A simple guide to Mastitis

January 17, 2016

A Simple Guide to Mastitis

A Simple Guide to Mastitis
—————————–What is Mastitis?
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Mastitis is inflammation or infection of the breasts, resulting in pain and swelling.

What causes Mastitis?
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The causes of Mastitis are mostly due:

A.Hormonal:
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1.In babies whether male or female, the painless swelling of the breast may occur due to the effects of the mother’s female hormones.The swelling usually subsides after a few weeks.

2.At Puberty for girls the development of breasts may cause some pain and swelling. It may occur first on one side and then subsequently on the side.
The nipples may be red and tender andthis may cause worry for the adlolescent girl and her mother.

3.Premenstrual pain and swelling of breasts may occur

B.Infections:
———————

Infections of the breasts may occur due to
1.poor skin hygiene

2.Injuries or wounds allowing microganism to enter the wound

3.Breastfeeding as a result of the baby sucking the nipple incorrectly or as a result of blockage of the milk ducts. In either case bacteria can enter through the injured nipple or the inflammation of the blocked milk ducts may cause suppuration and abscess formation.

4.Mastitis may occur as a rare complication of mumps.

5.Most common bacteria infection is staphyloccus aures.

6.Other rare causes of mastitis are tuberculosis, syphlis or actinomycosis

What are the symptoms of Mastitis?
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The Symptoms of Mastitis are:

1.Pain usually present in all cases except in babies

2.swelling of the breasts or the nipple area

3.Pus discharge from the nipple

Signs:

1.redness of the nipple or areola

2.red, warm swelling of the breast tissue may indicate presence of formation of abscess.

3.Local tenderness of inflammed area

4.Fever and genral malaise

5.Axillary lymph nodes may be swollen and painful

What are the complications of Mastitis?
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1.Abscess formation

2.Cystic formation

3.Chronic mastitis or fibroadenosis

How is diagnosis of Mastitis confirmed?
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1. clinical features

2. Mammograms to exclude malignant tumors

3. Ultrasound scan of the breasts

What is the treatment of Mastitis?
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1. antibiotics are given to cure the infections.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.

2. Painkillers may be given if there is pain

3.Rest and support of the breasts with soft bras

4.Warm water bottle to apply to areas of inflmmation due to blocked milk to soften the milk and induce flow.

5. surgery with drainage of abscess if antibiotic do not work.
Aspiration of cysts may also be nessary

6.Reassurance in hormonal cases of mastitis

What is the Prognosis of Mastitis?
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Most cases of mastitis usually will recover with proper treatment.

What are the Preventive measures for Mastitis?
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Practice good personal and skin hygiene
Wash hands frequently
Clean the beasts properly before and after breastfeeding
Patients should be taught to do breast self examination and to do it frequently

A simple guide to Cervicitis

January 17, 2016

Cervicitis

The most dangerous effect of cervicitis is the danger of development of Cervical Cancer especially with human papilloma virus infection.

What is Cervicitis?

Cervicitis is medical non-specific infection of the cervix.

Cervicitis is a red swelling (inflammation) of the cervix – the lower part of the uterus that passes about one inch into the vaginal canal.

It is most frequent on the posterior cervix but may be anterior or concentric.

Cervicitis is probably the most frequent of all gynecological disorders, involving 50% of all women at some time in their lives.

A woman, regardless of age, who has ever had one sexual intercourse and who is now having abdominal pain or an abnormal discharge from the vagina, may have cervicitis.

Even though it is so frequent, cervicitis is not easily self-diagnosed, because its symptoms can be similar with those of other frequent ailments, such as vaginitis.

If not treated, cervicitis can lead to infertility problems conceiving or having a healthy baby.

But cervicitis can be diagnosed easily by the doctor and correctly treated with a wide variety of medicines and treatments.

Prolonged cervicitis may cause problems for a woman to become pregnant and affect fertility.

The abnormal production of mucus in the cervix area may interfere with the sperm’s ability to enter the cervical canal

Also the infection can also extend to the uterus or the fallopian tubes that lead to the ovaries.

A pregnant woman with cervicitis is more likely to have a miscarriage, premature delivery, or infection of the newborn during delivery which can result in pneumonia, a severe eye infection, or blindness.

Who are at risk of having Cervicitis?

1 .Congenital cervical erosions or cervicitis can be present in virgins.

2. All sexually active women

Dilatation may be induced in labor or during abortion

Risks are:

High-risk sexual behavior

History of STIs

Many sexual partners

Sex (intercourse) at an early age

Sexual partners who have involved in high-risk sexual activities or have had an STD

Bacteria (such as staphylococcus and streptococcus) and over growth of usual bacteria in the vagina (bacterial vaginosis) can also cause cervicitis.

What are the types of Cervicitis?

Simple:

When the erosion surface is smooth

Papillary:

When the erosion surface is not smooth, rougher

Follicular:

When the erosion surface is cystic

What are the causes of Cervicitis?

Cervicitis is most frequently induced by an infection that is caught during sexual activity.

Most commonly, cervicitis is due to an infection, although it can also be caused by trauma or irritation (allergic reaction to the chemicals in contraceptives and vaginal douches, or a tampon that had been left behind).

Cervicitis is only one of the many problems that these diseases induce.

A number of other organisms, such as streptococcus, staphylococcus, enterococcus, herpes simplex, and Gardnerella vaginitis, can also cause cervicitis.

Bacterial infections:

 Gonorrhea and Chlamydia

1. Trichomoniasis
2. Staphylococcus aureus
3. Streptococcus
4. Mycobacterium tuberculosis.
5. E.coli

Viral infections:

1. Genital herpes
2. Human papilloma virus (or genital warts)

Other causes:

1. Cervical cap (to prevent conception)
2. Device to support any prolapse of uterus (pessary)
3. Diaphragm
4. Allergy to spermicides used for birth control
5. Allergy to latex in condoms
6. Exposure to a chemical danger

Cervicitis is very common

It affects more than 50% of all women at some time during their adult life.

What are the symptoms of Cervicitis?

There may not be symptoms.

Women at risk for chlamydia infection should be tested for this infection even though they may not have symptoms

At the mildest form, no symptoms may be observed, but a more serious patient with cervicitis can induce a profuse, pussy vaginal discharge with an uncomfortable odor, together with severe vaginal itchiness or abdominal discomfort.

The first symptom of cervicitis tends to be a vaginal discharge that becomes more pronounced immediately after a menstrual period.

If the infection gets into the blood system, the woman may also have fever and nausea.

Unusual Mucopurulent vaginal discharge (Gray, white, or yellow color) with odor that does not go away

Other signs are itching, bleeding, or irritation of the external genitals; painful intercourse; a burning sensation during urination; and lower back pain.

Abnormal Blood in the vaginal discharge

After intercourse

After menopause

Between periods

Urinary tract infection symptoms – frequency and pain

Hematuria (blood in the urine)

Pelvic pain

Backache

Painful sexual intercourse

Pain in the vagina

Pressure or heaviness in the pelvis

Signs:

Reddened region of cervix

Eroded cervical wall

Vaginal surface of cervix may be involved

Pussy discharge from the lining of the cervix

Swelling (inflammation) of the walls of the vagina

Vaginal examination with Pap’s smear of cervical cells

Cervical swab for culture and sensitivity to antibiotics

Blood tests (white cell count, blood culture, chlamydia, gonorrhea)

How is Cervicitis diagnosed?

Diagnosis of cervicitis is accomplished through a knowledge of clinical history and a pelvic examination with direct view of the cervix.

A pap smear and culture for causative organisms is typically performed.

A pelvic examination is done to look for:

Discharge from the cervix

Redness of the cervix

Swelling (inflammation) of the walls of the vagina

Tests that may be done include:

Inspection of the discharge under a microscope (indicate candidiasis, trichomoniasis, or bacterial vaginosis)

Pap smear

Tests for gonorrhea or chlamydia

Rarely, colposcopy and biopsy of the cervix is necessary

What are the complications of Cervicitis?

Cervicitis may last for months to years.

Cervicitis may lead to pain with intercourse (dyspareunia).

Pelvic inflammatory disease

Urethritis and cystitis

Rarely malignant changes in cervix

Inguinal lymphadenitis

What is the treatment of Cervicitis?

If the diagnosis is chlamydial cervicitis, the doctor will probably prescribe a broad-spectrum antibiotic.

Among the most frequently prescribed treatments prescribed are doxycycline and other medicines that kill bacteria in the vagina and cervix.

Antibiotics are given to treat bacterial infections (such as chlamydia, gonorrhea, and others).

Medicines called antivirals may be given to treat herpes infections.

Hormonal therapy (with estrogen or progesterone) may be given in women who have reached menopause.

If a woman have prolonged or repeated bouts of cervicitis, the doctor may recommend a procedure focused on killing off the abnormal cells on the surface of the cervix.

When these treatments have not worked or when cervicitis has been present for a prolonged period, treatment may include:

The most common of these procedures are cautery, cryosurgery, and laser treatment.

After treatment, cells from untreated normal tissue normally will grow into and replace the area of damaged, abnormal tissue.

Cautery, which normally produces mild to moderate pain, tends to be less recommended than the other two newer treatments, if available.

The success rates are the same for laser and cryosurgery.

Cryosurgery (freezing)

Electrocauterization

Laser therapy

Acute Cervicitis

Antibiotics are given according to its sensitivity and resistance of bacteria in the culture.

Pelvic pain and backache may be relieved with paracetamol

Local application of tetracycline, sulphonamide, or other antibiotic cream

Cauterization of the affected cervical area

Cryosurgery

Cone biopsy if necessary.

Hormonal therapy (given in postmenopausal women)

Laser therapy

Laser treatment is indicated when there are bigger regions of abnormal mucosa.

Complete recovery may involve 6 to 8 weeks.

What is the prognosis of Cervicitis?

Most of the time, simple cervicitis normally recovers with treatment if the cervicitis cause is found and there is a treatment for that cause.

The outcome with proper treatment and correct antibiotics is normally good.

Recurrence is common.

Cervicitis may last for months to years.

How to prevent Cervicitis?

Avoid sexual intercourse with multiple partners.

Use condoms during sexual intercourse.

Vaccination against human papilloma virus

Avoid chemical irritants such as douches and deodorant tampons.

Avoid using spermicidal contraceptives

Make sure that any foreign objects that are inserted into the vagina are clean or sterile.

Things you can do to reduce the risk of cervicitis include:

Chemical irritants should be avoided such as douches and deodorant tampons.

Any foreign objects inserted into the vagina (such as tampons) are hygienic and properly placed.

Instructions must be followed on the duration, frequency, or cleansing of it.

A monogamous sexual relationship should be with a partner who is known to be free of any STI

Monogamous means the woman and her partner do not have sex with any other people.

Abstinence (No sexual intercourse) is the best way of preventing sexually transmitted cervicitis.

Using a condom at each sexual encounter lowers the danger of getting an STI.

There are condoms available for both men and women, but most of them are worn by the man.

The condom must be used correctly each time.

MULTIPLE SCLEROSIS

DOC I HAVE MULTIPLE SCLEROSIS

What is Multiple Sclerosis?

Multiple Sclerosis is a progressive degenerative disease of the central nervous system with recurrent episodes of neurologic

dysfunction disconnected in time and space and associated with evidence of demyelination of the central nervous system.

It affects the patient in different areas of the nervous system at various points in time.

What causes Multiple Sclerosis?

The cause is unknown but believed to be related to an auto immune disease resulting from a viral infection.

Multiple sclerosis results in destruction of the myelin surrounding the nerves of the CNS. The destruction is thought to be

caused by the body’s immune system attacking the myelin sheath disrupting the transmission of information in the CNS and

lead to the symptoms seen in multiple sclerosis.

1.In Multiple Sclerosis, there is multiple scattered greying well defined lesions from few small mm size to few cm in size

present in the white matter and extending to the grey matter of the brain.

2.The lesions vary from partial to complete destruction of the myelin sheath with relative sparing of the axon , glia and

other structure.

Who is at risk of Multiple Sclerosis?

Multiple Sclerosis occurs between 20 to 50 years old.

It is more common in Northern Europeans.

Women are affected 2 times more than men.

Triggers that can cause the onset of MS are:
infections
trauma
surgery
emotional upset,
stress
pregnancy

What are the symptoms of Multiple Sclerosis?

The typical symptoms of Multiple Sclerosis are multiple and variable which explains its name.
There may be mild cases which may not need treatment or severe cases which need confinement to wheelchairs.

There is a typical course of exacerbations and remissions over a peroid of years and increased residual neurological deficit

1.impairment of vision is usually an early sign of MS
2.diplopia can occur with optic neuritis
3.unsteady gait due to the effect of the disease on the cerebellum which control balance and co-ordination
4.paresthesia or tingling sensation in the fingers and toes
5.weakness of the muscles leading to hemiplegia
6.facial paresis, vertigo and hearing loss
7.seizures when foci in the brain are over stimulated
8.Constipation and urinary incontinence may also occur as a result of the weakened muscles
9.one peculiar trait is that higher temperatures aggravate the symptoms in MS patients. Nerve conduction at higher

temperature such as a hot shower cause the slowing in the transmission of messages in nerves that have already lost myelin.

How is the diagnosis of Multiple Sclerosis made?

The diagnosis of  Multiple Sclerosis is difficult and involve
1.History of a multiple symptoms involving the nervous system
2.physical and neurological examinations for peripheral neurological deficit.
3.blood count and chemistry, urine analysis are all routine laboratory tests used to rule out other diagnoses
4.Cerebral spinal fluid evaluation may show mild mononuclear pleocytosis (less than 40 cells per cubic meter, protein normal

or increased and high gamma globulin IgG.
5.MRI can search for changes within the brain or spinal cord that are particular to multiple sclerosis.

What are the complications for Multiple Sclerosis ?

1.Weakness of the muscles leading to hemiplegia

2.spasticity of the muscles with rigidity and cramps

3.Poor co-ordination and imbalance

4.urinary and bladder problems

5.visual loss and pain suggesting optic neuritis , an inflammation of the eyeball

What is the treatment for Multiple Sclerosis?

Multiple Sclerosis cannot be cured but can be suppressed:

Supportive measures
1.Bed rest
2.Proper diet and nutrition to strengthen the muscles of the body
3.physiotherapy to strengthen muscles
4.occupational therapy to help stimulate the mind
5.Speech therapy for speech and awallowing
6.social support
7.Avoid triggers

Medications:
1.Glatiramer acetate is able to reduce the relapse rates of multiple sclerosis by about one-third and appears to reduce the

overall progression of multiple sclerosis

2.Natalizumab is a monoclonal antibody that binds to white blood cells which are thought to play a role in causing the

nervous system damage in multiple sclerosis. It also reduces the rates of relapses of MS by two thirds.

3.Fingolimod is a daily oral medication to treat MS by reducing the number of lymphocytes which is believe to cause

inflammation in MS.

4.Interferon which are anti-viral agents has found to reduce relapses of MS by one third.
What is the prognosis of Multiple Sclerosis?

5.Previous treatment used to be ACTH injections and corticosteroids. These are are seldom used.

What is the prognosis of Multiple Sclerosis?
MS is unfortunately still not curable at this time.
Most patients about 65 % with the relapsing and remitting form may improve to a stage where relapses are very much reduced.

Unfortunately they continue to have more disabling symptoms or secondary progressive multiple sclerosis.
15% become worse with progressive relapses.
10% has primary progressive MS with no remissions in between.
Death usually results from pneumonia and heart trouble.

HUNTINGTON’S CHOREA

DOC I HAVE HUNTINGTON’S CHOREA

What is Huntington’s Chorea?

Huntington’s Chorea is a progressive degenrative disease affecting basal ganglia characterized by choeiform movements (movements such as writhing, twisting, and turning in a constant, uncontrollable dancing motion) and mental deterioration.

What causes Huntington’s Chorea?

The cause is believed to be genetic with autosomal dominance transmission from parent to offspring with full penetrance.

In Huntington’s Chorea, there is widespread degeneration changes with cell loss and reactive gliosis mainly in the cerebral cortex (thinking and perception), basal ganglia (balance) and caudate nucleus (co-ordination).

There is the belief that the deficiency of gamma-aminobutyric acid (GABA) in the cells may have contribute to the impairment of the nerve cells.

Who is at risk of Huntington’s Chorea?

Huntington’s Chorea affects sexes in equal numbers.

It is an inherited condition. On average 50 per cent of children of the sufferers will be affected.

What are the symptoms of Huntington’s Chorea?

The typical course of Huntington’s Chorea usually appear between 30 to 45 years but may be earlier or later.

1.choreiform movements (movements such as writhing, twisting, and turning in a constant, uncontrollable dancing motion )

2.emotional disturbance with mental changes

3.cognitive impairment

4.mood swings with inertia followed by irritability

5.apathy

6.anger

7.depression

8.delusion and hallucinations

9.The speech can become  slurred and vital functions, such as eating, speaking, swallowing and especially walking, begin to decline.

10.All the above may occur to varying degree but rate of progression is  generally parallel.

How is the diagnosis of Huntington’s Chorea made?

The diagnosis of  Huntington’s Chorea involve:
1.Typical history of choreiform movements,emotional and mental impairment with family history.

2.physical and neurological examinations for brain neurological deficit.

3.CT scan or MRI may show selective atrophy of the caudate nucleus and putamen. In addition there are enlargement of fluid-filled cavities within the brain called ventricles. These tests do not completely differentiate Huntingson’s Chorea from other conditions such as dementia but they will together with the choreiform movements,emotional and mental impairment point towards Huntingdon’s chorea.

What are the complications for Huntington’s Chorea ?

1.Progression of nerve involvement to whole body with paralysis

2.Dementia may gradually result from mental impairment

What is the treatment for Huntington’s Chorea?

The is no cure for Huntington’s Chorea but symptomatic control of choreiform movements and delusions with haliperidol or clonazepam may help.

Proper nutrition , fluids and exercise will help the patient to stay healthy and fit.

As the condition progress hospitalization or institutional care (such as nursing homes) is usually indicated.

Genetic counseling is important for treatment and prevention of  
Huntington’s Chorea.

What is the prognosis of Huntington’s Chorea?

Except for a few cases there is a relentless progression to death.
Death usually occurs in 10 to 15 years although the course may more acute or prolonged.

MOTOR NEURONE DISEASES

DOC I HAVE A MOTOR NEURONE DISEASE

What are Motor Neurone Diseases?

Motor Neurone Diseases is a group of progressive degenerative diseases affecting motor neurones with varying corticospinal involvement.

The diseases destroy cells that control important muscle activity such as speaking, walking, breathing, and swallowing. The damaged nerve cells are unable to send signals to the muscles to do their activity resulting in weakness, wasting and tremors of the muscles.

The Motor Neurone Diseases includes conditions such as Amyotrophic Lateral Sclerosis (ALS), progressive bulbar palsy, primary lateral sclerosis, and progressive muscular atrophy.

What causes Motor Neurone Diseases?

The cause is unknown but environmental, toxic, viral, or genetic factors have found to play a part in its formation.

1.In all Motor Neurone Diseases, there is loss of nerve cells in the anterior horn of spinal cord and motor nuclei of brain stem.

2.In Primary Lateral Sclerosis there is corticospinal tract degeneration most evident in the lower spinal cord but traceable to internal capsule and corona radiata.

Who is at risk of Motor Neurone Diseases?

Motor Neurone Diseases occurs in middle age 40-60 years old and are more common in males.

It occurs as endemic in Guam where there is high familial incidence in association with Parkinson dementia complex.

What are the symptoms of Motor Neurone Disease?

The typical course of Motor Neurone Diseases except for primary lateral sclerosis is 2 to 6 years resulting in death.

1.acute onset of asymmetrical muscle tremors, weakness and wasting in both lower limbs with ascending progression of the weakness upwards to the arms and face .

2.the lower cranial nerves can also be affected leading to bulbar weakness, (dysphagia or difficulty with swallowing), facial weakness and respiratory difficulties. If this happens , hospitalization is a must.

3.spasticity of the muscles

4.hyperreflexia

5.mental function is usually not affected

How is the diagnosis of Motor Neurone Disease made?

The diagnosis of  Motor Neurone Disease involve
1.History of a rapid onset and progression of motor weakness, wasting, tremors, hyperreflexia and the absence of fever.

2.physical and neurological examinations for peripheral neurological deficit.

What are the complications for Motor Neurone Disease ?

1.Progression of nerve involvement to whole body

2.Paralysis of respiratory muscles and swallowing can be life threatening

What is the treatment for Motor Neurone Disease?

Treatment for Motor Neurone Disease may be urgent especially in cases of respiratory distress:

1.Hospitalization and early intubation with a respirator on standby in case of difficulty in respiration

2.treatment of the condition is supportive only as there is no cure for the disease

a.physiotherapy to strengthen muscles

b.Speech therapy for speech and swallowing

3.The drug riluzole approved to treat ALS, prolongs life by 2-3 months but does not relieve symptoms. 

4.Symptoms such as spasticity  can be treated with muscle relaxants.

Anticonvulsants and pain killers can help to relieve pain.

5.A healthy and balanced diet is necessary to maintain strength in the muscles and mind

What is the prognosis of Motor Neurone Disease?

Most Motor Neurone Diseases except for primary lateral sclerosis (which is usually not fatal) are relentless diseases with  progression to death.

DUCHENNE MUSCULAR DYSTROPHY

DOC I HAVE DUCHENNE MUSCULAR DYSTROPHY

What is Duchenne muscular dystrophy?

Duchenne muscular dystrophy is a genetic disease which causes rapid weakness and wasting of muscles.

What is the cause of Duchenne muscular dystrophy?

Duchenne muscular dystrophy is believed to occur as a result of a defective gene for dystrophin (a protein in the muscles).

In Duchenne muscular dystrophy males are more likely to develop symptoms than are women.

Inheritance is usually sex-linked and recessive. The sons of women who are carriers of the disease have a 50% chance of having the disease while the daughters have a 50% chance of being carriers.

Duchenne muscular dystrophy occurs in 0.3 per cent of male infants in the population.

What are the symptoms of Duchenne muscular dystrophy?

Symptoms may appear as early as infancy and include:

1.Fatigue
2.Muscle weakness which is worse in the legs

3.waddling gait

4.use of hands to raise self from floor
4.Difficulty in running, jumping
5.Frequent falling

6,climbing stairs difficult

7.Pseudohypertrophy of the infraspinatus, deltoids , triceps and calf muscles

8.Atrophy of muscles occurs with contractures and deformity

9.Progressive difficulty in walking with ability to walk lost by 12 years of age
10.Most patients at age 12 are confined to a wheelchair.

Signs :

A complete physical examination may show:

1.Abnormal heart muscle (cardiomyopathy)
2.Congestive heart failure
3.Deformities of the chest and back (scoliosis)
4.Enlarged calf muscles which are later replaced by fat and connective tissue (pseudohypertrophy)
5.Loss of muscle mass (wasting)
6.Muscle deformities in the heels and legs
7.Respiratory difficulty due to weakness of lung muscles

Investigations:

1.Electromyography (EMG)
2.Genetic tests
3.Muscle biopsy

What is the Treatment of Duchenne muscular dystrophy?

Treatment of Duchenne muscular dystrophy are usually symptomatic to improve the quality of life as there is no cure for the disease.

Gene therapy may be able to cure by removing the defective gene in the future.

1.Physical activity is helpful to maintain muscle strength and function.
Inactivity may worsen the muscle disease.

2.massage and electrical stimulation of muscles
2.Orthopedic appliances (such as braces and wheelchairs) may increase the ability for self help.

What is the prognosis of Duchenne muscular dystrophy?

Duchenne muscular dystrophy usually leads to rapidly worsening muscular condition.
Death can occurs by age 25 typically from respiratory conditions such as pneumonia.

What are the complications of Duchenne muscular dystrophy?

1.heart disease such as cardiopathy and heart failure
2.muscle deformities such as scoliosis
3.mental impairment which is rare
4.permanent, progressive disability
5.pneumonia or other respiratory infections
6.death from respiratory failure

What is the preventive measures of Duchenne muscular dystrophy?

Duchenne muscular dystrophy can be detected with about 95% accuracy by genetic studies performed during pregnancy.
Genetic couseling will therefore be a great help to prevent the disease.

PURPURA

DOC I HAVE PURPURA

Purpura is a physical sign of escape of red blood cells through the endometrial wall of the dermal capillaries resulting in purplish blotches under the skin.

What is the cause of Purpura?

It is usually due to vacular wall defect, low platelets, infections or injury:

Vascular wall defect may be caused by:
1.Scurvy or lack of vitamin C
2.Fragilty of vascular wall due to age(senile purpura, anemia, diabetes or steroid therapy
3.Autoimmune disease such as Henoch Schonlein purpura
4.Blood cancer such as multiple myeloma

Infections:
1.Dengue fever – cause low platelets
2.Subacute bacterial endocarditis – cause low platelets
3.Typhoid fever
4.Rocky mountain fever

Low Platelets:
1.Aplastic anemia – low production of red blood cells, white blood cells and platelets from marrow
2.Megaloblastic anemia
3.Leukemia
4.Exposure to toxic drugs (chemotherapy) or radiation
5.Splenomegaly
6.Idiopathic thrombocytopenic purpura
7.Lymphoma
8.Neonatal thromocytopenia
9.Drug induced thrombocytopenia

Others:
1.Injury
2.Trauma
3.Burns
4.Dialysis
5.Blood thinners such as aspirin, warfarin, plavix
3.alcohol

What are the symptoms of Purpura?

Symptoms:

1.typical purple blotches under the skin
2.fever with purpura is a medical emergency
3.fundoscopic bleeding
4.abdominal pain may be a recurring symptom
5.splenomegaly
6.low platelets
7.bleeding time prolonged

How do you made the diagnosis of Purpura?

Diagnosis of Purpura is often based on
1. history of Purpura
2. history of drug allergy
3. history of blood thinners
4. Full blood count
5. Bone marrow biopsy

What are the complications of Purpura?

The complications of Purpura are:

1. Anemia

2. damage to liver , spleen and nerves

What is the treatment of Purpura?

Treat the underlying cause:
1.Blood transfusion of platelets in severe cases

2.Antibiotics for infections

3.Avoid causative agents especially drugs, vitamin deficiency,renal disease,radiation

4.corticosteroids is useful in idiopathic thrombocytopenic purpura

5.Splenectomy may be helpful

What is the prognosis of Purpura?

Prognosis depends on the cause of Purpura.
Patients with blood cancer has a poorer prognosis compared to injury.

WEIGHT LOSS 3

DOC HOW DO I LOSE WEIGHT?

Control Diet

15.)Grocery store shop at outer aisles

There is one common thread in all grocery store designs: the healthy foods are on the perimeter aisles. Think about it, when you go into the grocery all of the healthy stuff, fruits, vegetables, meats, and dairy products are arranged around the stores walls whereas the center aisle areas in those few stores that stock butter and cheese in the center near the frozen foods. .

Train yourself to start on one end of the outer aisle and work your way around. You will be able to fill your basket with healthy items if you do so.

16.)Get good cook books

Get a good cookbook. Not all recipes in a cookbook are low-carbohydrate fare. However you will be surprised at the number of low-carbohydrate friendly recipes you can find in a standard Betty Crocker Cookbook.

Cookbooks often contain handy tips on purchasing cuts of meat and preparing meats, fruits and vegetables in new and exciting ways. New low-carbohydrate cookbooks are hitting the shelves all the time. Try to take advantage of these resources to eat something new, different and nutritious.

17.)Take a good multivitamin as supplement to your diet The most conscientious food combiner may miss some healthy vitamins, minerals and trace elements in their diets. To help supplement your diet, consider taking a good multivitamin. If you are an otherwise healthy individual, your body will do its part. Keep to the low-carbohydrate diet plan that is right for you with some variety to your meals to help you on the path to good health and weight loss goals.

18.) Reward Yourself

Once in a while reward yourself. You will be less likely to cheat on your new diet if you grant yourself small rewards. If you are a chocolate lover, treat yourself to a small square of chocolate  each evening.

BURN YOUR CALORIES

1.) Work Out with Weights

Beside the diet control the other way is to burn up the fat. One way is to add a weight exercise program and routine work out. Weight training will not only tone your muscles but will strengthen your body and improve your general health. Lifting weights will also help to burn calories and fat more quickly than ordinary exercise.It will also boost your blood circulation and metabolism.

2.) Avoid Marathon Work Outs

Some people feel that the best way to burn fat and lose weight is to have one long, extensive work out. That is not true because it will exhaust all your energy leaving less energy for the next exercise. Break up your work out plan into small manageable sessions throughout the day. For example take a brisk walk in the morning, enjoy a work out at lunch, and then exercise more in the evening. This will keep you active all day long and will better maintain your metabolism.

3.) Mix It Up

Being active in different quality exercises will keep your interest and help you to maintain your goal of burning fat. Changing exercises such as to swim laps one day, jog another, and riding a bicycle the next will not only allow you to experience a variety of physical activities, it will also allow you to better tone your body.

Finally a positive and cheerful optimism will help a long way to reduce your weight. If you can control your diet and burn your calories you will definitely lose weight! Do not doubt that!

WEIGHT LOSS 2

DOC HOW DO I LOSE WEIGHT?

Control Diet

7.)Avoid meal replacements

Every day new meal replacement shakes and bars are sold on the market.They may claim to be healthy, but almost all of them contain hydrogenated oil and sweeteners.

Low carbohydrate doughnuts and muffins can be found at your neighborhood grocery store . While low-carbohydrate pastries may be tempting to buy, unfortunately they still contain all of the usual carbohydrate suspects: sugar and flour.

They may be healthier than your typical muffin as an occasional treat but not for long term eating.

8.) Low Glycemic Index Diet

A low Glycemic Index(sugar index) diet is a good way of burning fat quickly. This diet allows people to take large amounts of foods with low rankings on the Glycemic Index. These foods have enough nutrition and will help your body to burn fats and calories faster. The diet includes many of your favorite fruits, vegetable, meats, dairy, and grain products.

9.)Get fresh fruits not squeezed

Fruit juice can be very tempting as a replacement for soda but most commercial fruit juice has very little actual fruit juice.

Instead you will find lots of sugar water and other ingredients. Skip the juice altogether and eat a fresh piece of fruit instead. Not only does fresh fruit contain less sugar than juice. Fresh fruit also has fiber which is good for you and will help you feel fuller longer.

10.)Cooking your own food:

Many food in restaurents claims to have low carbohydrate and calories but most of them are not ideal low-carbohydrate fare. There are many recipes for good nutritional and easily prepared meals that you can cook yourself at home.

If you cook your own foods, you will be able to know exactly the contents of the food and you will have better control for hidden sugar and otherwise processed foods.

The other benefit is the significant cost per meal as opposed to eating at restaurants and fast food establishments.

It is also easier to control your diet with your favorite fresh food selections available at your kitchen.

11.) Eat slowly and enjoy your food

You will feel full and more satisfied if you take the time eat slowly by chewing it and savouring your food. Do not eat while standing . Sit down and chew.

Eating slower will help you enjoy your food more, notice what it is you are actually eating and get a better knowledge of when you are actually full.

12.) Cut Calories Wisely

It is tempting to drastically cut your calorie intake when you start on a healthy lifestyle. By reducing calories too quickly, your body will be too rapidly burning all available calories, which will slow down your metabolism.
Instead use a step method when cutting your calorie intake to minimize risk.Furthermore, you are more likely to maintain your healthy lifestyle through this step method.

13.) Skip Happy Hour

Avoid alcohol. Alcohol is rich in sugars and carbohydrates, and therefore a high calorie substance. These calories can add up quickly and take away from essemtial nutrients that should be included in your daily diet. Besides this alcohol acts as an inhibitor for burning fat allowing your body to store the fat faster.

14.)Having your food storage containers

Using your food storage containers of various sizes will make it so much easier for you to plan your meals. You can buy and store nuts, fruits and vegetables in bulk for easy use later.

Fix your own lunch and snacks and bring them in containers with you to work.

WEIGHT LOSS 1

DOC HOW DO I LOSE WEIGHT?

A Simple Guide to your weight loss program involve 2 main components:
1.Control Diet
2.Burn up Calories

Control Diet
1.) Drink More Water

Drinking water 8 to 10 times each day to stay hydrated and healthy. Once you get started, you will begin to crave water.

Start with a glass of water first thing in the morning before you eat. If you really do not like the taste of water, try adding a few drops of lemon or lime to your water but no sugar or sweetener! Ice also helps.

One of the best weight loss secrets is to avoid the sweet drinks and the sodas which are all calorie laden. Instead grab a refreshing glass of water.

Besides flushing toxins and waste material out of your system, drinking water encourages you to build muscle.

Drinking a glass of water after very meaal will help you get in your 8 to 10 glasses of water each day but it can also have other benefits.If you feel hungry after a smaller meal, try drinking water after the meal. The water will help you feel full and prevent further eating.

2.) Eat More Small Meals

Do not skip breakfast each morning even if you will have to go bed earlier 20 mins each night to wake up for a proper breaskfast! Breakfast is the most important meal of the day and will contribute to your good health and to weight control.

Eating breakfast is not only good for overall weight loss, it will help you control your diet the rest of the day. You will less likely to eat something sweet and in the bread group if you skip breakfast.

Keep a couple of hard-boiled eggs in the fridge or some high-fiber, low starch fruit around to take for breakfast. Breakfast is the best time to take fruits.

You will feel better and lose weight quicker if you eat a large breakfast and eat a smaller dinner. Try and eat the majority of your carbohydrates earlier in the day, leaving a salad and lean meat protein for dinner.

By eating larger meals during the part of the day when you are most active will help you to feel less hungry throughout the day and stop cravings for unhealthy snacks.

Traditional three-large-meals-a-day plan will not help your body to burn up large meals and any excess will be turned into fat. Many nutritionist believe you should eat six small meals a day. You should cut back on your food consumption at each meal, or else you will be doubling your intake of calories!

Just like eating breakfast will increase your metabolism, so will eating small meals more often. This will also help you reduce the total carbohydrate intake by making sure that your meals are planned and occur regularly throughout the day.

3.) Consider eating a salmon or fish during breakfast

This is one way to work in Omega-3 fatty acids that are good for you and add some variety to your daily diet. After a time you may tire of eating eggs and bacon for breakfast. Eating a salmon or fish will give you the protein and healthy fish oils you need.

4.)Avoid White Foods

Anything which is made from sugar, flour, potatoes, rice or corn – just avoid. Always look for colorful fruits and veggies to substitute for the white foods. Buy broccoli, lettuce, bell peppers, green beans and peas, brown rice in moderation, leafy greens like kale and spinach, apples, melons, oranges and grapes.

Fruits and vegetables are not only colorful but they are also high in fiber, nutrients and important antioxidants. Eating colorful fruits and vegetables will give your diet variety as well as healthy benefits with their fresh vitamins, minerals and fiber. Most people will find some vegetables that they enjoy eating. Vegetarians have food that looks and taste as good as meat .They are actually made out of soya bean and flour.

5.) Choose Protein

Choose protein-laden foods for boosting your metabolism and enabling your body to burn fat rapidly. In addition to burning fat, consuming a protein-enriched diet will help you rebuild muscle after work outs and maintain leanness of that muscle. Wisely choose proteins for your diet. Take great care to pick proteins low in fat so you do not consume extra calories.

6.)Eat more protein at every meal

Eating protein helps you burn more calories. This iss because protein is made up mainly of amino acids, which are harder to breakdown in your body so you burn more calories getting rid of them.

Eating a protein rich snack can help you to lose weight.

Eating protein will also help you feel full so that you have less craving for unhealthy snacks.