2nd Medical Advice

Riboflavin (Vitamin B 2) This is another Vitamin of the B group. It is water soluble. The rich sources of this vitamin are, eggs, meat, milk and other dairy products, fish, green vegetables, yeast etc. This vitamin works in the cells mainly in energy transport, dehydrogenation, oxidation and electron transport mechanisms. Deficiency of this vitamin is common in cases  where food intake is less starvation, after natural and man-made calamities, in anorexia nervosa and diseases of intestines where absorption is limited, Deficiency suggests relatively recent problem as the vitamin is not stored for long in the body. The daily requirement is about 1.3 mg in men and 1.1 mg in women. Deficiency causes non-specific signs and symptoms. The common manifestations are Redness of throat,  Sores at angles of the mouth,  Redness of inner lining of cheeks,  Dermatitis with excess sebum production,  Anemia etc. Treatment consists of replacement of the hor

Thiamine B eriBeri was known to the Chinese 5000 years back. However the fact that it was due to Vitamin B 1  deficiency was only known in 1926. This vitamin is found in nuts, legumes, yeast and rice (unpolished). It is not found in fruits, milk or vegetables. The meagre quantities found in these can be destroyed by cooking as well. This vitamin is required for the metabolism of carbohydrates and proteins in the body. It forms part of a chemical required for enzymatic activity. The requirement for man and woman is slightly more than 1 mg /day. A pregnant woman may require about one and half times of this. Severe deficiency of this vitamin can cause the following diseases: Infantile beriberi Adult beriberi Wernicke-Korsakoff syndrome Leigh disease Infantile beriberi occurs in infants less than 6 months fed exclusively on formula feeds not having thiamine. It is now rare. Adult Beriberi: Dry beriberi usually causes nervous system disorder. Wet beriberi causes swel

V itamins are essential parts of nutrition, required in small quantities for normal metabolism. These are not produced in human bodies and their deficiency can cause diseases. Vitamin D however, is an exception as it can be produced in the human skin. Vitamin D : Rickets in children and osteomalacia in adults are bone diseases due to deficiency of Vitamin D. Rickets was 1 st  described in 1600 but the cause of the disease discovered later. Vit D is also called Calciferol. Vitamin D 2  from plants is called ergosterol while the vitamin found in animal sources is Vitamin D 3 . Sources: Vitamin D is found in fatty fish, cod liver, eggs etc. Milk is, however, a poor source. Milk and vegetable oils in some countries may be fortified with Vitamin D. In human beings, Provitamin D in the skin is converted to Cholecalciferol. This then is converted 1 st  in the liver and then in the kidneys to its active form (1,25 OHD). Requirements of Vitamin D: About 600 units of Vit D are

T he prostate gland is located in the midline at the junction of the urinary bladder and urinary passage in the penis. It is present only in men and is about 20 gms in weight at 20 yrs of age, but increases in size to about 50 gms by the age of 80 yrs. It surrounds the urinary passage on all sides just below the bladder and this part of the urinary passage is called prostatic urethra. The prostate gland is a chemical factory. It produces secretions which act as lubricants, produces chemicals which can increase or decrease blood pressure. It also produces a substance called prostacyclin which reduces blood clotting by stopping platelets from adhering to each other. As the prostate enlarges over the age, in about 20% of men, it can produce symptoms or obstruction. The incidence of obstruction rises with advancing age. The symptoms of prostatic enlargement are often referred as LUTS (men) or lower urinary tract symptoms. Symptoms Urgency or inability to hold urine fo

Part I (Lung TB) T uberculosis is a worldwide disease. It was equally found in the western developed world until a century back. Better treatment, hygiene, case detection, prevention has decreased the incidence in the developed world. It is a common cause of prolonged illness and fatalities in the 3 rd  world. HIV had caused spread and increase in no of TB patients which are now declining. It is caused by a bacteria (Mycobacterium) which grows better in tissues with high Oxygen levels. Since oxygen levels are high in the upper portion of lungs, the commonest form of TB involves upper lungs. It is spread by droplet infection. Droplets are small drops of body fluid sent out of the body during coughing and sneezing. The TB bacteria are present in the phlegm of patients and is spread in patients vicinity when they cough. Once it is inhaled by susceptible people, the infection may occur. Susceptible persons are ones with decreased or low immunity. These include young

Our Kidneys Common Questions Are both my kidneys affected ? Ans:  Most diseases involve both kidney diseases simultaneously. Exceptions are obstructions in one kidney or ureter, the tumor of one kidney, injury to one kidney or ureter, infections confined to one kidney etc. However, some people may be born with only one kidney! Have both my kidneys failed ? Ans:      If the urea and creatinine are high, it means both kidneys are functioning less. If one kidney function is normal, urea and creatinine are usually not elevated. Will the kidney function recover with dialysis ? Ans:     Dialysis does not improve kidney function. It is a substitute for some of the kidney functions. In acute kidney injuries, dialysis may buy time and allow the kidneys to start functioning again. In Chronic kidney disease, unless there are some reversible elements, the kidney function will not only not recover but the residual function will also decrease with time. Do kidney donors lead a

Stone Disease of the Kidneys S tone formation in the kidneys is a common disease. About 1 in 8 men and 1 in 20 women suffer from the symptomatic stone disease. Stone formation without symptoms is even more common. About ¾ of the stones contain calcium and 10% have uric acid. Rest are due to combinations and rare diseases. Calcium Stones These contain calcium oxalate or calcium phosphate. Former is more common. The risk factors for stone formation are In Urine  Low volume, High calcium in urine, High acid concentration and Low citrate levels. In Diet Water and fluid intake is low, fruits are seldom eaten, food has high oxalate level or if calcium content of the diet is on the lower side. Other diseases with high risk for stone formation are overweight, gout, diabetes, recurrent urinary tract infection etc. Bariatric surgery is a very significant risk factor. If kidneys have certain diseases like the inability to excrete acid, a stone formation may occur. Sympto

How to Prevent Swine Flu ~ T ake vaccines. These vaccines keep undergoing changes depending on the current viruses. Since it takes 6 months to produce a vaccine, the vaccine available now is based on the likely viral types as seems most likely from last influenza season. Children > 6 months of age, older adults >65 yrs, pregnant woman, asthmatics, Chronic liver, heart and kidney disease patients, those suffering from neurological illnesses should certainly take vaccines. Treatment with antiviral drugs are recommended in all these cases as they suffer more complications. Health care workers are more likely to come in contact with flu patients and should be vaccinated. Personal protective measures: Stay away from people suffering from infectious respiratory illness. Wash hands often with soap and water or if not available alcohol-based solutions. Do not touch eyes, mouth or nose often. Use a handkerchief or tissue during sneezing or coughing. Disposable tissues

Scrub Typhus T he disease is caused by a very small parasite of Rickettsia group called Orientiasis tsutsugamushi. It is spread by the bite of a mite (chiggers) technically called trombiculid mite of genus Leptotrombidia. The mite remains in small bushes. A mite can transmit the disease causing organism to its offsprings by transovarian route. The bite occurs during visit to infected areas (mite islands). In India this may occur during the clearing of fields for agriculture, or during a visit to these areas where toilets are not available. It can also infect soldiers training or staying in bushy jungle areas. Signs and Symptoms: The incubation period is usually 7 to 10 days. The illness starts with fever and chills, muscle pains, decreased appetite, vomiting, sometimes diarrhoea, cough and tiredness. Untreated with antibiotics it may last for about 3 weeks before recovery. Clinical Signs : On clinical examination, at the site of bite, a small dark (few mms to 1 cm) area m

Malaria Introduction It is a disease caused by a protozoan parasite named Plasmodium. The various species are P falciparum, P vivax, P malariae, P ovale and P knowlesi. First 2 are common in India. P ovale is found only in Africa. P malariae is also rare while it is not certain whether P knowlesi transmission occurs through monkeys. The disease is spread from one human being to another by the bite of female Anopheles mosquito. This bites during the night (after sunset) till day break. Transmission is influenced by no of mosquitoes, no of bites, the no of parasites in the blood which is ingested by mosquitoes and the no of parasites in the saliva of mosquitoes injected in man. Falciparum is usually more dangerous than vivax. However, more and more cases of complicated vivax malaria are being seen now. After a bite of infected man by mosquitoes, it takes 8 to 30 days before the mosquito can transmit malaria. Malaria FREE ~ 2nd Medical Advice / Opinion

CKD ( Chronic kidney disease) Causes: The  common causes of CKD are Long standing Diabetes mellitus Hypertension Chronic glomerular diseases ( usually underlying cause is obscure) Chronic interstitial diseases Stone disease or other obstructive diseases like enlarged prostate, narrowing of urethra, cancer of cervix in woman or prostate in man, Genetic diseases Polycystic kidneys, vesicoureteric reflux Acute kidney injury that does not recover, Analgesic abuse, HIV related kidney disease etc. CKD (Chronic Kidney Disease) FREE ~ 2nd Medical Advice / Opinion

Japanese Encephalitis( JE) I t is caused by a virus called JE Virus or JEV. It is now endemic in Asia. Most cases occur in the beginning of rainy season. The disease is spread by mosquitoes. The virus multiplies in pigs and aquatic birds. When a mosquito bites human beings after biting pigs the virus is transmitted to man. Pigs are the most important hosts due to very high levels of virus in their blood. In man the virus multiplies but does not reach levels where a mosquito after biting one human being can transmit it to others. The name of mosquito spreading it most often is Culex Vishnui. However, it is found in other species of mosquitoes as well. After a gap of 5 to 15 days (called incubation period), signs and symptoms of the disease appear. Most of the cases where the bite transmits the virus are subclinical or mild. Only about 1% of the cases are severe and brain inflammation or encephalitis is seen. In the beginning, there is fever and sometimes loose motions and

Immunosuppression after Kidney Transplant The drugs are always taken on the advice of a physician experienced in dealing with transplants. Patients should never change doses on their own. Stopping of drugs may result in acute rejection and damage to or loss of the kidney. Usually three drugs are given. These are required to be taken lifelong. The medicines may be Tacrolimus/ cyclosporine. Older patients of functioning transplants may be on cyclosporine. These drugs are similar and called Calcineurin inhibitors. These drugs have a no of interactions with other drugs. Simultaneous intake of other drugs may increase or decrease the levels of these drugs. Some common side efftects of CNI inhibitors are tremors, high BP, increase in urea and creatinine( due to kidney dysfunction) , swelling of the feet and high blood sugars. These also increase chances of infections. Cyclosporine can also increase body hair, facial hair, or hair from the ears. This is called hirsutism and may be

Cadaver Transplantation C adaver transplant refers to removal of organs for transplant after a person's death. Death can be of two types : Cardiac death or cessation of cardiac activity permanently is the conventional concept of death. Brain dead donation (Heart beating donors) In cases admitted to the ICUs of various hospitals, a person may have cessation of all functions of brain or brainstem due to lack of blood supply to the brain. In these cases heart, kidneys, lungs and other organs can continue to function for sometime. In India a committee of doctors in the hospital, declare a person brain dead after testing for the same as per Human organ trasplant act and rules. The organs i.e. heart, lungs , kidneys, pancreas and other useful organs may be allocated by the authorities as per guidelines. Prior permission of the deceased individual and his close family members is required before organ retrieval. Till the organs are removed the ventilator and other supportive me