Health is Wealth

RESPIRATORY FAILURE IN CHILDRENN

2009-07-14T05:17:00.000-07:00

Respiratory distress syndrome (RDS) in the newborn or hyaline membrane disease, is clinical

syndrome the exclusively affects preterm infants.

Characterized pathologically by a hyaline membrane lining the alveoli and clinically by

respiratory distress, which may be fatal.

Results from maturational deficiency of lung surfactant.

Clinical syndrome consists of

- Tachypnea

- Sternal Recession

- Cyanosis

- Present from birth over the succeeding 24-48hrs

- Most deaths occur between 48-72hrs

Clinical features :

•Begins from birth

• RR, around 100 beats / minute

•Grunting and distressed respiration

•Flaring of Alae nasae, intercostal, supraclavicular and sternal respiratory retraction.

•Tachycardia

•Cyanosis

•Auscultations – crackles

•Edema of hands and feet

•CXR shows diffuse fine granularity throughout the lungs.

•Later more uniform opacification with air bronchogram

Diagnosis :

Clinical features

CXR

-Confirmed indirectly by measurement of surfactant activity in tracheal aspirates or amniotic

fluid to assess fetal lung maturity.

- Two techniques are used, the lacithin – sphingomyelin ratio and amniotic foam test.

D/D : Congenital pneumonia

Transient Hypoxemia of newborn.

Treatment :

•Prompt resuscitative measures should be initiated on the basis of the 1-minute Apgar score.

• Supportive treatment

– maintenance of environmental warm to prevent cold stress and resultant increased O2

consumption and aggrevation of acidosis.

- O2 should be given, to maintain PaO2 60-90 mmHg

- Higher levels carry risk of retrolentral fibroplasia or pulmonary O2 toxicity.

- Blood pH should be corrected

- Close attention for fluid balance, serum calcium and glucose

- Criteria for ventilation is very ill babies have been developed PaO2 of less than 40mmHg.

Respiratory failure in children

2009-07-14T05:16:00.000-07:00

COPD GENERAL

2009-07-14T04:55:00.000-07:00

FACTS ABOUT COPD

Airflow limitation that is not fully reversible, generally progressive.

6th leading cause of death in world

4th leading cause of death in U.S.A.

3rd most common reason for hospitalization.

Rare under 40, Common in elderly.

SYMPTOMS

SSx. Exertional dyspnea, cough,

85% have chronic bronchitis (productive cough > 3 mos of the yr for > 2 yrs)

Blue bloaters. Chronic sputum production.

15% have Emphysema (RECENTLY POP STAR MICHAELJACKSON DIED WITH THIS)

Pink puffers. Barrel chested, wt loss due to poor nutrition.

Pathology

Smoking accounts for 80 – 90% risk of developing COPD.

Only 15% of smokers clinically get COPD.

Caused by bronchial irritation and swelling of airway.

Chronic Compensated COPD
Dx

Best tool is pulmonary function testing (table 69-1)

ABG Hypoxia is main sign, increases with severity of disease.

CXR

R sided heart failure (Cor Pulmonal)

BNP (helps more to dif from CHF)

ECG or recent Echo with EF

Usually due to increased airway obstruction 2°

Increased bronchospasm

CV deterioration

Continued smoking, really, Smoking.

Noncompliance with medication.

Noxious / Environmental exposures

Clinical Apperance:

Dyspnea

Orthopnea

Pursed lip exhalation

Accessory muscles of resperation used.

Diaphoresis

Pt speaks in shorter increments as obstruction progresses

Assesment of O2 status is Key.

Pluse ox ok but does not give PCO2 or pH.

ABG is best, PaO2 <60>

FEV1 <>

CXR

ECG could reveal concurrent disease process.

O2 titrate to PaO2 >60 mmHg SaO2 >90%

Bronchodilators b2 agonist (albuterol, levalbuterol)

Anticholinergics Ipatropium Bromide 0.5 mg (atrovent)

Corticosteroids Prednisone 60 – 180 mg per/day for 7 to 14 days.

(methylprednisolone 60 -125 mg IV given in asthma exacerbations)

WARNINGS ON TOBACCO PACKS

2009-07-13T06:33:00.000-07:00

Call for pictorial warnings on tobacco packs

29 MAY 2009 GENEVA -- WHO today urged governments to require that all tobacco packages

include pictorial warnings to show the sickness and suffering caused by tobacco use.

WHO's call to action comes on the eve of World No Tobacco Day, 31 May. This year’s campaign focuses on decreasing tobacco use by increasing public awareness of its dangers.

Studies reveal that even among people who believe tobacco is harmful, few understand its specific health risks. Despite this, health warnings on tobacco packages in most countries do not provide information to warn consumers of the risks.

A 2009 survey in China revealed that only 37% of smokers knew that smoking causes coronary heart disease and only 17% knew that it causes stroke. A 2003 survey in Syria found that only a small fraction of university students correctly identified cardiovascular disease as a hazard of cigarette or water pipe smoking. Research in other countries shows similar results.The leading preventable cause of death, tobacco kills more than five million people every year. It is the only legal consumer product that kills when used exactly as intended by the manufacturer.

Effective health warnings, especially those that include pictures, have been proven to motivate users to quit and to reduce the appeal of tobacco for those who are not yet addicted.

Studies carried out after the implementation of pictorial package warnings (warnings using pictures and text) in Brazil, Canada, Singapore and Thailand reveal remarkably consistent findings on the positive impact of the warnings.

“Health warnings on tobacco packages are a simple, cheap and effective strategy that can vastly reduce tobacco use and save lives,"

said WHO Assistant Director-General Dr Ala Alwan.

But

"they only work if they communicate the risk. Warnings that include images of the harm that tobacco causes are particularly effective at communicating risk and motivating behavioural changes, such as quitting or reducing tobacco consumption.”

Yet only 10% of the people in the world live in countries that require warnings with pictures on tobacco packages.

"In order to survive, the tobacco industry needs to divert attention from the deadly effects of its products," said Dr Douglas Bettcher, Director of WHO's Tobacco Free Initiative.

"It uses multi-million dollar promotional campaigns, including carefully crafted package designs, to ensnare new users and keep them from quitting."

“Health warnings on tobacco packages can be a powerful tool to illuminate the stark reality of tobacco use,” Dr Bettcher added.

Some Interesting Facts and Figures for Cancer: (NATIONAL CANCER REGISTRY PROGRAMME 1981-2001

2009-07-13T06:14:00.000-07:00

none in about 15 men and one in about 12 women in the urban areas could develop cancer in

their lifetime

ncancer lung is commonest out of all tobacco related cancers in men

nage adjusted incidence rate of oesophageal cancer in women of bangalore is one of the highest

(8.3 per 1,00,000) in the world.

ncancer of tongue in males at bhopal (8.8 per 1,00,000) is highest in all continents

ngall bladder in delhi women is one of the highest (8.9 per 1,00,000) in the world.

n75-80% patients are in advance stage of the disease at the time first attendence.

nnew cancer patients in india are estimated between 7-9 lakhs

WHY SHOULD WE INVEST IN SAFE HEALTH FACILITIES IN EMERGENCIES?

2009-07-13T06:08:00.001-07:00

Why should we invest in safe health facilities in emergencies?

WHO’s Eastern Mediterranean Region is home to some of today’s most intractable

crises. Natural disasters, conflicts and other emergencies continue to affect

populations across the region, putting the health services under extensive strain.

Ladies and Gentlemen

We are all still living the tragedy of Gaza and the catastrophe resulting from the

destruction of the health facilities there. This is a violation of international law and

should be considered a war crime and a grave crime against health. We also still

remember the earthquake that hit Pakistan in October 2005. In a few seconds, out of

796 health facilities ranging from sophisticated hospitals to rural clinics,

388 were completely destroyed. The remaining facilities that were able to continue

functioning were utterly overwhelmed.

The health care workforce was also severely affected by this event.

In the past five years, over 800 health facilities were partially or fully damaged from

several events within the region. They were earthquakes in the Islamic Republic of

Iran and Pakistan, conflict in Iraq, Lebanon and Palestine,

a cyclone in Oman and floods in Yemen. Natural disasters and all sort of emergencies

can affect anyone, anywhere.

Although climate change and the subsequent warming of the planet may be gradual,

the increasing frequency and severity of extreme weather events—intense storms,

heat waves, drought and floods—will be abrupt and the health consequences will be

acutely felt.

Health facilities are about more than just bricks and mortar. In addition to their

physical structure, health facilities must have the functionality to continue providing

services throughout and after the events in order to save lives. Functional collapse,

not structural damage, is the usual reason for hospitals being put out of service

during disasters.

A crisis happens when it is least expected, and we know that disasters can hit at any

time. Saving lives can only be achieved if proper investments are made in emergency

preparedness and training of the health workforce. Hospital failure and health system

disruption during emergencies is as often due to system overload and lack of

contingency planning as of physical failure. Staff training is just as important as

physical protection.

Incorporating comprehensive disaster protection for earthquakes and extreme

weather events into new building designs adds only an additional 4% to total costs.

We must remember that when a hospital is out of service, many thousands of people

are left without health care. In the long run, disruption of essential health services

affects a country’s development potential.

Don’t let health facilities be another victim of emergencies.

Thank you.

WHY SHOULD WE INVEST IN SAFE HEALTH FACILITIES IN EMERGENCIES?

2009-07-13T06:08:00.000-07:00

Why should we invest in safe health facilities in emergencies?

WHO’s Eastern Mediterranean Region is home to some of today’s most intractable

crises. Natural disasters, conflicts and other emergencies continue to affect

populations across the region, putting the health services under extensive strain.

Ladies and Gentlemen

We are all still living the tragedy of Gaza and the catastrophe resulting from the

destruction of the health facilities there. This is a violation of international law and

should be considered a war crime and a grave crime against health. We also still

remember the earthquake that hit Pakistan in October 2005. In a few seconds, out of

796 health facilities ranging from sophisticated hospitals to rural clinics,

388 were completely destroyed. The remaining facilities that were able to continue

functioning were utterly overwhelmed.

The health care workforce was also severely affected by this event.

In the past five years, over 800 health facilities were partially or fully damaged from several events within the region. They were earthquakes in the Islamic Republic of Iran and Pakistan, conflict in Iraq, Lebanon and Palestine, a cyclone in Oman and floods in Yemen. Natural disasters and all sort of emergencies can affect anyone, anywhere.
Although climate change and the subsequent warming of the planet may be gradual, the increasing frequency and severity of extreme weather events—intense storms, heat waves, drought and floods—will be abrupt and the health consequences will be acutely felt.
Health facilities are about more than just bricks and mortar. In addition to their physical structure, health facilities must have the functionality to continue providing services throughout and after the events in order to save lives. Functional collapse, not structural damage, is the usual reason for hospitals being put out of service during disasters.
A crisis happens when it is least expected, and we know that disasters can hit at any time. Saving lives can only be achieved if proper investments are made in emergency preparedness and training of the health workforce. Hospital failure and health system disruption during emergencies is as often due to system overload and lack of contingency planning as of physical failure. Staff training is just as important as physical protection.
Incorporating comprehensive disaster protection for earthquakes and extreme weather events into new building designs adds only an additional 4% to total costs. We must remember that when a hospital is out of service, many thousands of people are left without health care. In the long run, disruption of essential health services affects a country’s development potential.
Don’t let health facilities be another victim of emergencies.
Thank you.

WHY SHOULD WE INVEST IN SAFE HEALTH FACILITIES IN EMERGENCY?

2009-07-13T06:07:00.000-07:00

Why should we invest in safe health facilities in emergencies?
WHO’s Eastern Mediterranean Region is home to some of today’s most intractable crises. Natural disasters, conflicts and other emergencies continue to affect populations across the region, putting the health services under extensive strain.
Ladies and Gentlemen
We are all still living the tragedy of Gaza and the catastrophe resulting from the destruction of the health facilities there. This is a violation of international law and should be considered a war crime and a grave crime against health. We also still remember the earthquake that hit Pakistan in October 2005. In a few seconds, out of 796 health facilities ranging from sophisticated hospitals to rural clinics, 388 were completely destroyed. The remaining facilities that were able to continue functioning were utterly overwhelmed. The health care workforce was also severely affected by this event.
In the past five years, over 800 health facilities were partially or fully damaged from several events within the region. They were earthquakes in the Islamic Republic of Iran and Pakistan, conflict in Iraq, Lebanon and Palestine, a cyclone in Oman and floods in Yemen. Natural disasters and all sort of emergencies can affect anyone, anywhere.
Although climate change and the subsequent warming of the planet may be gradual, the increasing frequency and severity of extreme weather events—intense storms, heat waves, drought and floods—will be abrupt and the health consequences will be acutely felt.
Health facilities are about more than just bricks and mortar. In addition to their physical structure, health facilities must have the functionality to continue providing services throughout and after the events in order to save lives. Functional collapse, not structural damage, is the usual reason for hospitals being put out of service during disasters.
A crisis happens when it is least expected, and we know that disasters can hit at any time. Saving lives can only be achieved if proper investments are made in emergency preparedness and training of the health workforce. Hospital failure and health system disruption during emergencies is as often due to system overload and lack of contingency planning as of physical failure. Staff training is just as important as physical protection.
Incorporating comprehensive disaster protection for earthquakes and extreme weather events into new building designs adds only an additional 4% to total costs. We must remember that when a hospital is out of service, many thousands of people are left without health care. In the long run, disruption of essential health services affects a country’s development potential.
Don’t let health facilities be another victim of emergencies.
Thank you.

MORPHOLOGICAL CHANGES IN NEUROBLASTOMA

2009-07-13T05:58:00.000-07:00

MORPHOLOGICAL FEATURES

Gross
neuroblastomas are usually large,soft,grey and relatively well circumscribed;areas of hemorrhage,necrosisand calcification are often present.some time hemorrhage is so extensive as to mimic hematoma.cystic degeneration also occur.
Microscopy
The pattern of growth is vaguely nodular as a result of delicate,incomplete fibrous septa.the tumor cells are small and regular,slightly larger than small lymphocyte.Homer-wright’s rosettes are present,characterized by collection of tumor cells around a central area filled with a fibrillary material,which is mass of nuerites as revealed by silver stains.

ELECTRON MICROSCOPY
Ultra structurally , neuroblastoma cells are characterized by the presence of neuritis ,neurosecretory granules and synaptic endings the neuritis form a complex interdigitating meshwork in the centre of rosette
Immunohistochemistry
Neuroblastoma cells expresses neuron-specific enolase, neurofilaments, neurofilament-66/a-internexin, peripherin, chromogranin, synaptophysin, secretogranin 2, vasoactive intestinal peptide, microtubule associated proteins, NB 84, nerve growth factor receptors and other neuron related antigens including cell surface ganglioside GD2. Expressoin of Insulin- like growth factor 2 is associated with a lobular growth pattern and good cytological differentiation.
Neuroblastoma produce catecholamines which can be demonstrated in sections or touch preparations by the twchnique of formaldehyde- induced fluorescence.
Chromosomal and molecular markers
During last 2 decade, many chromosomal and molecular abnormalities have been identified in neuroblastoma. these biologic markers have been evaluated to determine their value in assigning prognosis,and some of these have been incorporated in to the stratergie sused for risk assignment
The most important of these biologic markers is MYCN ,which is over expressed oncogene in neuroblastoma with amplification of distal arm of chromosome 2.it is amplified in approximately 25% of do novo cases and is more common in patients with advanced-stage disease,and is marker of poor prognosis.in contrast to MYCN ,H-ras oncogene correlates with lower stage of the disease.
Deletion of short arm of chromosome 1 is most common chromosomal abnormality, which confers poor prognosis. Other alleic losses of chromosomes 11q, 14q, 17q and gain of chromosome 1 have been reported.
DNA index is another useful test that correlates with response to therapy in infants. Look.et al demonstrated that

LAB STUDIES IN NEUROBLASTOMA

2009-07-13T05:54:00.000-07:00

Lab studies
• General laboratory studies should be routinely obtained in children suspected of having neuroblastoma.
•
o A CBC count should be obtained to determine if the child has anemia, which typically does not occur until the tumor has become widely disseminated.
o Once dissemination occurs, abnormalities in findings of coagulation studies (prothrombin time [PT], activated partial thromboplastin time [aPTT]) may secondary to liver involvement. Thrombocytopenia due to overwhelming bone marrow involvement may also be present.
o The erythrocyte sedimentation rate, a nonspecific acute-phase reactant, is elevated in classic neuroblastoma.
• Specific laboratory studies should be obtained when the diagnosis of neuroblastoma is considered.
•
o Metabolic tumor by-products are useful as diagnostic inclusion criteria for detecting neuroblastoma.
o Elevated metabolic catecholamine by-products can be detected in the urine of patients with neuroblastoma.
o Phenylalanine and tyrosine are catecholamine precursors, which are converted through a sequence of enzymatic events to dihydroxyphenylalanine (DOPA), dopamine, norepinephrine, and epinephrine.
o DOPA and dopamine are metabolized into their final product, homovanillic acid (HVA), while norepinephrine and epinephrine are metabolized into vanillylmandelic acid (VMA).
o Ninety percent of neuroblastoma tumors secrete these by-products. This fact becomes clinically relevant because children with dedifferentiated tumors excrete higher levels of HVA than VMA. This occurs because dedifferentiated tumors have lost the final enzymatic pathway that converts HVA to VMA. A low VMA-to-HVA ratio is consistent with a poorly differentiated tumor and indicative of a poor prognosis.
o Neuroblastoma cells lack the enzyme that converts norepinephrine to epinephrine. Despite this fact, elevated levels of norepinephrine are not identified in the serum of patients with neuroblastoma. This might be explained by at least 2 processes—(1) norepinephrine may be catabolized within the tumor; or (2) tyrosine hydrolase, the initial enzyme in catecholamine synthesis, is subject to a negative feedback loop by norepinephrine. For either or both reasons, norepinephrine does not reach detectable serum levels.
o A LaBrosse VMA spot test may be used to screen patients in certain institutions. It is economical but has low sensitivity and specificity.
o High-performance liquid chromatography has a much lower false-positive rate and is more sensitive than the LaBrosse VMA spot test, but its only drawback is that it is more expensive and is therefore often used only to confirm a positive result on spot test.
• Nonspecific tumor markers can be identified in patients with neuroblastoma.
•
o Neuron-specific enolase (NSE), lactic dehydrogenase (LDH), and ferritin are markers useful in the identification of active disease, as well as in prognostication.
o Approximately 96% of patients with metastatic neuroblastomas demonstrate an elevated NSE level, which has been associated with a poor prognosis.

Imaging studies
Radiographic assessment is recommended in all infants and children with an abdominal mass. The standard diagnostic imaging modalities include plain abdominal radiography (kidneys, ureters, bladder [KUB]), renal/bladder ultrasonography, bone scintigraphy, and CT scanning or MRI.
• KUB most commonly reveals finely stippled calcifications of the abdomen or posterior mediastinum.
• Renal/bladder ultrasonography improves the diagnostic evaluation and is probably the single best imaging modality to obtain. Ultrasonography is noninvasive and provides relevant information regarding the laterality, consistency, and size of the mass.
• Abdominal CT scanning or MRI usually follows ultrasonography. Both of these studies are more invasive, in that they require general sedation for young children. The benefit is that they enhance the ultrasonographic findings by providing information about regional lymph nodes, vessel invasion, and distant metastatic disease.
• Bone scintigraphy and a skeletal survey to detect cortical bone disease are helpful in the diagnosis of neuroblastoma. Metaiodobenzylguanidine (MIBG) is a compound taken up by catecholaminergic cells that competes for uptake even in neuroblastoma cells. In this way, MIBG is quite sensitive and specific in the detection of metastasis to bones and soft tissue, with highest sensitivity (91-97%) in the detection of bone deposits. Bone scintigraphy using 99Tc diphosphonate and a skeletal bone survey to detect cortical bone disease are essential if MIBG scintigraphy results are negative in the bone. MIBG is recommended for re-assessment both during and after therapy in high-risk patients with MIBG-avid disease at diagnosis.
• Expression of somatostatin (SS) receptors has been described in neuroblastoma cell lines and tumors. Studies have shown that these tumors can be successfully targeted with radioactive SS analogs as a method of detection. Currently, the indication for radio-labeled SS analog in children with neuroblastoma is not well-defined because this method is less sensitive than MIBG scan (64% vs 94%). However, because neuroblastoma SS receptors are associated with favorable clinical and biological prognostic factors, radio-labeled SS analog could provide valuable information. In fact, improved survival has been found in patients with SS receptor–positive neuroblastoma. However, more studies need to be performed to confirm the benefits of SS receptor scanning.

THE INTERNATIONAL NEUROBLASTOMA STAGING SYSTEM (INSS)

2009-07-13T05:47:00.000-07:00

The international neuroblastoma staging system (INSS)

Stage 1 Localized tumour with complete gross excision, with or without microscopic residual disease; representative
ipsilateral lymph nodes negative for tumour microscopically (nodes attached to and removed with the primary
tumour may be positive).
Stage 2A Localized tumour with incomplete gross excision; representative ipsilateral nonadherent lymph nodes negative for tumour microscopically.
Stage 2B Localized tumour with or without complete gross excision, with ipsilateral nonadherent lymph nodes positive for tumour. Enlarged contralateral lymph nodes must be negative microscopically.
Stage 3 Unresectable unilateral tumour infiltrating across the midline (vertebral column) with or without regional lymph node involvement; or localized unilateral tumour with contralateral regional lymph node involvement; or midline tumour with bilateral extension by infiltration (unresectable) or by lymph node involvement.
Stage 4 Any primary tumour with dissemination to distant lymph nodes, bone, bone marrow, liver, skin and/or other organs (except as defined for stage 4S).
Stage 4S Localized primary tumour (as defined for stage 1, 2A or 2B), with dissemination limited to skin, liver and/or bone marrow (limited to infants <1 year of age).

CHILDHOOD CANCERS HISTORY AND CAUSES

2009-07-13T05:37:00.000-07:00

History

Neuroblastoma was first described by Sir Rudolf Virchow in 1864 and at that time it was

referred as glioma.

In 1891 Marchand histologically linked Neuroblastoma to sympathetic ganglia.

Herxheimer,In1914 gave the substantial evidence of neural origin by demonstrating the fibrils of the tumor stained positively with special neural silver stains.

In 1927, Cushing and WOlbach first described the transformation of malignant Neuroblatoma

into its benign counterpart , ganglioneuroma.IN 1957, Mason published report of a child with

Neuroblastoma whose urine contained pressor amines which helped to understand the possible

origin from sympathetic neurons.

causes:

The etiology of Neuroblastoma is not well understood.

Several risk factors have been prposed and are the subject of ongoing research.

Due to characteristic early onset , many studies have focused on parenteral factors

around conception and during gestation.Factors investgated have included

occupation , that is exposure to chemicals in specific industries,smoking,

alcohol consumption, use of medicinal drugs during pregnancy.

However results have been inconsistent.

Neuroblastoma can exhibit familial incidence .

It can be associated with Beckwith-wiedemann syndrome,

HIrschprungs, Neurofibromatoses or occur as a complication of fetal hydantoin syndrome.

Neuroblastoma has been called the great mimicker because of its myriad clinical

presentations related to the site of tumor, metastatic disease and its metabolic tumor

byproduct.The most common site of neuroblastoma is abdomen arising either in the

adrenals or less commonly in the para midline sympathetic chains.

Other sites being neck, mediastinum, pelvis.Neuroblastoma is one of the rare human

malignancies known to demonstrate spontaneous regression from undifferentiated to

a completely benign cellular appearance.

The initial symptoms are often vague and often include fatigue,

loss of appetite and fever.Later symptoms depend on tumor location.

The most common finding on physical examination is a non tender ,

firm,irregular abdominal mass.at the time of diagnosis ,the site of neuroblastoma

predictably age dependant.Infants often present with compression of sympathetic

ganglia in thoracic region which might result in Horner’s syndrome

(mioses, anhydrosis and ptosis)or Superior vena cava syndrome.

Older children typically present with abdominal complaints.

More than 50% of patients presenting with neuroblastoma have metastatic disease,

which resulted in syndromes. Pepper Syndrome occurs in infants with

metastatic deposits in liver. it generally confers a better prognosis, however,

may die of massive hepatomegaly,respiratory failure and overwhelming sepsis.

Blue-berry muffin babies are infant in whom neuroblastoma has become metastatic

to random subcutaneous sites.Opsoclonus/myoclonus ,thought to be

paraneoplastic ,perhaps autoimmune.

widespread metastasis of neuroblastoma to bone may result in Hutchinson

syndrome. It results in bone pain ,limping and pathological fractures.

Most neuroblastomas produce catecholamines as metabolic by-products resulting,

in some patients, Kerner-morrison syndrome, causes intractable secretory diarrhea,

leading to hypovolaemia ,hypokalaemia, prostration. It is secondary to vasoactive

intestinal peptide(VIP) tumor secretion.

This syndrome more commonly associated with Ganglioneuroblastoma /

Ganglioneuroma typically resolves with complete removal of the tumor.

CHILDHOOD CANCERS

2009-07-13T05:24:00.000-07:00

Introduction

Cancers of infancy and childhood differs biologically and histologically from their counterparts occurring later in life.

The common childhood cancers are Leukemias,Lymphomas,Brain tumors and small round cell

tumors otherwise known as Blueomas, which are very unique with aprimitive or embryonic

microscopic appearance. These tumors are united by having a similar histological appearance

that is small round blue cells.

Neuroblastoma is neuroendocrine tumor arising from any neural crest elements of sympathetic

nervous system.It is the most common intraabdominal malignancy of infancy and most

common extracranial solid tumor of childhood. It comprises of 6%-10% of all childhood cancers

and causes 15% of cancer deaths in children.

annual cases of malaria

2009-07-13T04:08:00.000-07:00

Annual cases of malaria

Globally: 247 millionAfrica: 212 millionAsia: 21 millionMiddle East: 8.1 millionAmericas: 2.7 million

Annual deaths from malaria
Globally: 881,000Africa: 801,000Middle East: 38,000Asia: 36,000Americas: 3,000

Figures on malaria deaths

91% of deaths were in Africa85% of deaths were in children under 5 years of age4% of deaths were in South-East Asia region (especially India)4% of deaths were in Eastern Mediterranean region (especially Sudan)

Population at risk

3.3 billion (half of the world population)

Number of countries affected
109(35 countries - 30 in Sub-Saharan Africa and 5 in Asia - account for 98 percent of global malaria deaths)

Top five countries for malaria numbers

Nigeria: 57,506,000Democratic Republic of the Congo: 23,620,000Ethiopia: 12,405,000United Republic of Tanzania: 11,540,000Kenya: 11,342,000

Top five countries for malaria deaths

Nigeria: 225,424Democratic Republic of the Congo: 96,113Uganda: 43,490Ethiopia: 40,963United Republic of Tanzania: 38,730
Required health expenditure (Abuja declaration)
15% of national budget

Child mortality from malaria

85% of deaths in children under 5 years old

Economic cost

Direct: USD 12 billion per year in direct losses,lost 1.3% of GDP growth per year for Africa.

For Nigeria alone the direct loss to the economy is estimated at GBP530 million

Burden
35.4 million Disability Adjusted Life Years (sub-Saharan Africa)

Cost per DALY averted

USD 2-24 (sub-Saharan Africa)

Cost of malaria

Around 40% of public health spending in sub-Saharan Africa20-50% of inpatient admissionsUp

to 50% of outpatient visits

Average household spending

Over 10% of yearly spending in AfricaDirect costs $0.41 in Malawi, $7.38 in Ghana

Financial need to tackle Malaria

2009: USD 5.335 billion2010: USD 6.180 billion2011-2020: USD 5.126 billion (average)

Annual funding
2007: USD 1.107 billionFunding gap: USD 4,266 billion
Required investment in research (10 years)
USD 8.9 billion

Current level of coverage

Treatment: more than 100 millionNets: 66.2 millionDiagnostics: 16 million rapid diagnostics

tests delivered in 2006 among which 11 million in Africa

Required coverage by 2010
Protective nets: 730 million long-lasting insecticidal nets (LLINs). (350 million in Africa)Indoor spraying with insecticide: 172 million households need annual spraying.Preventive treatment for pregnant women: 25 million pregnant women annually.Diagnostic tests: approximately 1.5 billion annually.Drugs: 228 million doses of ACTs are needed to treat P. falciparum annually; additional 19 million doses of chloroquine and primaquine are needed annually for P.vivax.

Impact of full coverage

Up to an estimated 4.2 million lives could be saved by 2015 in the 20 highest burden African countries alone.

Malaria and humanitarian crises
Up to 30% of malaria deaths in Africa occur in the wake of war, local violence or natural disasters.

MDGs that could be impacted by addressing malaria problem
MDG 1 – Eradicating extreme poverty and hungerMDG 2 – Achieve universal primary educationMDG 4 – Reduce child mortalityMDG 5 – Improve maternal healthMDG 6 – Combat HIV/AIDS, malaria and other diseasesMDG 8 – global partnerships for development and access to affordable drugs

Costs of interventions
Long-lasting insecticidal net: $10 (includes the net, distribution, teaching usage and monitoring usage)Course of ACTs for adult: $6

Impact in tackling malaria

Eritrea, Rwanda, and Sao Tome and Principe reported declines in the number of cases and deaths of 50% or more between 2000 and 2006–2007 following high coverage of control activities. In addition, 22 countries outside of Africa reported declines of 50% or more in malaria cases and deaths between 2000 and 2006.

swine flu

2009-06-20T04:25:00.000-07:00

What is swine influenza (flu)?
•Swine influenza is a respiratory disease of of pigs caused by type A influenza virus(H1N1).
•Swine flu viruses (SIV) do not normally infect human beings.
•This is the disease of swine (pigs).

History
•The H1N1 form of swine flu is one of the descendants of the Spanish flu that caused a pandemic in humans in 1918–1919.
•For almost 60 years, from the first isolation in 1930 through 1998, SIV strains were almost exclusively H1N1
• In 1997-1998, H3N2 strains emerged

•Swine influenza (also called swine flu, hog flu, and pig flu) refers to influenza caused by any strain of the influenza virus endemic in pigs (swine).
•Strains endemic in swine are called swine influenza virus (SIV).
•Of the three genera of human flu, two are endemic also in swine:
• Influenzavirus A is common and Influenzavirus C is rare.
•Influenzavirus B has not been reported in swine.

CAUSED BY GENETIC RE-ASSORTMENT OF DIFFERENT STRAINS
•The 2009 flu outbreak in humans that is widely known as "swine flu" is due to a new strain of influenza A virus subtype H1N1 that derives by genetic reassortment from one strain of human influenza virus, one strain of avian influenza virus, and
two separate strains of swine influenza virus
SWINE FLU DIFFER FROM HUMAN FLU
»The H1N1 strain virus are antigenically different from those of human type of H1N1 strain virus.
•Therefore vaccines for human seasonal flu does not provide protection from H1N1 strain of swine flu viruses.

PRESENT SWINE FLU STRAINS
•At this time, there are four different types of influenza A strains of viruses in pigs.
•They are 1. H1N1
2. H1N2
3. H3N1 and
4. H3N2.

CAN CLOSE PROXIMITY SPREAD THE DISEASE?
•Yes, influenza viruses can directly be transmitted from pigs to human beings and from humans to pigs.
•Close proximity to infected pigs such as pig barns, livestock exhibit, and housing pigs at farms.
•Human to human transmission of swine flu can also occur.
in swine
•Fever,
•Lethargy
•Sneezing
•Coughing
•Weight loss
•Poor growth

In humans
Fever
Running nose
Coughing
Diarrhea
Loss of appetite

Signs and symptoms
Transmission
•Transmission between pigs:
The main route of transmission is through direct contact between infected and uninfected animals
Airborne transmission through the aerosols produced by pigs coughing or sneezing are also an important means of infection

Transmission to humans
•People who work with poultry and swine, especially people with intense exposures, are at increased risk of zoonotic infection with influenza virus endemic in these animals
•The 2009 swine flu outbreak is an apparent reassortment of several strains of influenza A virus subtype H1N1, including a strain endemic in humans and two strains endemic in pigs, as well as an avian influenza.

prevention
•Prevention of swine influenza has three components:
• prevention in swine,
• prevention of transmission to humans, and
• prevention of its spread among humans

Prevention in swine
•Methods of preventing the spread of influenza among swine include facility management, herd management, and vaccination.
•Present vaccination strategies for SIV control and prevention in swine farms, typically include the use of one of several bivalent SIV vaccines commercially available.

Prevention in humans
•Prevention of pig to human transmission: The transmission from swine to human is believed to occur mainly in swine farms where farmers are in close contact with live pigs.
•farmers and veterinarians are encouraged to use a face mask when dealing with infected animals.
•Hand washing.
•Using hand kerchief while sneezing.

•Prevention of human to human transmission:
• Influenza spreads between humans through coughing or sneezing and people touching something with the virus on it and then touching their own nose or mouth
• Swine flu cannot be spread by pork products, since the virus is not transmitted through food.

Treatment
•In swine: As swine influenza is not usually fatal to pigs, little treatment is required.
•Vaccination and animal management techniques are most important in these efforts.

Recommendations
Strengthen national disease surveillance, prevention, control and response system

►Requires a commitment of States Parties
Mobilization of national resources: e.g. staff, infrastructure, budget
Development of national action plans, integrated and coordinated with
intermediate and local levels and points of entry (ports, airports, ground crossings)

►Builds on existing national and regional strategies
► Requires sustained multisectorial approach and international collaboration

Responsibilities of Countries
•􀂄 Develop, strengthen, and maintain core public health capacities for surveillance and response
•􀂄 Identify a National IHR Focal Point for 24/7 communication with WHO
•􀂄 Notify WHO of potential public health emergencies of international concern
•􀂄 Immediately report to WHO outbreaks of smallpox, polio, new strains of human influenza, and SARS
•􀂄 Respond to public health risks that may spread internationally.

ROUX en Gastric Bypass

2009-03-25T03:41:00.000-07:00

ROUX en Gastric Bypass

Considered the gold standard in bariatric surgery, a Roux-en-Y gastric bypass is what is known as a combined restrictive and malabsorptive procedure. It is restrictive because the stomach is reduced to a small pouch that can only hold a very small amount of food at a time. It is malabsorptive because a portion of the small intestine is bypassed, reducing the body’s ability to absorb the full amount of calories that are consumed. These two factors, working together, make this procedure extremely effective at helping patients shed large amounts of excess weight. We perform laparoscopic gastric bypass at our practice serving Fort Worth, Arlington, and the entire Dallas region so that patients can enjoy the benefits of bariatric procedures without the discomfort of open surgery.

Laparoscopic Roux-en-Y Gastric Bypass
Benefits
Risks

Laparoscopic Roux-en-Y Gastric Bypass

Roux-en-Y gastric bypass involves the separation of the stomach into two sections. The small upper portion can collect and digest food, but only in very small quantities. This small stomach pouch is then connected to the middle portion of the small intestine. The remainder of the stomach and upper segment of the small intestine are left in place, but bypassed. These bypassed segments are responsible for producing certain necessary digestive acids and proteins, which they will continue to do, even though food will no longer pass through them.

Traditionally, Roux-en-Y has been performed as an open procedure, involving a significant amount of pain, a long recovery time, and substantial surgical risk. Using laparoscopic techniques, we can perform the same gastric bypass procedure at our Dallas, Arlington, and Fort Worth-area practice while using only five small incisions. This results in a much shorter and easier recovery and virtually no noticeable scarring.

Benefits

There are many reasons why this procedure has become the leader in the field of bariatrics. First and foremost, it is extremely effective for the majority of patients. It does not involve the use of any implanted device, like gastric banding, and because nothing is removed, it is technically reversible, although this is strongly advised against.

People who have undergone gastric bypass surgery have experienced reduction or resolution of such conditions as type 2 diabetes and acid reflux disease, even before a significant amount of weight is lost. As the weight comes off, additional benefits include decreased hypertension, increased energy, reduced pressure on the joints, and improved confidence.

Risks

Gastric bypass surgery, like all surgery, carries an inherent amount of risk. Although patients who are obese present with a more complicated medical history, bariatric surgery is actually statistically safer than many of the common surgical procedures performed every day in the United States. At Minimally Invasive Bariatrics, we thoroughly discuss all of the potential risks with each patient prior to surgery.

After the surgery is complete, some side effects associated with Roux-en-Y gastric bypass could still occur. Due to the malabsorptive aspect of the procedure, some patients experience vitamin or nutrient deficiencies. This can be avoided by carefully following the dietary guidelines provided by our practice and taking the recommended vitamin supplements. Many patients have also experienced an extremely uncomfortable side effect known as “dumping syndrome,” which is caused by the stomach emptying food into the intestine too quickly. This is most often triggered by the consumption of high-fat or sugary foods, so once again, following a proper Post-bariatric diet will minimize the chances of this condition appearing.

Bariatric surgery in Arlington

2009-03-25T03:34:00.000-07:00

Minimally Invasive Bariatrics is committed to providing our patients with the best care possible. As part of this commitment, we offer a wide range of procedures, which we perform using only the most advanced minimally invasive methods available.

Often called the gold standard in bariatric surgery techniques, Roux-en-Y gastric bypass is a well-established weight loss surgery procedure that involves permanently altering the path of the upper digestive system. Learn more about Roux-en-Y surgery.

The LAP-BAND® System is a popular alternative to the classic gastric bypass surgery, as it restricts the amount of food that can be consumed without making permanent structural changes to the digestive system. Find out how the LAP-BAND® System and other gastric banding options, such as the REALIZE™ Band, work.

The sleeve gastrectomy is a relatively new form of bariatric surgery offered at Minimally Invasive Bariatrics in Arlington, Dallas, and the Fort Worth area. It involves reducing the size of the stomach as well as the stomach's ability to produce certain appetite-inducing hormones. Read more about sleeve gastrectomy.

StomaphyX™ allows surgeons to access the stomach through the esophagus, eliminating the need for incisions altogether. This results in significantly shorter healing times and no visible scars whatsoever. Learn more about StomaphyX™ and whether this remarkable technology might be right for you.

ANTI CANCER DRUGS INTRODUCTION

2009-03-24T07:03:00.000-07:00

THE ANTI CANCER DRUGS EITHER KILL

CANCER CELLS OR MODIFY THEIR

GROWTH . HOWEVER , SELECTIVITY OF

MAJORITY OF DRUGS IS LIMITED AND

THEY ARE ONE OF MOST TOXIC DRUGS USEDINTHERAPY.

TREATMENT OF MALIGNANT DISEASES WITH

DRUGS IS A RATHER DEVELOPMENT STARTED AFTER 1940

WHEN NITROGEN MUSTARD WAS USED ,

BUT PROGRESS HAS BEEN RAPID , BOTH IN REVEALING

PATHOBIOLOGY OF THE DISEASES AND DISCOVERY

OF NEW DRUGS. IN ADDITION , ATTEMPTS HAVE BEEN

MADE TO DEFINE OPTIMAL COMBINATIONS ,

TREATMENT STRATEGIES AND PATIENT SUPPORT

MEASURES. CANCER CHEMOTHERAPHY IS NOW

OF ESTABLISHED VALUE AND A HIGHLY SPECIALIZED FIELD ;

ONLY THE GENERAL PRINCIPLES AND OUT

LINE WILL BE PRESENTED HERE .

IN ADDITION TO THEIR PROMINENT ROLE IN

LEUKEMIAS AND LYMPHOMAS ,

DRUGS ARE USED IN CONJUNCTION WITH SURGERY ,

RADIOTHERAPY AND IMMUNO THERAPY IN THE COMBINED

MODALITY APPROACH FOR MANY SOLID TUMOURS , SPECIALLY METASTATIC.

harmonalfactors-obesity

2009-03-16T01:29:00.000-07:00

Obesity is a global epidemic resulting from sedentary life styles, improved socioeconomic conditions and availability of processed high caloric foods and soft drinks in industrialized society

Behavioural and dietary changes are the initial therapeutic strategies, wt loss drugs should be used with caution especially herbal preparations that combine ephedra alkaloids and caffenine, because there are serious potential adverse reactions.

Measurement of fat accumulation
• Ex or wt in relation to ht (BMI)
• Skin fold measurements
• Various body circumference particularly the ratio of waist to hip circumference.
BMI expressed in kilograms per sq meter is closely related to body fat
BMI of 25 kg/m2 is considered normal
30 kg/m2 is – obese
25 – 29.9 over weight
Other techniques for measuring body composition include under water weighing (densitometry), CAT, MRI and Dexa scanning.

CENTRAL OR VISCERAL OBESITY
Fat accumulates in trunk and in the abd cavity is associated with a much higher risk for several diseases than in excess accumulation of fat diffusely in subcutaneous tissue.

Obesity is a disorder of energy balance when food derived energy chronically exceeds expenditure the excess calories are stored as triglycerides in adipose tissue.
Three components of this system
1.The afferent system which generates humoral signals from adipose tissue (leptin) pancreas (insulin) and stomach (gherlin)
2.Central processing unit located primarily in the hypothalamus – interprets the afferent signals.
3.Effector system which carries out orders from the hypothalamic nuclei in the form of feeding behaviour.
•Gherlin is a short term mediator à increase sharply before every meal and fall promptly when the stomach is filled.
•Success of gastric bypass surgery is massively obese indiviuals may relate more to associated suppression of gherlin levels.
•Leptin has a more important role than insulin in CNS
•Adipocytes communicate with hypothalamic centers that control apeptite and energy expenditure by secreting leptin a member of cytokine family.
•Net effect of leptin therefore is to reduce food intake and promote energy expenditure.
•Hence over a period of time energy stores are reduced and wt is lost in turn reduces the circulating levels of leptin and now equilibrium reached.
•Decrease leptin levels the anabolic circuits are relieved of inhibition and catabolic circuits are not activated, resulting in net gain of weight.

GENETICS OF OBESITY
Disorder of multifactorial etiology
• BMI in monozygotic twins versus dizygotic
• Leptin – energy hemostasis – OB gene
• Leptin – melanocortin circuit – arcute nucleus of hypothalamus

Two major types of neurons that bear lepin receptors
Oraxogenic – apeptite stimulating neurotransmitters
Leptin – decrease NPY / agouti – related peptide
POMC / CART Neurons
Leptin – sensitive à POMC / CART
Anorexigenic neuropeptides alpha – melanocyte – stimulating hormone (alpha MSH) cocaine and amphetamine – related (CART)
Both are the products of POMC – catabolic effects.
NPY / AgRP and POMC / CART neurons – first order neurons.
The neurotransmitters produced by (NPY / AgRP and alpha MSH)
2nd order neurons à efferent system

Lung Cancers in Women

2009-03-13T06:32:00.001-07:00

Lung cancer strikes 900,000 men and 330,000 women yearly.

Among men, smoking causes more than 80 per cent

of lung cancer cases. In women,

smoking is the cause of 45 per cent of all lung cancer worldwide,

but more than 70 per cent in North America and Northern Europe.

In both men and women, the incidence of lung cancer is low before age 40,

and increases up to age 70 or 75.

The rise in female smoking prevalence is a

major public health concern.

In the US, more women die from smoking-induced

lung cancer than from breast cancer and in some Nordic countries,

including Iceland and Denmark,

female lung cancer deaths have begun to

outnumber male tobacco victims.

Considering that in several European countries

up to 50 per cent of young women are now regular smokers,

this will cause a disease burden that significantly

reduces women’s health in decades to come.

Cancer prevention:

2009-03-13T06:32:00.000-07:00

Cancer prevention:

a healthy diet can help!

Epidemiological studies indicate that the frequent consumption

of fruit and vegetables may reduce the risk of developing cancers of epithelial origin, including

carcinomas of the pharynx, larynx, lung, oesophagus, stomach,

colon and cervix. Recent data from the European

Prospective Investigation into Cancer and Nutrition (EPIC

suggests that a daily consumption of 500 grams (1.1. lbs.)

of fruits and vegetables can decrease incidence of cancers

of the digestive tract by up to 25 per cent.

The report also says that given the multi-faceted

impact of diet on cancer, many countries should encourage

consumption of locally produced vegetables,

fruit and agricultural products, and avoid the adoption of

Western style dietary habits. IARC says that such actions
would have health benefits beyond cancer,

since other common non-communicable diseases,

notably cardiovascular disease and diabetes,

share the same lifestyle-related risk factors.

Early detection – the best strategy second to

primary prevention The best possible prevention against

cancer remains the avoidance of exposure to

cancer-causing agents: this is called primary prevention

(eg tobacco, industrial carcinogens, etc).

There is sound evidence that the recent decline in cancer mortality

observed in several countries is to a significant

extent due to early detection. Responsible for

this success are not only improvements in imaging

(mammography, magnetic resonance (MR) and

computed tomography (CT) imaging),

but also a higher degree of disease awareness and

educational programmes on typical early symptoms.

Most successful so far has been the early detection
of cervical cancer by cytology and of breast cancer by mammography.

A recent analysis by an IARC Working Group

concluded that under trial conditions, mammography

screening may reduce breast cancer mortality

by 25-30 per cent and that in nation-wide screening

programmes a reduction by 20 per cent appears feasible.

There is also emerging evidence that prostate

cancer screening by assessment of serum PSA levels may

result in lower mortality rates but management

of early lesions is still very invasive. For colon cancer,

colonoscopy is considered the gold standard although

its application in population-based screening

programmes would require considerable medical resources.

Nutrition and cancer - good news

2009-03-13T06:10:00.000-07:00

Nutrition and cancer – the good news

Stomach cancer is among the most common malignancies worldwide,

with some 870,000 cases every year, and 650,000 deaths.

About 60 per cent of cases occur in developing countries,

with the highest incidence rates coming in Eastern Asia,

the Andean regions of South America and Eastern Europe.

The good news is that stomach cancer is declining world-wide,

in some regions almost dramatically.

In Switzerland and neighbouring European countries,

the mortality fell by 60 per cent within one generation.

If this trend continues, stomach cancer may in some

world regions become a rare disease during the next 30 years.

The main reason for this welcome development

is the invention of the refrigerator,

allowing fish and meat preservation without salting.

The drop in incidence and mortality rates is therefore

particularly impressive in Nordic countries

in which fish consumption is traditionally high, e.g. Iceland.

In populations that still prefer salty food,

e.g. Portugal and Brazil (salted cod, bacalao),

Japan and Korea (salted pickles and salad),

stomach cancer rates are still high but have

also started to decline significantly.

An additional factor contributing to this trend is the availability

in many countries of fresh fruit and vegetables throughout the year.

cancer introductiion

2009-03-13T05:53:00.000-07:00

There are more than 100 types of cancers;

any part of the body can be affected

In 2005, 7.6 million people died of cancer -

13% of the 58 million deaths worldwide

More than 70% of all cancer deaths occur

in low and middle income countries.

Worldwide, the 5 most common types of cancer that

kill men are (in order of frequency):

lung, stomach,

liver, colorectal and oesophagus

Worldwide, the 5 most common types of cancer

that kill women are (in the order of frequency):

breast, lung, stomach, colorectal and cervical

Tobacco use is the single largest preventable

cause of cancer in the world

One fifth of all cancers worldwide are caused by a

chronic infection, for example human papillomavirus

(HPV) causes cervical cancer and hepatitis B virus

(HBV) causes liver cancer.

A third of cancers could be cured if detected

early and treated adequately

All patients in need of pain relief could be helped if current

knowledge about pain control and palliative care were applied

30% of cancer could be prevented,

mainly by not using tobhaving a healthy diet,

being physically active and preventing

infections that may cause canceracco,

having a healthy diet, being physically

active and preventing infections

that may cause cancer

BREAST CANCER

2009-03-12T03:46:00.000-07:00

It is one of the commonest cause of death in

many developed countries in middle aged women.

risk factors:

1)age:

1) it is most common in beetween age of 35 and 50 and

uncommon below the age of 35.

2)family history

1)the risk is high in those with a positive family history of breast cancer.

3)socio-economic status

it is common in higher socio-economic group.

4)others

1)early menarcheand late menopause

2)using oral contraceptives

3)elevated levels of estrogen and progesterone.

prevention

1)primary prevension:

1)eliminate the risk factors

2)promation of cancer education .

3)the average age at menarche can be increased through

a reduction in childhood obesity and increase in strenuous physical activity

2)secondary prevention

1)breast screening leads to early diagnosis of breast cancer.

2)after confermation start treament

3)detect recurrence as early as possible.

OBESITY- CONTROL

2009-03-12T00:27:00.000-07:00

PREVENTION AND CONTROL OF OBESITY

Prevention of obesity should begin in early childhood.

obesity is harder to treat in adults than it is in childran .

the main aim is weight redution, it is achieved by

1)Dietery changes

2)increased physical activity

3)others

1)DIETARY CHANGES:

1)Energy dence food such as simple carbohydrates andfat should be reduced.

2)the fibre content in diet should be increased.

3)adequate levels of essential nutrients in low energy diet should be ensured.

4)the reducing diet should be as close as possible to existing nutritional patterns.

5)the most basic consideration is that the food energy intake shouldnot be

greater than what ia necessary for energy expenditure.

2)increased physical activity

1)it is the important part opf weight reducing programme.

2)regular physical exercise is the key to an increased energy expenditure

3)others

1)appetite suppressing drugs have been tried in ythe control of obesity.

2)surgical treatment (gastric bypass,gasroplasty,jaw-wiring to eleminate to eating of solid food)

2009-03-12T00:09:00.000-07:00

HAZARDS OF OBESITY

Relative risk of health problems associated with obesity

Greatly increased:

1)Gallbladder diseases

2)Dyslipidaemia

3)Insulin resistance

4)Breathlessness

5)Sleep apnea

6)NIDDM

Moderately increased

1)CHD

2)HYPERTENSION

3)Osteoarthritis

4)Hyperuricaemia

5)Gout

Slightly increased

1)Cancer(Breast and endometrial)

2)Reproductive hormone abnormalities

3)Polycystic ovary syndrome

4)Impaired fertility

5)Low back pain

6)Increased risk of anaesthesia complications

7)Fetal defects associated with maternal obesity.

seizure disorder

2009-03-09T07:54:00.000-07:00

SEIZURE

Caused by transient, paroxymal and synchronous discharge

of groups of Neurons in the brain

Clinical manifestations depends on the location and number

of neurons involved, in the seizure discharge and its duration.

May be

1.Transient or

2.Permanent (Epilepsy)

Classification of Epileptic seizures

• Partial

• Generalized

• Unclassified

PARTIAL

-Simple partial seizures (consciousness not impaired)

- Complex partial seizures (consciousness impaired)

- Partial seizures evolving to generalized seizures (Tonic, clonic or tonic-clonic)

GENERALIZED SEIZURES
(Convulsive or non convulsive)

•Absence seizures

•Myoclonic seizures

•Clonic seizures

•Tonic seizures

•Clonic tonic seizures

•Atomic seizures.

DRUGS USED IN DIFFERENT DISORDERS

Partial Seizures

- Carbamazepine

- Phenyotin and

- valproate

Generalized seizures

- Carbamazepine

- Phenyotin
- Valproate

- Barbiturates

- Gabapentin or

- Lamotrigine

Generalized non seizures

- Ethosuximide (or)

- Valproate

SIDE EFFECTS

Depression of cerebral function with symptoms of sedation

- Diploma

- Persistent or fluctuation ataxia

Dyskinesias of the tongue, face and limbs

- Mild sensory neuropathy

- Altered peripheral nerve function

•Hepatic failure

• Pancreatitis

• Mild anaemia to aplastic anaemia

• Depress circulating platelets

• Skin rashes

• SLE

• Seroderma and

• Sjogrens syndrome

• Steven johnsons syndrome

STATUS EPILEPTICUS

Def : Continuous seizure activity or two or more seizures

occurring in sequence without recovery of consciousness between the seizures

PHARMACOLOGIC MANAGEMENT OF STATUS EPILEPTICUS

1.Lorazepam / Diazepam – 0.1 mg / kg I.V at 2 mg/ min

2.Phenytoin – 20mg / kg I.V at 50mg / min or fosphenytoin 20mg/kg IV at 150mg/min

3.Phenyotin or fosphenytoin additional 5-10 mg/kg

4.Phenobarbitol 20mg/kg I.V at 50-75 mg/min

5.Phenobarbitol – additional 5-10mg/kg

6.Anaesthesia with propofol or midazolam

OTHER AREAS OF TREATMENT

•Exclude hypoglycemia

•Tracheal intubation

•ABG

•Hyperthermic management

Management of Anaesthesia for seizure disorders

Consider impact of drugs on organ function

- Coagulation

- Response to anaesthetic drugs.

TONSILITIS

2009-03-04T05:23:00.000-08:00

DEFINITION:

It is the inflammation of the tonsils.

TYPES:

ACUTE

Sub acute

Chronic

ACCUTE TONSILITIS:

It is the acute inflammation of the tonsil.

CLASSIFICATION

1)Acute catarrhal / superficial

2)Acute follicular

3)Acute parenchymatous

4)Acute membranous

AETIOLOGY:

Age :

CHILD

Sex :

BOTH

Predisposing factors:

Preexisting chronic tonsillitis

Post nasal discharge due to chronic tonsillitis

Preexisting infections of URT

General lowering of resistance

Ingestion of cool drinks

Infection can be contracted from others

CAUSATIVE ORGANISMS :

Haemolytic streptococcus- most common

Staphylococci

Pneumococci

H.infuenzae

Diptheriods

SYMPTOMS:

Sore throat.

Difficulty in swallowing

Fever.

Otalgia

Foul breath

Constitutional symptoms:

Headache

General body aches

Malaise

Constipation

Thick & muffled voice

SIGNS:

Foetid breath & coasted tongue.

Hyperaemia of pillars, soft palate& uvula

Follicular: Red & swollen tonsils with yellowish purulent material at crypts

Membranous: Whitish membrane on the medial surface can be wiped off

Parenchymatous: Enlarged & congested tonsils with oedema of uvula & soft palate.

Tender & enlarged jugulodigastric lymph nodes.

TREATMENT:

Bed rest & soft diet.

Analgesics & antibiotics to be given.

Warm saline gargles are soothing.

Lozenges with local anaesthetic action.

Antimicrobial therapy

Tonsillectomy for recurrent attack.

Note: rash appear if amoxycillin or ampicillin are given

COMPLICATIONS:

Acute otitis media

Peritonsillar abscess

Parapharyngeal abscess

Cervical abscess

Rheumatic fever

Acute glomerulonephritis

Subacute bacterial endocarditis

Acute nephritis

HOW DO WE TASTE THE FOOD?

2009-03-04T04:38:00.000-08:00

PHYSIOLOGY OF TASTE

.Taste is one of the special senses,

sensed by tongue through taste buds.

.There are 4 primary taste sensations

SALT,SWEET,BITTER,SOUR and umami

.Taste buds are present on papillae

Circumvallate papillae present

on the posterior part of the tongue

Foliate papillae present on the lateral

surface of the tongue and Filiform

papillae on the anterior surface of the tongue
.

ACNE

2009-03-02T03:00:00.000-08:00

ACNE VULGARIS

It is a self limited disorder

It is seen mainly in teenagers and young adults

PATHOLOGY

Mainly by increase in sebum production by sebaceous glands after puberty.

small cysts called comedons,form in hair follicles due to blockage of follicular orifice

by retention of sebam and keratinous material.

Proprionobacterium acnes bacteria with in comedones release free fatty acids from sebum, causes inflammation within the cysts, and results in rupture of the cyst wall.

Clinical features

the clinical hallmark of acne vulgaris is the comedone,2types

1)closed (whitehead)

2)open(blackhead)

Closedcomedones-

they appear as 1 to 2mm pebbly white papules

they are the precursors of inflammatory lesions of acne vulgaris

open comedones

these have a large dilated follicular orifice

and filled with easily expressible oxidized,darkened,oily debries

comedones are usually accompanied by inflammatory lesions

1)papule

2)pustules

3)nodules

sites mainly seen

the earlist lesions seen on the forehead subsequently more typical inflammatory

lesions on the cheek,nose and chine.

most common locations for acne is face ,uncommons sites are chest and back.

factors influence acne

1)glucocorticoids,applied topically or adminstered systemically in high doses may

elicit acne

2)systemic medications such as lithium,isoniazid,halogens,phenytoin

and phenobarbital may produce or aggravate preexisting acne.

3)application of comedogenic topical agents

treatment

it may be treated with either localor systemic medications

Areas affected with acne should be kept clean.

topical agents-

prevent formation of comedones

1)retinoic acid

2)benzoyl peroxide

3)salicylic acids

topical antibacterial agents

DEVIATED NASAL SEPTUM

2009-03-01T21:50:00.000-08:00

THE NASAL SEPTUM IS THAT PART OF

THE NOSE WHICH SEPARATES THE TWO

AIRWAYS&NOSTRILS. A DEVIATED NASAL

SEPTUM IS WHEN THERE THE SHIFT FROM

THE MIDDLE OR CENTRAL POSITION

AETIOLOGY:

1) TRAUMA: USUALLY IN CHILDHOOD , MAY EVEN BE DURING DELIVERY.

2) CONGENITAL DISORDERS 3) HEREDITARY DISORDERS

4) RACIAL PREDISPOSITION

TYPES OF DNS:

1) ANTERIOR DISLOCATION 2) C-SHAPED DEFORMITY 3) SPURS

4) SEPTALTHICKENING 5) S-SHAPED DEFORMITY

CLINICAL FEATURES:

1) NASAL OBSTRUCTION 2) COTTLE'S TEST 3) MUCOSAL CHANGES

4) NEUROLOGICAL CHANGES

SYMPTOMS:

THE SYMPTOMS CAUSED BY SEPTAL DEVIATIONS AREENTIRELY RESULTS OF THEIR

EFFECTS ON NASALFUNCTION. THE DOMINANT EFFECT BEING NASAL

OBSTRUCTION,BUT THIS IS RARELY SEVERE ENOUGH TO CAUSE ANOSMIA

. SIGNS:

1)HEADACHE 2) SINUSITIS 3) BLEEDING FROM THE NOSE 4) EXTERNAL DE FORMITY

5) MIDDLE EAR INFECTION 6) NOISY BREATHING DURING SLEEP

COTTLE'S CLASSIFICATION:

1) SIMPLE DEVIATION 2) OBSTRUCTION 3) IMPACTION

TREATMENT :

MEDICAL MANAGEMENT
1) ANTIBIOTICS 2) ANTIHISTAMINS 3)ANTI INFLAMMATORY DRUG

4) NASAL DECONGEST DROPS

SURGICAL MANAGEMENT :

1)SEPTOPLASTY 2) SUBMUCOUS RESECTION(SMR)

HOW TO AVOID DNS :
1) USE APPROPRIATE SAFETY EQUIPMENT DURING SPORTS .

2)USE A HELMET WHEN RIDING A BIKE OR ROLLER SKATING

3) FASTEN UR SEAT BELT WHEN DRIVING

AP Tops in crimes against women

2009-02-20T23:16:00.000-08:00

AP tops in crimes against women
Hyderabad, December 07 2008: HYDERABAD: At a time when Andhra Pradesh, and Hyderabad in particular, is attracting hundreds of women software professionals from all over the country, the state has earned the dubious distinction for crimes against the fair sex.The latest statistics of the National Crime Records Bureau (NCRB) for 2007 reveals a telling tale of increasing crimes against women in the state, much more than any other part of the country.Of the 1,85,312 crimes against women in the entire country in 2007, 24,738 cases, or 13.3 percent, were reported from Andhra Pradesh.Even more disturbing is the statistics pertaining to Hyderabad and its outskirts.A comparison of crimes against women in 35 cities across the country shows that Hyderabad stands second, next only to Delhi.While 4,331 cases (17.5 per cent) were registered in Delhi, Hyderabad came second with 1,931 cases (7.8 per cent).Vijayawada topped in the number of eve-teasing cases by accounting for 11.3 per cent of the total cases in the country."If the police is strict in dealing with the offenders, things would not have come to such a pass.One of the reasons why there are more crimes against women is that law enforcers do not deal with the offenders firmly," says G Sucharitha, joint director, gender programming, Centre for World Solidarity.Interestingly, Andhra Pradesh, which has 7.2 per cent of the country's population, has reported 13.3 per cent of cases of crimes against women while Uttar Pradesh, which has 16.6 per cent of the country's population, reported 11.3 per cent or 20,993 cases.According to NCRB figures, crimes against women in general in the country have been increasing every year.In 2003, there were 1,40,601 cases, in 2004 1,54,333 cases, in 2005 1,55,553 cases and in 2006 there were 1,64,765 cases.Another disturbing trend is that the rate of crime has increased against women.While the overall, rate of crimes against women increased marginally from 14.7 per cent in 2006 to 16.3 per cent in 2007, for Andhra Pradesh in particular, it has been bad.The crime rate against women increased by 30.3 in Andhra Pradesh, which is almost that of Tripura at 30.7 per cent which is at the top."Women in Andhra Pradesh feel unsafe because the government is also not sincere in ensuring their protection," said women's rights activist Noorjehan Siddiqui.What is also alarming is the number of torture cases in the state.Of the 75,930 cases registered in the country under section 498A IPC (dowry harassment), as many as 11,335 cases (14.9%) are from Andhra Pradesh.Only Tripura is slightly ahead with 15.7 per cent."There are two reasons why such cases are more in AP.There is an insatiable desire for dowry here.Even people who go abroad demand dowry," an IG in the CID said.That is not all.AP with 3,316 cases has the most number of sexual harassment cases in the country.This is 30.3 per cent of the total number of cases.Even in cases pertaining to the Indecent Representation of Women (Prohibition) Act, in Andhra Pradesh, the most number of cases have been registered.In all, 1005 cases were registered, which is 83.8 per cent of cases registered in the entire country.

2009-02-20T23:06:00.000-08:00

COMPARATIVE STUDY OF ELISA AND RAPID SEROLOGICAL TECHNIQUES FOR THE DIAGNOSIS OF DENGUE FEVER IN PAEDIATRIC CASES IN ANDHRA PRADESH
INTRODUCTION
Dengue fever is a mosquito-borne flavivirus infection of humans caused by four serologically distinct viruses (dengue virus 1, 2, 3, 4)4. Dengue and its severe manifestations, dengue hemorrhagic fever and dengue shock syndrome are the serious public health problems in the tropics4. Dengue is the most important mosquito borne disease in the world especially in the tropics, causing regular epidemics in these regions4.
In India, dengue virus infections have been frequently encountered in epidemic proportions in several states3. In southern India, the disease has been reported in Tamil Nadu3, Karnataka3, Andhra Pradesh3, and Kerala3. The most recent dengue fever outbreak in Andhra Pradesh was in 20065. A significant increase in the number of children being affected by dengue virus was observed in a study done at Vellore between 1999 and 20031. Dengue is a fast emerging health concern in South India1.
Diagnosis of dengue infection is easily and best accomplished by demonstrating specific IgM antibodies in the blood4. Conventionally, this is done by using an IgM capture ELISA, which has to be done in the laboratory and takes a few hours to complete4. A newer method that has emerged is a rapid immunochromatographic card test with which a bedside test can be done for both IgM and IgG antibodies in the serum4. While the ELISA test is known to be a standard test, the results of the rapid technique are not consistent2.
OBJECTIVES
The objective of this study is:
To compare the sensitivity of the rapid immunochromatographic test to the known sensitivity of the ELISA test in a paediatric tertiary care hospital in Andhra Pradesh.
MATERIALS AND METHODOLOGY
STUDY SETTING: The study will be conducted in a tertiary care hospital, Niloufer Hospital (Government) in Hyderabad, Andhra Pradesh.
STUDY PERIOD: The study will be done in a period of two months, May and June, 2009.
STUDY SAMPLE: Infants and children who are suspected to be suffering from dengue fever by their clinical presentation and laboratory parameters (such as platelet count)__.
SAMPLE SIZE: A study sample of a minimum of __ cases reporting to this hospital
METHOD: Blood samples will be collected from suspected patients of dengue fever. They will then be analyzed by ELISA technique and by rapid immunochromatographic technique. The sensitivity of the rapid test will then be compared to the ELISA test.
STATISTICAL ANALYSIS: Basic proportions and percentages.
IMPLICATIONS
The study will:
Indicate the sensitivity of a rapid immunochromatographic test compared to the standard ELISA test.
In the case that the rapid immunochromatographic test is found to be as sensitive as ELISA, the study will expedite the diagnosis of dengue of patients reporting to the tertiary health care center.

HOW TO PREVENT CANCERS

2009-02-13T03:09:00.000-08:00

Today's children, tomorrow's world. Public Service Announcement (30 sec)Many people around the world believe that cancer is fate - just something that happens to them if they are unlucky. They believe that they have no control over their chances of developing a cancer.In fact, more than one-third of all cancer cases worldwide - almost four million cases each year - can be prevented if we act on what we already know and apply that knowledge in our daily behaviour.Simple changes in lifestyle can reduce the risk of cancer.Tobacco use, diet, nutrition and exercise, and sun safety all play a role in influencing cancer risk. It is also possible to vaccinate children or young people against common viruses that cause specific cancers (liver and cervix).The aim of the "Today's children, tomorrow's world" campaign is to scale up awareness of what we can do to prevent cancer and to change people's behaviour in that light.Healthy habits established early in life have a significant impact in later years. Behaviour is already formed before adolescence. The environment in which children grow up - at home, in school, and in the community - powerfully influences their behaviour later on, whether this regards tobacco use and exposure to second-hand smoke, diet and physical activity, or smart behaviour in the sun. Policymakers' decisions about cancer vaccination at an early age determine how far children and young people will be protected against cancers of the liver or cervix. For all these reasons, the "Today's children, tomorrow's world" campaign will focus on the young.Parents have a key role in influencing healthy habits in their children. We need to help parents to understand the long-terms benefits of a healthy lifestyle and to engage them as partners in cancer prevention activities that start early in life.From a prevention perspective, there is strong justification for focusing the campaign on what can be done to tackle four main cancer-causing factors: (1) avoid tobacco and second-hand smoke, (2) avoid obesity, be physically active, and adopt healthy diets, (3) learn the facts about viruses, infections and new vaccinations, and (4) be smart in the sun. [1]The campaign message globally consists of four key precepts:1. provide a smokefree environment for children ("no smoking in homes")2. encourage an energy-balanced lifestyle (regular physical activity and low-fat diet, avoid obesity)3. learn the facts about vaccinations (HBV & HPV)4. teach your children to be sun-smartIn the course of this campaign, UICC, its member organizations and its partners throughout the world will engage in awareness-building, information-sharing, educational activities and community mobilization.Around 700 million children - almost half of the world's children - breathe air polluted by tobacco smoke, particularly at home

2009-02-13T02:14:00.000-08:00

smoking
smoking India caught in catastrophic smoking epidimic Researchers predict 1M tobacco deaths a year during the 2010sIndia is in the midst of a catastrophic epidemic of smokingdeaths that is expected to cause about one million (10 lakh) deaths a year during the 2010s - including one in five of all male deaths and one in 20 of all female deaths at ages 30-69. On average, male bidi smokers lose about six years of life, female bidi smokers lose about eight years and male cigarette smokers lose about ten years.The findings are from the first nationally representative study of smoking in India as a whole. The research, led by a team from India, Canada and the UK, is published online today (February 13, 2008)[1] in the New England Journal of Medicine.About 900 field workers surveyed all adult deaths during 2001-2003 in a nationally representative sample of 1.1 million (11 lakh) homes in all parts of India. Researchers compared smoking histories of 74,000 adults who had died with 78,000 living controls.Among men in the study who died at ages 30-69, smoking caused about:38% of all deaths from tuberculosis (1,174 out of 3,119 deaths)31% of all deaths from respiratory disease (1,078 out of 3,487)20% of all deaths from vascular disease (1,102 out of 5,409)32% of all deaths from cancer (709 out of 2,248)23% of all deaths from disease (5,651 out of 25,290)Lead author Professor Prabhat Jha of the Centre for Global Health Research (CGHR), St. Michael's Hospital, University of Toronto, Canada, said: "The extreme risks from smoking that we found surprised us, as smokers in India start at a later age than those in Europe or America and smoke less. And, smoking kills not only from diseases like cancer and lung diseases but also from tuberculosis and heart attacks.In India, there are about 120 million (12 crore) smokers. More than one-third of men and about five per cent of women aged 30-69 smoke either cigarettes or bidis (which contain only about a quarter as much tobacco as a cigarette, wrapped in the leaf of another plant - temburni).The study found that, among men, about 61% of those who smoke can expect to die at ages 30-69 compared with only 41% of otherwise similar non-smokers. Among women, 62% of those who smoke can expect to die at ages 30-69 compared with only 38% of non-smokers.I am alarmed by the results of this study," said India's Health Minister Dr Abumani Ramadoss. "The government of India is trying to take all steps to control tobacco use - in particular by informing the many poor and illiterate of smoke risks"."It is truly remarkable that one single factor, namely smoking, which is entirely preventable, accounts for nearly one in ten of all deaths in India. The study brings out forcefully the need for immediate public action in this much neglected field", states Professor Amartya Sen, Nobel Laureate in Economics, 2001.The study found there were no safe levels of smoking, but while the hazards of smoking even a few bidis a day were substantial, the dangers of cigarette smoking were even greater, corresponding to more than a doubling of the risk of death in middle age. This suggests that cigarette smokers lose about 10 years of life compared to non-smokers - risks similar to those seen in the West."Smoking kills, but stopping works - about a quarter of all smokers will be killed by tobacco in middle age, unless they stop," said co-author Professor Sir Richard Peto of Oxford University. "British studies show that stopping smoking is remarkably effective."Summary of key findingsThis is the first nationally representative study of smoking in India as a whole;During the 2010s there will be about one million (10 lakh) tobacco deaths a year in India;About 70% of these one million deaths will be before old age; meaning 700,000 (7 lakh) per year killed at ages 30-69 (600,000 men and 100,000 women);Tobacco is responsible for 1 in 5 of all male deaths and 1 in 20 of all female deaths in middle age (i.e., at ages 30-69);Men who smoke bidis lose on average six years of expected life, women who smoke bidis lose about eight years and men who smoke cigarette smokers lose ten years;Smoking kills mainly by tuberculosis, respiratory and heart disease, but also by cancer;Even smoking only a few (1-7) bidis a day raised mortality risks by one-third, and smoking only a few (1-7) cigarettes a day nearly doubled the risk;Most of the gap between male and female mortality rates in middle age is due to smoking;Substantial hazards were found both among educated and among illiterate adults and were found both in urban and in rural areas;Stopping smoking works - but, only 2% of adults have quit in India, and often only after falling ill.NoteIndian and western numbers: 1 lakh=100 thousand, 10 lakh=1 million, 1 crore=10 million

E.N.T-CSOM

2009-02-13T02:05:00.000-08:00

CHRONIC SUPPURATIVE OTITIS MEDIA

It is a long standing infection of a part or

whole of the middle ear cleft charactrised

by ear discharge and a perforation.

Epidemiology

Incidence of CSOM is higher in developing

countries because of low socio-economic

standards,poor nutrition and lack of

health education.

It affects both sexes and all age groups.

Types of CSOM

It is divided into two types

1)Tybotympanic

2)Atticoantral

1)Tybotympanic

It is also called safe or benign type and

it involves anterioinferior part of middle

ear cleft and is associated with a central

perforation.

Aetiology

It is common in childhood

It is the sequela of acute otitis media

usuallyfollowing exanthematous fever

Ascending infection via the eustachian tube.

Pathology

1)Perforation of pars tensa

2)Edematous of middle ear mucosa

3)Polyp in external canal

4)Some degree of nicrosis in ossicular chain

5)Tympanosclerosis

6)Fibrosis and adhesions

Bacteriology

Common aerobic organims-

1)PS aeruginosa

2)Proteus

3)Esch. coli

4)staph. aureus

common anaerobes are

1)Bacteroides fragilis

2)anaerobic sreptococci

Clinical Features

1)Ear discharge

2)Hearing loss

3)Perforation of tympanic membrane

4)Oedematous and swollen of middle ear

Investigation

1)Examination under microscope

2)Audiogram

3)Culture and sensitivityof ear discharge

4)Mastiod x-rays

Treatment

1)aural tiolet

2)ear drops containing neomycin,

polymyxin,chloromycetin.

3)systemic antibiotics

4)precausions

5)treatment of contributory causes

6)surgical treatment

7)reconstrutive surgery

E.N.T-A.S.O.M

2009-02-11T21:54:00.001-08:00

ACUTE SUPPURATIVE OTITIS MEDIA

It is an acute inflammation of middle ear cleft by

pyogenic organisms .

(Middle ear cleft i.e. eustachian tube,middle

ear,attic,antrum and mastiod air cells)

Aetiology

More commen in infants and children of lower

socio-economic groups.

Ratio of male:femail is 1:1

Routes of infection

1)Via eustachian tube

2)Via external ear

3)Blood borne

Predisposing factors

1)Recrrent attacks of common cold

2)upper respiretory tract infections

3)Exanthomatous fevers

4)Infections of tonsils and adenoids

5)Chronic rhinitis and sinusitis

6)Nasal allergy

7)Cleft palate

8)Tumors of nasopharynx

Causative organisms

1)Strptococcus pneumoniae(30%)

2)Haemophilus influenzae(20%)

3)Moraxella catarrhalis(12%)
others

4)Streptococcus pyogenes

5)Staphylococcus aureus

6)Pseudomonos aeruginosa

Pathology

The disease runs through the following stages

1)Stage of tubal occlusion

2)Stage of pre-suppuration

3)Stage of suppuration

4)Stage of resolution or complication

Treatment

1)Antibacterial therapy

2)Decongestant nasal drops

3)Oral nasal decongestants

4)Analgesics and antipyretics

5)Ear tiolet

6)Dry local heat

7)Myringotomy

anaemia

2009-02-09T21:54:00.000-08:00

INTRODUCTION

Anaemia is defined as a reduction of the red blood cell (RBC) volume or hemoglobin concentration below the range of values occurring in healthy persons.

Age

Range (gm/dl)

2wks

13.0 – 20.0

3 months

9.5 – 14.5

6 months – 6yrs

10.5 – 14.0

7 - 12 yrs

11.0 – 16.0

Iron deficiency anaemia in children and infants is very common. It is the most frequent cause of anaemia and perhaps the most common single nutrient deficiency in developing countries like India.

history

Iron was used in the treatment of anaemia since ancient times “Loha Bhasma” was used by the Ayurvedic physicians in treatment of anaemia in India long time ago, Hippocrates, the father of medicine, used iron for treating weak and pale people. The Greek physicians used iron for treating weakness which is one of the important symptoms of anaemia. Sydenham was the first person to put on paper the use of iron. He wrote “we gave mars in the pale colour”.

chemistry and source

IRON : Iron is a chemical element with symbol Fe and atomic number 26. Iron is a group 8 and period 4 element.9 Iron is lustrous and silvery in color. It is one of the few ferromagnetic elements. Its melting point is 1538o C and boiling point is 2862oC. Most of the iron in the earth’s crust is found combined with oxygen as iron oxide minerals such as hematite and magnetite.9 Iron oxidises readily in air and water to form Fe2O3 and is rarely found as a free element. Good sources of dietary iron include red meat, fish, poultry, lentis, beans, leaf vegetables, tofu, chickpeas, black – eyed peas, fortified bread, and fortified breakfast cereals.9 Iron in meat is more easily absorbed than iron in vegetables (haem iron). Iron provided by dietary supplements is often found as iron (II) fumarate, although iron sulphate is cheaper and is absorbed equally well. Iron is most available to the body when chelated to aminoacids – iron in this form is ten to fifteen times more bioavailable11 than any other, and is also available for use as a common iron supplement. Often the aminoacid chosen for this purpose is the cheapest and most common aminoacid, glycine, leading to “iron glycinate” supplements

absorption and metabolism

IRON :

Iron is mainly absorbed in the duodenum. About 10% of dietery iron usually absorbed.15 However, in iron deficient (anaemic) individuals and growing children, a much higher proportion of dietary iron is absorbed to meet the increased body demands.

Factors affecting Fe absorption15

1. Acidity, ascorbic acid and cysteine promote iron absorption

2. In iron deficiency anaemia, Fe absorption is increased to 2-10 times than that of normal.

3. Phytate (found in cereals) and oxalate (found in leafy vegetables) interfere with Fe absorption.

4. A diet with high phosphate content decreases Fe absorption while low phosphate promotes.

5. Impaired absorption of iron is observed in malabsorption syndromes.CLINICAL FEATURES

Severity of anaemia symptoms and management

2. Speed of its development

3. Primary disease causing anemia

4. Presence of other co-morbid conditions

The following symptomatology should alert the clinician to look for anaemia.

a) Often asymptomatic in mild anaemia

b) Weakness, fatigue, lethargy

c) Tiredness, dizziness

d) Light headedness, headache, ,lack of concentration

e) Breathlessness on exertion, palpitation, congestive cardiac failure IRON :

iron deficiency may results from

1. low iron stores

2. reduced iron intake

3. excessive losses of iron from the body

4. decreased iron absorption

5. incresed iron demands RECOMMENDATIONS

investigations

Hb% (gm/dl)

Peripheral smear : 1. microcytic hypochromic 2. normocytic normochromic

3. macrocytic

Reticount

Iron(microgm/dl)

Zinc(microgm/dl)

Copper(microgm/dl)

Lead(microgm/dl)

ALAD activity

%Stimulation ALAD

treatment

· Iron supplementation should be given in case of nutritional anaemia, as the effects of iron deficiency will depend on the duration and severity of the anaemia. If left untreated, it may lead to behavioural or learning problems. These may not be reversible, even with later iron supplementation.

· Iron deficiency anaemia is the commonest cause of nutritional anaemia, it can be prevented by following recommendations :

a) Infants younger than 1yr should drink breast milk or an infant formula supplemented with iron. It is important for breastfed infants to receive iron fortified solid foods starting at about 6 months of age.

b) Children under 2yrs should have no more than 24 ounces of cows milk a day. Cows milk can inhibit absorption of iron, and drinking too much milk can dampen a child’s appetite for other iron rich foods.

c) Foods with nutritious sources of iron should be given to children especially during periods of rapid growth : lean meat, fish, egg yolk, beans, spinach, green leafy vegetables and fortified bread. Iron fortified foods should be given to those who take only vegetarian diet as iron from plant sources is less easily absorbed than meat sources

6. defective iron metabolism