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Part I (Lung TB)
Tuberculosis 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 3rd 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 children, elderly patients, those who have not been immunised with BCG, cancer patients, transplant recipients, diabetics, HIV patients, other debilitating illnesses like cirrhosis liver, chronic kidney disease etc.
The initial infection after the mycobacterium is inhaled has been studied in Norway in about 500 new tuberculin converters.
It manifests usually as fever of 2 to 3 weeks, cough, tiredness and occasionally chest pain.
Inv in primary tuberculosis show: enlargement of lymph nodes in hilar areas of lungs, pneumonia or effusion at times on chest X-Ray. Skin tuberculin test is +ve. Most of these patients recover (90%). However, in some cases, it may spread to other organs including brain, bones, kidneys, intestines etc. Spread is more likely in HIV sufferers or other low immune states.
After a gap of few years to at times few decades, when the body immunity is low, the common form seen in adults takes shape. It can be symptom-free for 2-3 yrs and then cause disablement.
In the chest, upper lobe areas are involved more often. These may initially be like pneumonia but later cavities may appear.
Common symptoms are fever, weight loss, poor appetite, fatigue and cough. About ¼ may have blood in phlegm. Fever is maximum in the evenings and night and drenching sweats are seen in ½ the patients. Phlegm may be initially scanty but later green or yellow and copious. If untreated lung may be destroyed.
X-Ray is usually the 1st clue for diagnosis. Normal X Rays can be seen rarely and then CT may show lung lesions. Tuberculin test is +ve, bacteria may be seen in sputum(phlegm) and can be grown in culture. Hemoglobin, albumin and serum sodium may be low while CRP and globulins are usually high. Antibodies specifically against TB are found in the blood.
Complications of TB:
Complications are in the form of massive bleeding, bronchiectasis, spread to other organs, pneumothorax (air in the pleural cavity) and sometimes cancer of the lungs.
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. Continue Reading ~ Second Medical Opinion / Advice
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…
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…