chest x-ray, sputum culture for mycobacteria, if available), the patient can be treated for tuberculosis.

Treatment of of Tuberculosis in patients with HIV

Treatment of TB in patients with HIV infection is as effective as in TB patients without HIV. Prompt diagnosis and effective treatment using DOTS can cure TB, prevent spread of the the disease and prolong the life of the patients with HIV. However, because of the risk of fatal skin reactions, thiacetazone should not be used in HIV positive persons or in an area or groups having a high prevalence of HIV. Proper sterlization of reusable needles and syringes, and proper disposal of disposable needles and syringes must be ensured to prevent spread of HIV and other blood borne diseases.Last but not the least it is extremely important to ensure that all patients with TB who are in hospital or residential facility for HIV infected persons have an un interrupted drug supply and are on DOTS. If these patients do not take anti tuberculosis medicatins as prescribed, they may spread the disease rapidly to both HIV infected as well as non HIV infected population.

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DOTS in tuberculosis

What is DOTS

DOTS (Directly Observed Treatment, Short course chemotherapy ) is a strategy to ensure cure by providing the most effective medicine and confirming that it is taken. It is the only strategy which has been documented to be effective Worldwide on a program basis. DOTS ensures that patient take medicine regularly until they are cured.
During the intensive phase of treatment, a health worker or other trained person watches as the patient swallows the drug in his presence.
During the continuation phase the patient is issue medicines for one week of which the first dose is taken in presence of health worker or other trained person issuing the drugs. The consumption of medicine in the continuation phase is also checked by return of the empty multiblister combipack when the patient comes to collect medicine for the next week.
Sputum microscopy is done at defined intervals during treatment to monitor the patients progress toward cure.

History of DOTS

The essential principles of DOTS were first demonstrated in India. The determination that tuberculosis patients need not be hospitalized, and the necessity and effectiveness of directly observed, intermittent treatment was first proven at the Tuberculosis Research Centre in Chennai in the 1950s and 1960s. The key to the success of the DOTS strategy is that it places the responsibility of curing TB patients on the health worker and not the patients.
This strategy has proven successful throughout the World. China has implemented DOTS for more than 650 million people, with cure rates of more than 90%. Vietnam and Combodia have implemented hihgly effective programs. Recently Bangladesh has also implemented DOTS in two-third of the Country, with high cure rates and excellent collaboration with non.governmental organization.
In India the pilot project s covering a population of 13.85 million have demonstrated a cure rate of about 80%.
Categoies and Treatment by DOTS regime will soon follow.

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Diagnosis and Management of Ectopic Pregnancy

Ectopic pregnancy is a dangerous entity and can be life threatening if not attended urgently.
Here are some basic facts about ectopic pregnancy.
It occur in about 1% of all pregnancies.
It usually presents at between 6 and 8 weeks gestation.
A sensitive beta-HCG test is usually positive.
Commonest site is in the tubal ampulla

Clinical presentation of Ectopic pregnancy
* Clinically patient has lower abdominal pain and slight vaginal bleeding.Vaginal bleeding may not be obvious at times.
* Cardiovascular collapse and shoulder tip pain suggest large intraperitoneal bleed and patient may be in shock.
* Examination will often shown abdominal and adnexal tenderness.
Thus an early pregnancy with abdominal pain with or without vaginal bleeding with palor should immediately attend a gynaecologist.

Criteria for medical management of ectopic pregnancy
1. Gestational Sac size must be less than 3.5cm.
2. Patient should be stable.
3. No jaundice should be present.
4. Hemoglobin should be above 10gm%

Management of ectopic pregnancy
Laparoscopic management is the preferred treatment option in all but the haemodynamically compromised or in those with a large ectopic pregnancy.
Conversation of the tube by linear salpingostomy using unipolar needlepoint diathermy is effective, and the tube is left to close spontaneously.
Salpingectomy can be carried out using a pre-tied loop or with excision using coagulation diathermy or by laparotomy where, in addition, the pregnancy may be milked through the fimbrial end of the tube.
Non-surgical conservative technique is salphingcentsis which involves injecting 50% dextrose or methotrexate in the sac laparoscopically. If the tube is conserved it is essential to ensure that the hCG is falling; if not there is likely to be residual trophoblast.
The hCG should fall to 25% of the pre-treatment level within 4 days of surgery.

Following aspects should be looked in management of ectopic pregnancy
* Patient invariably has positive urinary pregnancy test.
* In cases of doubt sensitive serum beta-HCG is helpful.
* Ultrasound shows empty uterus and may identify ectopic.
* An intrauterine pregnancy on USG almost invariably excludes an ectopic.
* If no evidence of cardiovascular compromise laparoscopy is investigation of choice.
* If patient is shocked immediate laparotomy is essential.
* Fetus can then be removed by salpingotomy or salpingectomy.

Risk factors for ectopic pregnancy include
1. Previous Pelvic Inflammatory disease (PID)
2. Infertility
3. Tubal surgery
4. Intrauterine contraceptive device
5. Previous ectopic.
6. PID increases risk of ectopic by seven fold.

All the queries regarding ectopic pregnancies are invited.
Regards.

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