2nd Medical Advice

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

Obesity II O besity is evaluated by screening for confirmation and assessment of risk factors. Once the BMI confirms obesity severity is divided into Grade I BMI >30 but < 35 Grade II BMI >35 but < 40 Grade III BMI > 40 Waist circumference is measured at the highest level of the hip bone by a tape placing it horizontally. In woman a waist circumference of > 88 cm or 35 inches and in Man >102 cm or 40 inches signifies central obesity. Persons with central obesity are more at risk for heart disease, diabetes, Obstructive sleep apnoea and hyperlipidemia (excess lipids in blood). Coexistence of coronary artery disease, atherosclerosis elsewhere, Sleep apnoea, high BP, h/o premature heart attacks in other close relatives, smoking and lack of exercise : all these act togather to increase   mortality. Obesity & Related Articles FREE ~ 2nd Medical Advice / Opinion

Swine Flu I t is also known as H1N1 viral influenza A or simply as H1N1 Influenza. The last big pandemic was in 2009. Nowadays it occurs off and on in India and other countries mainly during flu season. Fever usually more than 100 o  F is common. It is accompanied by a sore throat, running nose, cough, headache and muscle pains. Shivering may occur as do vomiting and loose motions. Individuals both very young and very old as well as pregnant women are at high risk of complications. Similarly, those with other debilitating conditions: malignancy, asthma, smokers, HIV +ve patients and those who have low immunity due to various drugs and disease may develop severe complications. About 10 % persons may have no symptoms. Fever may not occur in some cases. The complications may occur in about 20 % cases. These are in the form of failure of gas exchange by lungs, low BP, altered level or lack of consciousness, fits, liver and kidney failure etc.  The diagnosis is made by both

Chronic Kidney Disease Introduction D isease of the kidney of long standing, ie > 3 months are called chronic disease. These can be diagnosed If the kidney function is lower. This is measured indirectly by Serum Creatinine. If the measured GFR is > 90 ml / min, it is normal. CKD is diagnosed if GFR is < 60 ml/min persistently for > 3 months. If the urine albumin is > 30 mg/day, red or white blood cells are present in urine If on ultrasound, X Rays or kidney biopsy, the kidneys are found to have abnormalities. CKD in early cases is without symptoms. Symptoms gradually increase as the kidney function decreases with time. Nearly all kidney diseases are progressive in nature and keep worsening with time. These will result in End-Stage renal disease in most cases. End-Stage is diagnosed when the kidney function is so low that life without external support is difficult and RRT or Renal Replacement Therapy in the form of Dialysis (either Hemo or peritoneal dialy

Chikungunya Fever C hikungunya fever is an acute febrile illness caused by a virus. Originally from Africa, now it is widespread in India and Asia. It is spread by a bite from a mosquito. Multiple species of Aedes can spread the virus. In some countries, the virus can also be transmitted to primates and other animals. Aedes egypti transmission is usually from a man to man or woman. The virus multiplies in the mosquito and then goes to mosquito's salivary gland. Multiplication is faster in summer months in mosquitoes. After a gap of 2-5 days (called incubation period) patient develops fever and pain in multiple joints. Sometimes more than 5 or 6 joints, usually hands, ankles knees etc are involved. Joint swelling is common. Due to the pain patients often walk with a stoop or bending up (In Tanzania Chikungunya means bending up) A rash over trunk which may be pinkish or bright may occur over limbs, chest or abdomen. This rash fades on pressure. Loose motions or vomitings

Renal Transplant : Survival after kidney transplant. R enal transplant is the treatment of choice for patients of End Stage Renal Disease. Compared to Hemodialysis and peritoneal dialysis, the patients live longer and overall have a better quality of life. After the 1 st  2 weeks of transplant, the death rate in transplant patients is lower than patients on dialysis. In the USA, survival recipients of living donor kidneys at 5 yrs is now 91 % while in the case of cadaver kidneys, it is 84 %. If not so well functioning kidneys (called extended donor kidneys ) are transplanted survival at 5 yrs is 70%. This does not mean that all kidneys are working, but the patients are living. Survival is better in children and less in those over 40, men compared to women, smokers, those suffering from diabetes and heart diseases. The death when it occurs is usually due to heart diseases or due to infections. The no of cancers also increases after transplant and this is another major cause.

Dengue D engue (pronounced as Dengii) fever is caused by a virus. Four types of viruses called DENV 1 to 4 are seen. These are spread while a mosquito (Aedes egypticus) is biting a human being. This mosquito bites during the day and breeds in stagnant water. It is widespread throughout india and south east asia. About 400 million cases occur every year in the world. Most of the infections do not produce symptoms. About ¼ may cause fever usually in children and young adults. Dengue infection can recur if a person is infected with the same type of virus as immunity decreases with time. Common manifestations : These begin 3-14 days after the bite. The symptoms are Fever with temp of > 38.5  o  C Headache, pain behind the eyes Pain in the back (at times severe : break bone fever) Pain in the abdomen or chest Mild pain in the joints. All symptoms need not occur simultaneously. The doctors or patient may notice a pink rash which fades temporarily on pressing the area. I

Renal Replacement Therapy  : When kidney function is such that life can not be sustained without supplementing kidney function by external help, renal replacement therapy is started. In temporary renal disease (most cases of AKI) this is required for short periods only. Once kidneys recover, RRT is stopped. In permanent kidney disease (End stage Renal Disease) RRT is required through life. RRT is of 2 types Renal Transplant Dialysis either regular intermittent hemodialysis or Continuous Ambulatory Peritoneal Dialysis. Renal Transplant is the method of choice in all age groups where feasible. All human beings usually have 2 kidneys. However, about 1 in 400 persons is born with one kidney. They can pass through life without difficulty and without realising that they have only one kidney. Since one fully functioning kidney is enough to sustain life, in renal transplant an extra kidney is placed in the patient of CKD (Chronic kidney disease). This kidney than can maintai