Showing posts from 2018


Asthma or Bronchial Asthma is a common disease. About 75 % cases start in childhood before 10 years of age. A large no of patients stop having symptoms at the time of puberty and some may again have the disease in the later years. It is uncommon after 50 years of age. It can be troublesome, disabling and if not treated properly may be dangerous.
The disease results from heightened reactivity of the airways in response to irritants, allergens, fumes and at times exercise. It is typically intermittent and a person feels well when there is no ongoing attack of asthma. Symptoms: Symptoms of asthma are shortness of breath, difficulty in breathing, cough and whistling sounds during breathing. These symptoms may also be seen in a no of heart, lung or infective conditions. Hence the diagnosis is usually made by experienced doctors after a few episodes have occurred! The important markers of the disease are rapid reversibility of the signs and symptoms with appropriate treatment or spontaneousl…

Nephrotic Syndrome

Nephrotic Syndrome Kidneys receive approximately 1 liter of blood every minute. Of this, about 100 ml gets filtered in the kidney. This contains, small molecules and few large molecules. This is due to the intricate cellular structure that prevents proteins from getting filtered into the urinary space. A derangement of this filter results in passage of heavy amounts of proteins in urine. This condition is called HeavyProteinuria or Nephrotic syndrome or Nephrosis. Definition: In the urine, the protein excretion is > 3.5 gm/day or in children, it is >50mg/kg of body weight. In most cases, the serum albumin is <3gm/dl (normal>4), and passage of lipids in the urine. The lipids in the blood increase and swelling of face and feet also occur. Causes of Nephrotic Syndrome: In children, most cases are due to Minimal Change Disease, FSGS, MPGN etc. In adults, most cases are due to primary illness while upto 30% may be due to secondary illness. Clinical Features: Apart from Edema, ther…

Diabetes Care

For patients suffering from type II /adult onset diabetes :In type II diabetes, diagnosis is often late (after the disease has already been present for some time). In early days T2DM (short for the adult type of diabetes) are often without symptoms. Hence the delay in diagnosis. This means complications will be seen early after diagnosis. Foot Care : Foot disease in diabetes may lead to difficulty in walking, pain and may lead to infections. If neglected amputation may be required. Inspect feet with a mirror before going to sleep every night. Use well fitting shoewear. Do not walk bare feet even in the house. Socks should be clean and correct size. In case of deformities of feet, special shoes can be worn. Eye Care : It is nowadays the commonest cause of blindness throughout the world.
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Second Medical Opinion / Advice

Blood Pressure

How to measure BP: The Correct WayBP measured at home and clinics of doctors vary with the time of day or night, physical activity and methods of measuring. To reach a diagnosis of hypertension, various precautions are required. The following should be kept in mind while measuring BP. Methods used for Measuring BP.Mercury sphygmomanometers: Traditional and accurate. Requires correct training. Now not used due to a ban on the use of mercury due to environmental pollution.Aneroid sphygmomanometers: The cuff may be inflated manually. With a stethoscope, sounds are heard over the brachial artery.Automated oscillometric BP measurement: The most popular method nowadays. It has a battery operated system for inflating the cuff. The cuff deflates on its own and BP is displayed digitally.Ambulatory BP monitoring(ABPM): Measures Blood Pressure every 15 mins in the day and every 30 to 60 mins at night. The readings can be recorded and later displayed digitally via a computer. ABPM is the best and …

Fats in the Diet

Each gram of fat provides 9 kcal of energy. Fats are essential for the human body as these make up the important part of all tissues and cells. The cell membrane is rich in lipids and brain is full of fat. In combination with proteins and phosphates, fats (lipids) for many important molecules. Linoleic and a-linolenic acids are essential fatty acids. Trans fats are usually of animal origin or provided by hydrogenation of oils. These are harmful for the body. Poly-unsaturated fats and Mono-unsaturated fats are associated with less risk to heart and brain compared to saturated fats. Fats of animal origin are more harmful compared to fats from vegetable sources. In terms of health benefits, olive oil, soya oil, sunflower and safflower oils rank high. In the body, lipids are measured in blood by the test of lipid profile (best done after 8-10 hrs of fasting). It measures S cholesterol (HDL or high density, LDL or low density and VLDL and IDL very low and intermediate respectively), Trigl…

Proteins in the Diet

Proteins are made of amino-acids, which join together to form peptides, poly-peptides and finally proteins. These take part in the maintenance of biological functions, growth and death of the body. These are essential parts of the diet and are 2ndmost common molecules after water in the body. The nine essential amino-acids not produced in the body are phenylalanine, valinethreoninetryptophanmethionineleucineisoleucinelysine, and histidine. The dietary requirements for proteins are about 1 gm/kg/day in adults. Children and pregnant and lactating mothers require additional amounts. Higher quantities of protein increase acid content in the body. To compensate for this kidneys have to excrete higher amounts in the urine. Calcium excretion also increases. This may result in a tendency towards stone formation. Acidosis may result in osteoporosis. For more on Proteins in the Diet   click below ~ Proteins in the Diet 2nd Medical Advice / Opinion

Metabolic Syndrome

(Syndrome X, MetS, Insulin Resistance Syndrome)It is being increasingly identified in the urban population. The importance lies in its association with risk of developing diabetes mellitus and cardiovascular disease. The incidence in South Asian Population during middle age groups is estimated at 30 to 40%. The criteria for diagnosis (ATPIII) areWaist circumference >40 inches in man and > 35 inches in womanFasting blood glucose >100 mg/dl or treatment for high sugarsBP of >130/85 mm Hg or drug treatment for hypertensionS Triglycerides >150 mg/dl or drug treatment for elevated triglyceridesHDL cholesterol <40 mg/dl in man or <50 mg/dl in woman Any 3 of these 5 criteria qualify for a diagnosis of metabolic syndrome. In some modifications, waist circumference has been made an essential criterion while in some waist circumference has been modified for different ethnic groups. In South Asians now the waist circumference has been reduced to 90 and 80 cms respectively for…

UTI in Men

UTI in MenCompared to women, Urinary tract infections in men are uncommon. This is due to the longer length of urethra and dryness of the urethral opening (called meatus). Prostatic secretions have antibacterial properties and hence these may prevent urinary tract infections. Non-circumcision is also a risk factor for UTI. The commonest organism is E coli. UTI is common if there is an anatomic abnormality, obstruction, instrumentation of the urinary tract or prior surgery. In men after 50 years of age, prostatic enlargement can make a person prone to UTI. As in the case of women, the infections of the urinary tract may involve urethra, bladder or kidney or a combination of all of them. In addition, the prostate gland can also be infected. Symptoms : Symptoms are similar to those in women. However, infections of the prostate can give rise to fever and pain in the perineum (the area between anus and scrotum). Diagnosis of UTI is by its symptoms, physical examination and laboratory tests.…

Urinary Tract Infections : Women

UTI in short, is a common illness in a woman, especially during the reproductive period. The incidence in western countries is .5/woman /year. It is commoner in women compared to men due to their shorter urethra (Tube from the lower end of the bladder to opening for urine). Bacteria from large intestines contaminate the skin around the anus, migrate to the vaginal opening and may ascend through the urethra to the bladder and sometimes via ureter to the kidneys. Infections of the bladder are called cystitis, infections of urethra urethritis and that of kidneys pyelonephritis. Symptoms of UTI In cases of urethritis, pain while passing urine (dysuria), more frequency, pus discharge from urine opening may occur. In cases of cystitis, dysuria, frequency, urgency (inability to hold urine), lower abdominal pain or discomfort and sometimes blood in urine may occur. In pyelonephritis, the symptoms usually are fever (temp above 38° C ), flank pain or discomfort, tenderness on touching at the ang…


Myth : All kidney diseases are serious and incurableFact : Most kidney diseases are treatable. Some are self-limiting and occur only once in a lifetime. Some progress towards renal failure but this progression can be slowed down if the disease is detected early. Even in late cases, treatment may help in reversing or slowing down the loss of kidney function. Myth : Only one kidney is affected by kidney diseases. Fact : All medical diseases (high BP, diabetes, glomerulonephritis, nephrotic syndrome, poisonings, infections of urinary tract etc) affect both kidneys. Some structural diseases like tumours, stones, abscesses, renal artery or vein clots, ureteral narrowings, may affect only one kidney. Myth : I am passing enough urine. Hence my kidneys are not obstructed. Facts : Most obstructions of the bladder and partial obstructions of the ureter  (stones or accidental ligation during surgery) cause more urine to be formed and passed. Only bilateral total obstruction or obstruction below bl…

Calcium Balance

Calcium Balance in a Healthy BodyCalcium is the most abundant mineral in the body. In a healthy person, each Kg of body weight includes about 22 gms of calcium. 99% of this calcium is in the bones. Normal diet contains about 1000 mg of calcium in a day. About 400 mg is absorbed from the intestines. Intestines secrete about 150 mg and thus 750 mg is passed in stools. About 9000 mg of calcium is filtered from the kidney. 8750 mg is reabsorbed and 250 mg is passed in the urine. Approximately 800 mg of bone calcium moves into the extracellular space (intestinal secretions, blood, fluid in the space outside blood vessels, lymph etc) and similar amount moves back into bones. Calcium Requirements Requirements in health change with age. Requirements in children areBirth to 1 yr about 200- 250 mg,1 to 3 yrs about 700mg,4 to 8 yrs 1000 mg andduring puberty 1300mg. In adults upto 50 yrs of age about 1000 mg is sufficient. Man older than 70 yrs and pregnant woman under 18 yrs may require 200 mg e…


Water BalanceLife on earth began in water. Water is the largest molecular constituent of the body. It makes up for about 60% of the total body weight in males and 55% in females. It provides a medium for metabolic functions in the body. Enzymatic reactions occur in aqueous media. It maintains the form of cells, tissues and organs, helps in digestion, evacuation of body wastes, maintenance of body temperature, lubrication in joints, prevention of infections and many more such functions. Water Distribution in the body Of the total body water, 2/3 is in the cells and 1/3 is extracellular. Of the extracellular water, 2/3 is outside the vascular system and 1/3 is in blood. Regulation of water balance The osmolality( a measure of solute concentration in water) is held in a very narrow limit in the human body. This typically is 280 to 295 mosm/kg. If the osmolality increases in the body fluids, a hormone called ADH is produced at the base of the brain. This hormone increases thirst and decreas…

Kidney Biopsy

Kidney Biopsy is a procedure in which a very tiny piece of the kidney is removed for examination under a microscope for diagnosis of the kidney disease. It may also inform us about prognosis (future course ) of the disease, severity of disease and suggest ways of treatment. The information given below is relevant for cases of native kidney biopsy. Indications for kidney biopsy: When urine shows high levels of protein, RBCs or other abnormalities like casts. Unexplained acute kidney injury Some cases of chronic kidney disease renal transplant dysfunction The procedure of kidney biopsy: Patients consent is taken. Blood group is checked. Tests are done to see that the bleeding and clotting is normal Ultrasonography to confirm that both kidneys are present , normal or large, more or less symmetrical, there is no stone disease, tumour or cyst etc. The person is made to lie down on his abdomen with the back facing up. After cleaning the area with antiseptics, the site of biopsy is injected w…

Vitamin B Complex

Vitamin B6  Pyridoxine / Pyridoxal / PyridoxamineVit B 6 is referred as pyridoxine which is available from plant sources and Pyridoxal phosphate which is available from animal sources. The vitamin is found in legumes, wheat grain covering(bran), meat, nuts etc. Deficiency states are due to poor intake of the vitamin. It can also occur if the bran is removed from wheat and starvation states. Deficiency may occur if less than .2 mg is taken daily. If a person is put on antituberculosis drug Isoniazid, deficiency symptoms can occur. This drug interacts with pyridoxal phosphate and hence vitamin B 6 is given together with Isoniazid to TB patients. Symptoms of deficiency are burning and strange sensations in hands and feet (neuropathy), confusion, madness (psychosis), anemia, fits, depression, red tongue and seborrhea. Deficiency is treated by giving Vit B6 in a dose of 50 mg/day. Intake of > 100 mg/day may cause toxic side effects which can be severe. Vitamin B12  CyanocobalminVitamin B12  …