Gastritis Is More Than Indigestion

It is the inflammation of the stomach getting the defense system on roll. It would mean that the stomach is injured and the white blood cells move on the walls of the stomach for help. The inflammation can be caused due to an infection caused by bacterium which can lead to stomach ulcers. Any other injury can also cause such problems.

Some of the other reasons for having gastritis other than bacterial infection is due to smoking, alcohol abuse, excess caffeine, irregular eating habits, greasy foods and spicy food are all causes of gastritis. Avoid using drugs which can be more harmful than beneficial.

Some of the methods to prevent gastritis is to eat regularly and have the right kind of food. There should be a complete stoppage of smoking as well as limiting yourself on the consumption of caffeine and alcohol. Avoid taking medications which can be harmful and could create more problems with the current condition. Avoid having foods which would take time to digest.

Some of the signs and symptoms which you would face during this condition is abdominal discomfort, continuous pain which occurs between the navel and lower ribs, there are increasing chances of nausea and which may occur with the addition of vomiting. The lack of good appetite does not help in such case and just happens to make things worse for you. Belching, bloating or the fullness of your stomach shows you the signs of gastritis.

You can take good care of yourself without the interference of the doctor. If you practice some of the basic requirements for better health there won’t be any need for the doctor. Have regular eating habits, have a healthy diet, try to exercise regularly and avoid stress in you life.

The Diversity of Lupus Symptoms

Lupus is a complex autoimmune disease that generates a wide variety of symptoms. The symptoms produced by lupus may range from mild to severe and generally occur in flares, unpredictably aggravating or ameliorating over time. Some of the common symptoms of lupus are: pronounced fatigue, pain and swelling of the joints, skin rashes and fever. At skin level, lupus often causes the occurrence of the “butterfly rash”, which appears across the nose and cheeks. Although the butterfly rash is the most common rash characteristic to lupus, the disease can cause many other different types of rashes located in various regions of the body: face and ears, scalp, neck, arms, shoulders, hands, chest and back.

The autoimmune disease can also produce symptoms such as chest pain, increased sensitivity to sunlight, alopecia (hair loss), anemia or leucopenia (decrease in the number of red blood cells, respectively white blood cells), and paleness or cyanosis of the fingers and toes (due to poor oxygenation of the body extremities). Patients with lupus often suffer from headaches, vertigo (dizziness), decreased vision, poor concentration, psychological conditions (depression) and sometimes even seizures and faints. The progression of the disease is unpredictable and symptoms may come and go unexpectedly. Over time, patients with lupus may experience different sets of symptoms, occurring in flares and varying in intensity and duration.

When lupus affects the lymphatic system of the body, the most common symptoms of lupus are swelling and pain of the lymph nodes throughout the body. Most cases of lupus either affect the lymphatic system, the musculoskeletal system or the skin. When lupus affects the musculoskeletal system, the most common symptoms are muscular pain, fatigue, swelling and stiffness of the joints. When confined to the skin, lupus commonly generates rashes, inflammation and irritation of the skin.

Lupus often causes kidney affections such as nephritis (inflammation of the kidneys), interfering in the process of excretion and determining the accumulation of toxins inside the body. Lupus patients who also suffer from kidney impairments usually require strong medication treatments in order to prevent the occurrence of serious complications.

In many cases, lupus affects the circulatory system of the body, causing inflammation of the blood vessels (vasculitis), anemia or leucopenia (decrease in red and white blood cells). Lupus may also lead to the occurrence of thrombocytopenia, a decrease in the number of platelets in the blood, condition that interferes in the process of blood coagulation, increasing the risk of bleeding.

When lupus affects the central nervous system, the most common symptoms are dizziness, headaches, temporary memory loss (amnesia), decreased vision, or neuropsychological problems (depression, unpredictable behavioral changes). Some of these previously mentioned symptoms aren’t solely caused by lupus; often they occur as a result of emotional stress and prolonged lupus medication. The majority of these symptoms can be reversed by interrupting the treatment or reducing the dose of medication.

At pulmonary level, patients with lupus may suffer from pleuritis (inflammation of the interior lining of the chest), condition that causes pronounced discomfort and pain, especially when taking deep breaths. Patients with lupus are also very susceptible of developing pneumonia. At coronary level, patients with lupus may suffer from coronary vasculitis (inflammation of the arteries that deliver blood to the heart), myocarditis and endocarditis (inflammation of the heart itself) and pericarditis (inflammation of the heart protective membrane). If discovered in time, the implications of lupus at coronary level can be efficiently reversed with medical treatment.

So if you want to find more about Lupus or more details about symptoms of lupus please follow this link

Lower Extremity Ulcers of the Legs, Ankles, and Feet

An ulcer is a sore on the skin or a mucous membrane often associated with the disintegration of tissue and the formation of pus. Ulcers can result in the complete loss of the epidermis, the dermis, and in more advanced cases subcutaneous fat. Ulcers that appear in the skin are distinguished by inflamed tissue with an area of reddened skin. Skin ulcers are most often associated with diabetes, but have numerous other causes including exposure to heat or cold, irritation, and problems with blood circulation.

Lower extremity ulcers and amputations are an increasing problem among individuals with diabetes. Data from the 1983-90 National Hospital Discharge Surveys (NHDS) indicate that 6% of hospitalizations listing diabetes on the discharge record also listed a lower extremity ulcer condition. In hospitalizations that listed diabetes, chronic ulcers were present in 2.7% of the patients. The average length of stay for diabetes discharges with ulcer conditions was 59% longer than for diabetes discharges without ulcers. Recent data suggest that foot ulcers precede approximately 85% of nontraumatic lower extremity amputations (LEAs) in individuals with diabetes.

More than half of lower limb amputations in the United States occur in people with diagnosed diabetes. NHDS data also indicate that there were  about 54,000 diabetic individuals who underwent  nontraumatic LEAs in 1990. Lower extremity amputations are more common in individuals with diabetes than without diabetes.

Several studies have demonstrated the beneficial effect of patient education on reducing LEAs. A randomized trial showed that patient self-care was helpful in preventing serious foot lesions. Several amputation prevention programs have reported striking pre- and post-intervention differences in amputation frequency after instituting comprehensive, multidisciplinary foot care programs. Part of the hospital care and self care program should be the administration of a topical growth factor gel to the wound.

What are the types and symptoms of ulcers? Ulcers may or may not be painful. The patient generally has a swollen leg and may feel burning or itching. There may also be a rash, redness, brown discoloration or dry, scaly skin. The three most common types of leg and foot ulcers are:

  1. Venous stasis ulcers
  2. Arterial (ischemic ulcers)
  3. Neurotrophic (diabetic ulcers)

Ulcers are typically defined by the appearance of the ulcer, the ulcer location, and the way the borders and surrounding skin of the ulcer look as defined below:

1. Venous stasis ulcers

Venous ulcers are located below the knee and are primarily found on the inner part of the leg, just above the ankle. The base of a venous ulcer is usually red and may also be covered with yellow fibrous tissue, or there may be a green or yellow discharge if the ulcer is infected. Fluid drainage can be significant with this type of ulcer.

The borders of a venous ulcer are usually irregularly shaped and the surrounding skin is often discolored and swollen. It may even feel warm or hot. With edema (swelling) the skin may appear shiny and tight. The skin of the lower leg may also have brown or purple discoloration known as “stasis skin changes.”

Venous stasis ulcers are common in patients who have a history of leg swelling, long standing varicose veins, or a history of blood clots in either the superficial or the deep veins of the legs. Ulcers may affect one or both legs.

Venous ulcers affect 500,000 to 600,000 people in the United States every year and account for 80 to 90% of all leg ulcers.

2. Arterial (ischemic)

Arterial ulcers are usually located on the feet and often occur on the heels, tips of toes, between the toes where the toes rub against one another or anywhere the bones may protrude and rub against bed sheets, socks or shoes. Arterial ulcers also commonly occur in the nail bed if the toenail cuts into the skin or if the patient has had recent aggressive toe nail trimming or an ingrown toenail removed.

The base of an arterial or ischemic ulcer usually does not bleed. It has a yellow, brown, gray, or blackened color. The borders and surrounding skin usually appear as though they have been punched out. If irritation or infection are present, there may or may not be swelling and redness around the ulcer base. There may also be redness on the entire foot when the leg is dangled; this redness often turns to a pale white/yellow color when the leg is elevated.

Arterial ulcers are usually very painful, especially at night. The patient may instinctively dangle their foot over the side of the bed to relieve the pain. Patients usually have prior knowledge of poor circulation in their legs and may have an accompanying disorder.

3. Neurotrophic (diabetic)

Neurotrophic ulcers are usually located at increased pressure points on the bottom of the feet. However, neurotrophic ulcers related to trauma can occur anywhere on the foot. These types of ulcers occur primarily in people with diabetes although anyone who has impaired sensation of the feet can be affected.

The base of the ulcer is variable, depending on the patient’s circulation and may appear pink/red or brown/black. The borders of the ulcer are punched out and the surrounding skin is typically calloused.

Neuropathy and peripheral artery disease are often co-morbid in people who have diabetes. Nerve damage (neuropathy) in the feet often results in a loss of foot sensation and changes in the sweat-producing glands. Thus, a person may not feel the development of foot calluses or cracks, increasing the risk of injury or infection. Symptoms of neuropathy include tingling, numbness, and burning or pain.

What causes leg ulcers? Leg ulcers may be caused by:

  1. Poor circulation, often caused by arteriosclerosis
  2. Diabetes
  3. Venous insufficiency (a failure of the valves in the veins of the leg that causes congestion and slowing of blood circulation in the veins)
  4. Other disorders of clotting and circulation that may or may not be related to atherosclerosis
  5. Renal (kidney) failure
  6. Hypertension (treated or untreated)
  7. Lymphedema (a buildup of fluid that causes swelling in the legs or feet)
  8. Inflammatory diseases including vasculitis, lupus, scleroderma or other rheumatological conditions
  9. Other medical conditions such as high cholesterol, heart disease, high blood pressure, sickle cell anemia, bowel disorders
  10. History of smoking (either current or past)
  11. Pressure caused by lying in one position for too long
  12. Genetics (they may be hereditary)
  13. A malignancy (tumor or cancerous mass)
  14. Infections
  15. Certain medications

How are leg ulcers diagnosed and treated?

First, the patient’s medical history is evaluated. A wound specialist will examine the wound thoroughly and may perform tests such as X-rays, MRIs, CT scans and noninvasive vascular studies to help develop a treatment plan. The goals of treatment are to relieve pain, speed recovery, and heal the wound. Each patient’s treatment plan should be individualized based on the patient’s health, medical condition, and ability to care for the wound.

Treatment options for all ulcers may include:

  1. Antibiotics, if an infection is present
  2. Anti-platelet or anti-clotting medications to prevent a blood clot
  3. Topical wound care therapies (including topical growth factors)
  4. Compression garments
  5. Prosthetics or orthotics, available to restore or enhance normal lifestyle function

Venous ulcers are treated somewhat differently with compression of the leg to minimize edema or swelling. Compression treatments may include wearing compression stockings, multilayer compression wraps, or wrapping an ACE bandage or dressing from the toes or foot to the area below the knee. The type of compression treatment prescribed is determined by the physician based on the characteristics of the ulcer base and amount of drainage from the ulcer.

The type of dressing prescribed for ulcers is determined by the type of ulcer and the appearance at the base of the ulcer. Types of dressings include:

  1. Moist to moist dressings
  2. Hydrogels/hydrocolloids
  3. Alginate dressings
  4. Collagen wound dressings
  5. Debriding agents
  6. Antimicrobial dressings
  7. Composite dressings
  8. Synthetic skin substitutes
  9. Growth factor ointment

Treatments of arterial ulcer vary, depending on the severity of the arterial disease. Non-invasive vascular tests provide the physician with the diagnostic tools to assess the potential for wound healing. Depending on the patient’s condition, the physician may recommend invasive testing, endovascular therapy or bypass surgery to restore circulation to the affected leg. The goals for arterial ulcer treatment include:

  1. Providing adequate protection of the surface of the skin
  2. Preventing new ulcers
  3. Removing contact irritation to the existing ulcer
  4. Monitoring for signs and symptoms of infection that may involve the soft tissues or bone.

Neurotrophic ulcers are treated are treated by avoiding pressure and weight-bearing on the affected leg until the ulcer has started to heal. Regular debridement (the removal of infected tissue) is usually necessary before a neurotrophic ulcer can heal. Frequently, special shoes or orthotic devices must be worn.

Wound Care at Home

As stated in the aforementioned section, a proper wound care program including home wound care by the patient is critical to the healing process. Patients should be given careful instructions to care for their wounds at home. These instructions include:

  1. Keeping the wound clean
  2. Changing the dressing as directed
  3. Taking prescribed medications as directed
  4. Applying topical growth factors as directed
  5. Drinking plenty of fluids
  6. Following a healthy diet, as recommended, including plenty of fruits and vegetables
  7. Exercising regularly, as directed by a physician
  8. Wearing appropriate shoes
  9. Wearing compression wraps, if appropriate, as directed

The treatment of all ulcers begins with careful skin and foot care. Inspection of the feet and skin by the patient is very important, especially for people with diabetes. Detecting and treating foot and skin sores early can help prevent infection and prevent the sore from becoming worse. Here are some guidelines:

  1. Gently wash the affected area on your leg and your feet every day with mild soap and lukewarm water. Washing helps loosen and remove dead skin and other debris or drainage from the ulcer. Gently and thoroughly dry your skin and feet, including between the toes. Do not rub your skin or area between the toes.
  2. Every day, examine your legs as well as the tops and bottoms of your feet and the areas between your toes. Look for any blisters, cuts, cracks, scratches or other sores. Also check for redness, increased warmth, ingrown toenails, corns and calluses. Use a mirror to view the leg or foot if necessary, or have a family member look at the area for you.
  3. Once or twice a day, apply a lanolin-based cream to your legs and soles and top of your feet to prevent dry skin and cracking. Do not apply lotion between your toes or on areas where there is an open sore or cut. If the skin is extremely dry, use the moisturizing cream more often.
  4. Care for your toenails regularly. Cut your toenails after bathing, when they are soft. Cut toenails straight across and smooth with an emery board.
  5. Do not self-treat corns, calluses or other foot problems. Go to a podiatrist to treat these conditions.
  6. Don’t wait to treat a minor foot or skin problem. Follow your physcian’s guidelines.
  7. Ask your physician about using a growth factor ointment on the open sore area.

How can ulcers be prevented? Controlling risk factors can help you prevent ulcers from developing or becoming worse. Here are some ways to reduce your risk factors:

  1. Quit smoking
  2. Manage your blood pressure
  3. Control your blood cholesterol and triglyceride levels by making dietary changes and taking medications as prescribed
  4. Limit your intake of sodium (salt)
  5. Manage your diabetes and other health conditions, if applicable
  6. Exercise — start a walking program after speaking with your physcian
  7. Lose weight if you are overweight
  8. Ask your physcian about aspirin therapy to prevent blood clots

Skin Surgery Options and Treatment

The skin is susceptible to many diseases, discolorations, and growths. It may also be damaged by excessive exposure to the sun and the effects of aging. In most cases, skin problems requiring dermatologic surgery can be addressed in the dermatologist’s office or in an outpatient setting, usually under local anesthesia, with minimal pain, and low risk of complications. There are different types of skin surgeries enumerated below.

Types of Skin Surgery
Skin biopsy – Skin biopsies are performed to help with the diagnosis of your skin condition. Sometimes, different skin conditions can look similar to the naked eye so additional information is required. This is obtained by looking at the structure of the skin under the microscope after the cells have been stained with special coloured dyes.
Excision of skin lesions – A common reason why skin lesions are excised, is to fully remove skin cancers such as basal cell carcinoma, squamous cell carcinoma or melanoma. If the cancer is not cut out it may spread to the surrounding skin and to other parts of the body (metastasise).
Curettage & cautery – Curettage and cautery or electrosurgery is a procedure in which your dermatologist scrapes off a skin lesion and applies heat to the skin surface.
Skin grafting – A skin graft consists of skin taken from another part of the body and applied to the site where skin is missing. This might follow surgical removal of a skin cancer or a burn. A skin graft is thus a skin transplant. Skin grafts are performed by surgeons (including plastic surgeons) and by some dermatologists.
Mohs microscopically controlled excision – Mohs Micrographic Surgery, an advanced treatment procedure for skin cancer, offers the highest potential for recovery—even if the skin cancer has been previously treated. This procedure is state-of-the-art treatment in which the physician serves as surgeon, pathologist and reconstructive surgeon.
Laser Skin Resurfacing – A laser is a high-energy beam of light that can selectively transfer its energy into tissue to treat the skin. The laser makes it possible to change tissue without making an incision. So a surgeon can treat birthmarks or damaged blood vessels, remove port wine stains, and shrink facial “spider veins” without major surgery.
Photodynamic therapy – Applying a chemical called aminolevulinic acid to the skin and exposing the skin to a special light source.
Topical chemotherapy – Applying a chemical such as 5-fluorouracil, diclofenac sodium, or imiquimod to destroy pre-cancerous growths and some cancerous lesions.
Radiation therapy – Using x-rays to destroy tissue in certain types of skin cancer, as well as in selected individuals for whom surgery is not possible.
Dermabrasion – Removing the outer layers of skin and softening irregular edges. After the skin is frozen with a spray medication, a high-speed, rotary abrasive wheel is used.
Cryotherapy (liquid nitrogen) Applying or spraying liquid nitrogen onto the skin to freeze and destroy the tissue.
Precautions and care for Skin Surgery
Your skin growth will be removed surgically in the office and sent for microscopic examination to be certain it has been completely removed. Unless otherwise instructed, please eat normally and take all regularly prescribed medications.
After surgery, most patients may resume their usual activities; sometimes, there are temporary restrictions on sports, dancing, or other physical activity.
Aspirin makes people bleed more easily, and we prefer that patients not take it for seven days before surgery and for two days after surgery.
If you are taking aspirin, or a medicine containing aspirin, on your own, please stop it for seven days before surgery.
Antibiotics – People who have had hip replacements, have artificial heart valves, or who have mitral valve prolapse often have to take antibiotics before dental procedures.
In the medical literature, most studies show antibiotics are not needed before and after skin surgery. The best thing to do is to check with the doctor who has implanted one of the above devices or the doctor who sees you for this problem.
Stitches (sutures) are used to close the wound after surgery. The type of stitch we use depends on the surgery and your skin. Stitches that need removal are usually taken out 7 to 14 days after surgery. Stitch removal and takes only a few minutes.

Risk factors of stroke disease

 High blood pressure Hypertension (high blood pressure) is a major risk factor in both ischaemic and haemorrhagic strokes (Wolf and D’Agostino 1993).  Welin et al (1987) found that high blood pressure was a risk factor in 789 men, 57 of whom had had a stroke and had been monitored for up to 18 years.  Sandercock, Warlow and Jones (1989) studied risk factors in 224 first embolic strokes in an Oxfordshire population of 104,000 and found that high blood pressure was present in 52 per cent of the cases compared with a healthy group.

Studies in developing countries have suggested that high blood pressure is a major risk factor (Akbar and Mushtaq 1999; El Sayed et al 1999).  The most common risk factor was hypertension concomitant with diabetes mellitus in 40.4 per cent of hospitalised patients and hypertension alone for 24.9 per cent (El Sayed et al 1999).  Akbar and Mushtaq (1999) found that high blood pressure was present in 20 per cent of stroke survivors.  However, there were no comparisons with a healthy group in these two studies, making it difficult to draw conclusions from them.

Cigarette smoking  Several studies  have shown that cigarette smoking is a major risk factor for stroke (Shaper et al 1991; Wannamethee et al 1995; Wishant, 1997)  In a population of 7,735 British men monitored for eight years, cigarette smoking was found to be associated with a risk of having a stroke (Shaper et al 1991).  Shinton and Beevers (1989) found that cigarette smoking increased the risk of cerebral infarction among smokers compared to non-smokers.  However, the risk of stroke disappeared two to four years after stopping smoking  (Kawachi, Colditz and Stampfer 1993).  In the only study in Saudi Arabia, El Sayed et al (1999) found that 1.8 per cent of stroke survivors who been admitted to hospital were smokers, although these results should be carefully interpreted because there were no comparisons between smokers and non-smokers.

 Diabetes  Several studies have shown that diabetes is another major stroke risk factor (Burchfield, Curb and Rodrigues 1994; United Kingdom Prospective Diabetes Study Group 1998).  Among Japanese living in the USA, those with diabetes had twice the risk of an embolic stroke of non-diabetic subjects (Burchfield, Curb and Rodrigues 1994).  In the Arab population one-fifth of stroke survivors were found to suffer from diabetes (Al-Jishi and Mohan 1999; Al-Rajeh et al 1993a, Al-Rajeh et al 1998; El Sayed et al 1999).

Atrial fibrillation  Irregular heart beat (atrial fibrillation) is another risk factor associated with stroke (Goldstein 1998).  Benjamin et al (1998) found that there was a dramatic increase in the risk of strokes, which increased with age, associated with atrial fibrillation.  The risk factors increased from 1.5 per cent for those aged between 55 and 59 to 23 per cent for those aged between 80 and 89.

In a few studies carried out in developing countries, atrial fibrillation was found to be present in around 5 to10 per cent of stroke patients admitted to hospital (Akbar and Mushtaq 1999; Al-Rajeh et al 1993b; El Sayed et al 1995). 

 Hyperlipidaemia  Hyperlipidaemia (raised cholesterol levels) is another factor associated with the risk of stroke (Goldstein 1998).  It is well documented that lipid abnormalities are associated with coronary artery disease but there is very little research into the relationship between lipid abnormalities and cerebrovascular diseases, including strokes.  In a review of 45 papers Qizilbash et al (1998) reported that there was no association between cholesterol level and haemorrhagic stroke.  Other studies have looked at the relationship between cholesterol levels and ischaemic stroke and found a weak association (Benfante et al 1994).

Silent Heart Attack and Its Atypical Signs

During heart attack one might feel dizzy although is not a common symptom it has been observed at some people with heart attack. Heart attacks are more often in the morning because of the amounts of adrenaline in the blood. Too much adrenaline in the blood may determine formation of clot and rupture of plaque. Cardiac pain is dull, vague and has been described as pressure, fullness, squeezing and other sensation of discomfort. Studies have shown that heart attacks are more frequent in winter, diabetic people have silent heart attacks which means that there is no pain in the chest.


If you feel an intense and suffocating pain in the chest for more than 15 minutes and doesn’t stop at nitroglycerin it means that you are having a heart attack. It is indicated to take aspirin and drink water that helps the heart getting more blood if you are having a heart attack indeed. Sometimes the heart attack symptoms may act as an indigestion with a sensation of fainting and pain in the middle of the abdomen.

Silent heart attacks

Silent heart attacks are the most dangerous ones because people don’t know what’s happening they consider it’s only a state of moment and forget soon about the discomfort and indisposition felt and do not announce a doctor which has a vital risk. Silent heart attacks are those attacks that have no warning symptoms or signs, or may appear atypical signs such as: nausea, sweating, headache and dizziness. Silent heart attacks are common in people older than 65 years and diabetics and women.

American Heart Association and other experts suggest that we should pay attention to the following signals: pain, squeezing, fullness in the center of the heart, pain radiating in the shoulder and arms, burning, pressure, heavy weight. Other symptoms may be: fainting, nausea, sweating, shortness of breath, anxiety, irregular heart rate, pallor, anxiety, nervousness. If you notice any of these symptoms you should address immediately to the emergency medical services at 911 or begin the CPR.

The doctor will diagnose the heart attack after studying several tests: EKG a device that gives the graphical record of the heart’s electrical activity, a physical examination and knowing the complete medical history of the patient, high enzymes in the blood appear in heart attack, those steps are also helpfull. Cardiac enzymes may be determined later in the intensive care unit and urgent care setting so they confirm or infirm the suspicions of heart attack.

Often heart attack is slowly with mild pain and the person in cause doesn’t understand what’s happening, on the other hand the heart attack might be intense and movie-like. The most common signs are: chest discomfort which may be felt as pain, pressure, squeezing, fullness and which may last for minutes. Other symptoms are: pain in both arms, neck, stomach, back, shortness of breath, nausea, cold sweating.

If you want to find out more resources about heart attack symptoms or about vioxx heart attack please review this page

Heart Attack – Causes, Signs, Symptoms and Treatment

Any of a number of conditions that can affect the heart. Some examples include coronary heart disease, heart attack, cardiovascular disease, pulmonary heart disease and high blood pressure. Heart disease is a big problem in today’s society because of lifestyle issues such as poor diet, lack of exercise and smoking.

Heart attack (myocardial infarction or coronary thrombosis) is when part of the heart muscle dies because it has been starved of oxygen. . It can occur as a result of one or two effects of atherosclerosis:

(1) If the artery becomes completely blocked and ischemia becomes so extensive that oxygen-bearing tissues around the heart die.

(2) If the plaque itself develops fissures or tears. Blood platelets adhere to the site to seal off the plaque, and a blood clot (thrombus) forms. A heart attack can then occur if the formed blood clot completely blocks the passage of oxygen-rich blood to the heart.

Usually, this happens when a blood clot forms in one of the coronary arteries (blood vessels to the heart muscle), which blocks the blood supply. Occasionally, a blockage is caused by a spasm (sudden narrowing) of a coronary artery.

Cause of Heart attack:

A heart attack happens when a blood vessel in or near the heart becomes blocked. Not enough blood can get to that part of the heart muscle. That area of the heart muscle stops working, so the heart is weaker. During a heart attack, you may have chest pain along with nausea, indigestion, extreme weakness, and sweating

A heart attack occurs when there is a severe blockage in an artery that carries oxygen-rich blood to the heart muscle. The blockage is usually caused by the buildup of plaque (deposits of fat-like substances, or atherosclerosis) along the walls of the arteries. The sudden lack of blood flow to the heart muscle deprives the heart of needed oxygen and nutrients. If the blockage is not opened quickly, the heart muscle is likely to suffer serious, permanent damage as areas of tissue die.

Warning Signs for Heart Attack

• Chest discomfort: uncomfortable pressure, squeezing or fullness.
• Discomfort in other areas of the upper body: one or both arms or in the back, neck, jaw, or stomach.
• Shortness of breath, either with chest discomfort or alone.
• Other signs, including nausea, lightheadedness, or breaking out in a cold sweat.
Common Symptoms.
Other common symptoms of a heart attack include:
• Nausea, vomiting, and cold sweats
• A feeling of indigestion or heartburn
• Fainting
• A great fear of impending death, a phenomena known as angor animi
Medical Treatment
Medical treatment may be started immediately, before a definite diagnosis of a heart problem is made. General treatment measures include the following:
• Oxygen through a tube in the nose or face mask
• Nitroglycerin under the tongue
• Pain medicines (morphine or meperidine)
• Aspirin: Those with allergy to aspirin may be given clopidogrel (Plavix).


After a heart attack, you will usually be offered an exercise test. If this suggests that your coronary arteries have narrowed, an angiogram will be carried out. This involves injecting a dye into the blood so that the coronary blood vessels show up on an X-ray. If your arteries are narrowed, you can sometimes be treated with angioplasty or coronary artery bypass grafting.

Three Times Weekly Anti-tuberculosis Treatment of Category 1 and Category 11 Patients of Pulmonary Tuberculosis Under Directly Observed Therapy (dots)













The purpose of this study was to evaluate three times weekly anti-tuberculosis treatment (ATT) for both category 1 and category 11 patients of pulmonary tuberculosis under directly observed therapy to cut the cost and time required for ATT.


This study was conducted at TB clinic, Muhammad Medical College Hospital Mirpurkhas, sindh, Pakistan, from July 2005 to June 2007

 Patients and Methods:

130 patients were enrolled for study. 70 patients of category 1 and 60 patients of category11 pulmonary TB who promised to come regularly for treatment three days a week for eight months. Patients were given antituberculosis drugs three days a week under strict observed therapy strategy for eight months according to World Health Organization guide lines for treatment of tuberculosis 2003.


At the end of eight months in category1, out of 70 patients 67 patients (96%) were cured, 3 patients (4%) who were sputum smear positive at the start of ATT remained sputum positive. In category 11 out of 60 patients, 53 patients (88%) were cured, 7 patients (12%) remained smear positive. Over all cure rates for both categories 1 and 11 was 92%.


Three times a week ATT is as effective as daily regimen of ATT. It must be given under strict DOTS strategy. It saves 65-7-% of drug cost and time as compared to daily regimens.

Key words: Anti-tuberculosis treatment    ATT

          Directly Observed Therapy Short Course DOTS.

Address for correspondence:

(2) Dr:Ghulam Rasool Bhurgari

Assistant Professor

Department of Pharmacology and Therapeutics

Muhammad Medical College

Mirpurkhas, Pakistan

0333 2871918.




Nearly one third of the global population i.e. two billion people are infected with mycobacterium Tuberculosis and at risk of developing the disease. More than eight million people develop active tuberculosis (TB) every year and about million die (2).This problem is worse in Pakistan. There are no reliable data on the incidence and death caused by TB. It seems to be increasing every year. Although TB affects all classes of people, it is more prevalent in the poor especially of the productive ages of 22-55 years, causing great financial burden and misery to their families.

DOTS(Directly Observed Therapy Short course) was introduced in 1993 by World Health Organization(WHO) DECLARED TB A GLOBAL EMERGNCY IN RECOGNITION OF THE GROWING IMPORTANCE AS A PUBLIC HEALTH PROBLEM.(1)

A component of case management that helps to ensure that patients adhere to therapy is DOT.DOT means that a health care worker or another designated person watches the patient swallow each dose of TB medication. DOT ensures an accurate account of how much medication the patient really took. DOT should be considered for all patients because clinicians are often inaccurate in predicting which patient will adhere to medication regimens on their own. DOT has been shown to be effective when intermittent regimens are used. DOT can significantly reduce the frequency of development of drug resistant and of treatment failure or relapse after the end of treatment. Treatment for drug susceptible TB can be given intermittently if they are directly observed. Using intermittent regimens redress the total number of encounters with the Health worker, making these regimens more cost effective. (3)

Intermittent ATT given three times a week is as efficacious as daily therapy.Isoniazid; Rifampin, Pyrazinamide, and Streptomycin are all efficacious when given three times weekly as when given daily. This finding should not be surprising, because Mycobacterium tuberculosis doubles in 18-24 hours, compared with 12-20 minute for most bacteria(4).

DOTS has been employed with success UN many countries. We conducted this study under DOTS strategy to see the results of three days a week regimens to get better results with less cost.


Criteria for enrolling the patients for study:

1.  Patients who fulfilled the World Health Organization (WHO)diagnostic criteria for category 1(Patients who have never received treatment for TB) and category 11(Retreatment of ,relapse, treatment failure, smear positive who have taken ATT more than one month and defaulted)pulmonary tuberculosis (WHO) guidelines for national programmed treatment of tuberculosis 2003.

2.   Patients and their family promised to come regularly thrice a week for eight months.

130 patients were enrolled for study.70 patients of category 1 and 60 patients of category11.Out of 70 patients of category1, 40 patients (57%) were sputum smear positive and 30 patients (43%) were sputum smear negative.

In category 11 out of 60 patients, 10 patients (17%)were previously treated for 8 months,6 of these patients were sputum smear positive.50 patients had interrupted their treatment after more than one month. In category 11 36 patients (60%) was sputum smearing positive and 24 patients (40%) were sputum smear negative.

Out of the total 130 patients there were 70 male (54%) and 60 females (46%).Their ages ranged from 16-65 years. 80% of the patients were between 20 and 55 years of age.



A. The patient and his family were informed about TB disease, its spread, progress and treatment. Regular treatment for 8 months will cure the patient. Irregular treatment or interruption of treatment before 8 months will make the disease resistant to treatment and chances of cure will diminish.

B. Diet: Advised to eat everything available. Diet should increase every day some patients are given drugs to stimulate appetite. Few patients needed short course of corticosteroids.

C. Emphasis was on regular visits and not to miss treatment at all.                    Patients and their family’s contact numbers and address were noted.

2. Drug Treatment: All the patients were given treatment 3 days a week under DOTS strategy. The drugs were given as separate drugs and doses were calculated according to weight of the patients as recommended by WHO guidelines for treatment of tuberculosis 2003 for 3 days week regimen.

In category 1 during initial phase months Rifamicin, Isoniazid, Pyrazinamide and Ethambutol were given and during continuation phase of six months Rifampcin, Isoniazid, and Ethambutol were given.

 In category 11 patients, during initial phase of two months Rifamicin,    Isoniazid, Pyrazinamide, Ethambutol and Streptomycin were given. In 3rd months initial phase Streptomycin was stopped and other four drugs were continued. During continuation phase of 5 months Ionized, Rifampin, and Ethambutol were continued


3. On every visit:

a. Patient was attended straight away on arrival with greetings and enquired about his health, family and job.

b. Temperature and weight recorded. Patients not gaining weight were advised to increase the diet. Some were given drugs to stimulate appetite and few given corticosteroids.

c. A glass of water and medicine given under supervision

d. Any co-existent illness was also treated.

e. On leaving, patient was reminded about the next visit. If he cannot come then medicine were given to his family member to give the patient under his supervision. The patient was made to feel that we care for him and want him to get better.

PROGRESS: X-RAY CHEST, ESR,Hb, and soutum smear for A.F.B were repeated at 2 months, 5 months and end of treatment at 8 months.


After completion of eight months of ATT, the following criteria were taken for cure.


category type one patients of tuberculosis

categry two patients of tuberculosis

seventy patients in cat one

sixty patients in cat two

three patients missed

seven patients missed in cat two























Std. Error of Mean














Std. Deviation







Frequency Table

                                      category type one patients of tuberculosis



Valid Percent

Cumulative Percent














                                            categry two patients of tuberculosis



Valid Percent

Cumulative Percent














                                                         three patients missed



Valid Percent

Cumulative Percent














                                               seven patients missed in cat two



Valid Percent

Cumulative Percent















  VARIABLES=catone cattwo senty sixty tree svn




Pie Chart


1. Sputum smear negative for AFB on three occasions.

2. Radiological opacities on x-ray chest had cleared or healed by fibrosis and calcification.

3.  Had gained weight.

4.  E.S.R had fallen to normal limits.

5.  Hb had risen.

6.  Patient was symptoms free and doing his job.

    In category 1 67 (96%) patients out of 70 cured.3 patients (4%) who were sputum positive at the start of ATT remained sputum smear positive. In category 11 53 patients (88%) out of 60 were cured.7 (12%) remained sputum positive as they were at the onset of ATT. Over all cure rate in both categories 1and 11 was 92%.


The global target for successful treatment of new sputum smear patients is 85% or more (5) .Average treatment success among national DOTS programs is 82% close to the 85% global target. (6)We achieved the cure rate of 96% for category 1, 88% for category 11 pulmonary TB patients and overall cure rate in both categories 1 and 11 was 92%.

The result is better than the global target for national programs set by WHO. This may be because our total number of patients was small and few multi-drug- resistant (MDR) cases were enrolled.

We think our high cure rate is due to the fact that during this trail we did not let any patient miss even a single dose of medicine. Council ling on every visit was useful. We had to scare the patient that if, he misses even a single dose of medicine he will not be cured. He will die coughing up blood and no medicine will help.

Patient’s family was told that successful treatment of the patient is in their interest also otherwise they will catch the disease from the patient.


On every visit the patient was weighed and advised to increase his daily consumption of food. Some very anorexic patients were given tonics and steroids.

DOT’S strategy does not just mean giving medicines under peon’s supervision. Doctor and his team treating the patient should win the confidence of the patient by care, sympathy, concern and politeness so that patient can complete his ATT without interruption. This will increase the cure rate  and reduce development of MDR.


3 days a week ATT for category 1 and category 11 pulmonary patients under a caring and strict DOTS strategy is more effective and less costly than half heartily supervised daily regimen.

If the total consumption of drugs for 8 months with 3 days a week regimen is compared with that of daily regimen for 8 months there is a saving of 65-70% in cost and time.

This means that with the amount allocated by Government for TB control, as many as three times more patients can be treated. It also means that only 40% sincere and dedicated personal can do better job than being done at present.


a)                  All patients of category 1 and 11 pulmonary tuberculosis can be treated successfully with 3 days a week ATT regimen under DOTS strategy.

b)                  3 days a week ATT saves 65-70% money and time,

c)                  DOTS strategy can improve results if employed with sincerity and devotion.                                                  


1      Guideline for National tuberculosis programs on management of tuberculosis, World Health Organization 2003

2      Dye C etal. Global burden of tuberculosis:estimated incidence, prevelence and morbidity by country. JAMA 1999, 282(7):677-678

3      Core circulation on tuberculosis 4th edition 200 US Department of health and human services.

4    North RJ,Izzo AA,Mycobactrium Virulence J.EXP.Med 1993:177(6);1723-33.

5 An expanded DOTS framework for effective tuberculosis control WHO/CDS/TB/2002.297.Geneva:World Health Organization global tuberculosis programme; 2002.

6 Global tuberculosis control, planning,financing.WHOreport 2005. WHO/HTM/TB/2005.49.Geneva(Switzerland);World Heath Org.

Ovarian Cystadenomas Are Considered A New Growth – A Form Of Ovarian Cyst

Ovarian cysts are one of the most common conditions that gynecologists and obstetricians deal with. However, being told that you have an ovarian cyst means different things to different women; there are several different common types of these abdominal masses.

An ovarian cystadenoma is just one of several ovarian cysts that many women experience. Unlike functional cysts, which occur as a normal part of a menstrual cycle, a ovarian cystadenoma is considered a new growth or neoplasm.

Different Types Of Ovarian Cystadenomas

An ovarian cystadenoma is categorized based upon the composition of the actual cyst mass. If the cyst is at least 2 inches in diameter and is filled with clear fluid, it is considered to be a serous cystadenoma. Women from the ages of 20 to 50 may be at risk for this type of ovarian cyst. However, it is more likely to occur in women who are in their 30s and 40s.

Serous cystadenomas are almost always benign, but there is some risk of cancer associated with the cyst. It is also possible that this mass will grow quite large, creating pressure on surrounding organs, as well as causing abdominal swelling and weight gain.

Another type of ovarian cystadenoma, the mucinous cystadenoma, is filled with thick, sticky fluid. These masses often grow to be quite large. They are usually not diagnosed until they are at least six inches in diameter; however, in some cases, they can grow to be extremely large, weighing upwards of 100 lbs!

Younger women suffer from mucinous cystadenomas at lower rates than older women; most cases occur in women between 30 and 50 years of age. This ovarian cystadenoma also brings the same risks as the serous type, including pressure on surrounding organs and possible malignancy.

Treatment for Ovarian Cystadenomas

Once ovarian cystadenomas are discovered, they rarely shrink or diminish on their own. Some cases can stabilize to the point where the cyst isn’t causing interference with normal function. Depending on the size and activity of the cyst, surgery may be recommended.

A small cystadenoma may be removed via laparoscopic surgical procedures. Large masses, however, usually require full abdominal surgery to successfully remove the cyst.

Prevention and Care

While there is really no good alternative treatment for an active ovarian cystadenoma, there is a lot that you can do to prevent developing this cyst in the first place.

Diet and lifestyle choices that are made in your younger years will directly contribute to your overall health, including in the reproductive system. Women who are overweight are at an increased risk of developing an ovarian cystadenoma.

In addition, eating processed foods, artificial preservatives and high-fat fast foods can also increase the chances of hormonal imbalance and all types of ovarian cysts.

Favoring a diet high in fruits and vegetables, quality proteins and lean dairy can ensure that you never have to suffer through a cystadenoma surgery. If you have a family history of ovarian cysts, extra caution is warranted to reduce your risks.

While there is always a place for medical intervention, natural care is often as effective. Doctors are becoming more aware that a person’s individual choices probably have the biggest impact on their overall health and well-being.

When it comes to an ovarian cystadenomas, adjusting your diet and lifestyle are big steps to reducing risk. There are supplements, herbs and holistic approaches that can assist your body in maintaining optimal reproductive function.

Esophageal Cancer Metastasis

The spread of the disease from one organ or part to another non-adjacent organ or part is called metastasis or metastatic disease. Previously it was that only malignant tumor cells had the capacity to metastasize which is now in reconsideration due to research. The word metastasis in Greek means “removal from one place to another” and the plural form of metastasis is given as metastases.

Metastases are given as the process through which the cancer spreads from the place it started as a primary tumor to other parts of the body distant from the affected area. For example, a person with melanoma may have metastases in their brain and another person with colon cancer may not show symptoms of metastases.

Cancerous cells have two abilities such as increased motility and invasiveness on which metastases depends. Cells that metastasize are basically of same kind and have acquired increased motility and capacity to invade other organs. If cancer arises in lungs and metastasizes to liver, the cancer cells present in the liver are lung cancer cells.

A clinical research was conducted on metastases. A 65 year old man was admitted with dysphagia and no pulmonary symptoms were noted in him. A barium swallow test marked constriction of the middle esophagus and also an esophageal stricture with apparently normal mucosa 35cm from the incisors. A 2staged operation was planned for the patient due to his past history of cerebral thrombosis with right hemiplegia. Then thoracotomy cervical esophagostomy was carried out in which a tumor mass measuring 3.0 X 3.0 cm was found at the base of the middle lobe of right lung.

Two months later, esophageal reconstruction with a gastric tube placed in subcutaneous space was performed. In lower lung field, a tumor shadow was found during the post operative period. The epithelial surface of the esophagus appeared smooth and was stained with Lugol’s solution. It was to provide evidence that mucosa was normal. But after histological examination, it was found that the tumor was in the muscle layer and infiltrating the submucosal and other deeper layers. The tumor was poorly differentiated adenocarcinoma as it was a metastatic lesion from a lung cancer, but no specimen of pulmonary tumor was obtained and the patient died 231 days after the surgery.

On the basis of research and findings in patients, an aggressive surgical approach is needed for metastatic esophageal carcinoma when the primary tumor growth is suspected to be slow. But the decision to resect these lesions should be made after evaluation which ensures clinical benefit to patients.

Oxaliplatin is one kind of drug belonging to 3rd generation of platinum and it plays an important role in treatment of cancer and tumors. Capecitabine has slighter side effect and can be taken orally in the gastro-intestinal tract. The investigators believed that Oxaliplatin combined with Capecitabine treatment provides a safe, well tolerated and effective treatment for patients with metastatic disease.

Natural Remedies:
There are certain natural remedies that offer a promising cure for esophageal cancer. Along with the natural remedies and a well-researched different diet pattern, a few simple adjustments to your lifestyle can make a huge difference to your efforts for prolonging the life for several years. You can increase your chances of surviving esophagus cancer now by trying these proven natural remedies discussed here

10 Simple and Natural Home Remedies for Pneumonia

Pneumonia is a common illness that refers to an infection of the lungs. It occurs in all age groups, and is a leading cause of death among children and elderly people in chronic conditions. The major symptoms of pneumonia are productive cough resulting in mucus, chest pains, fever, chills and breathing shortness.

Here, in this article you will find home remedies for pneumonia. These home remedies are simple, easy to prepare and easy to follow. You will get benefited from these home remedies if followed as instructed below. These remedies can be taken along with your medication to improve your health and give relief from pneumonia symptoms.

1. Turmeric has several medicinal properties and is widely used in treating a number of ailments. It also helps in treating pneumonia. Other herbs such as black pepper, fenugreek and ginger are also beneficial for your lungs. You can take these herbs in raw or cooked form.

2. Sesame seeds are also helpful in treating pneumonia. Add 15 grams of sesame seeds in 250 ml water. Add a pinch of common salt, a teaspoon of linseed, and a tablespoon of honey in this mixture. Consume daily to expel phlegm from the bronchial tubes.

3. Ginger is a popular home remedy for treating most of the respiratory disorders. Take 10 ml juice of the fresh ginger, or one or two grams dried ginger powder along with honey two times daily.

4. Add a teaspoon of honey to a glass of lukewarm water. Drink it two or three times a day. This drink has very soothing effect and relieves symptoms.

5. Mix some camphor with warm turpentine oil and apply it on the chest. Gently massage to get relief from pneumonia.

6. The patient should be kept in a clean, hot and healthy room. Make sure that sunshine enters in the patient room.

7. Try to keep the chest and the feet of the patient warmer than the other parts of the body.

8. Do not take foods that may lead to constipation. It may aggravate the condition.

9. To get relief from chest pain and discomfort, take a teaspoonful of garlic juice.

10. Holy basil is also very useful in pneumonia. Take the juice of few fresh leaves of holy basil. Add a pinch of ground black pepper to this juice and consume at six hourly intervals.

Disclaimer: The reader of this article should exercise all precautionary measures while following instructions on the pneumonia home remedies from this article. Avoid using any of these products or ingredients if you are allergic to it. The responsibility lies with the reader and not with the website or the writer.

Copyright © Ryan Mutt, All Rights Reserved. If you want to use this article on your website or in your ezine, make all the urls (links) active.

Chest pain

Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.

Chest pain is one of the most common reasons people call for emergency medical help. Every year emergency room doctors evaluate and treat millions of people for chest pain.

Fortunately, chest pain doesn’t always signal a heart attack. Often chest pain is unrelated to any heart problem. But even if the chest pain you experience has nothing to do with your cardiovascular system, the problem may still be important — and worth the time spent in an emergency room for evaluation.

Type of Causes

Cardiac causes
Digestive causes
Musculoskeletal causes
Respiratory causes
Other causes

# Panic attack. If you experience periods of intense fear accompanied by chest pain, rapid heartbeat, rapid breathing (hyperventilation), profuse sweating and shortness of breath, you may be experiencing a panic attack — a form of anxiety.

# Shingles. This infection of the nerves caused by the chickenpox virus can produce pain and a band of blisters from your back around to your chest wall.

# Cancer. Rarely, cancer involving the chest or cancer that has spread from another part of the body can cause chest pain.

* severe pressure, fullness, squeezing, pain and/or discomfort in the center of the chest that lasts for more than a few minutes
* pain or discomfort that spreads to the shoulders, neck, arms, or jaw
* chest pain that increases in intensity
* chest pain that is not relieved by rest or by taking nitroglycerin
* chest pain that occurs with any/all of the following (additional) symptoms:
o sweating, cool, clammy skin, and/or paleness
o shortness of breath
o nausea or vomiting
o dizziness or fainting
o unexplained weakness or fatigue
o rapid or irregular pulse

Although chest pain is the key warning sign of a heart attack, it may be confused with indigestion, pleurisy, pneumonia, or other disorders.

Seek Treatment if you experience

* Sudden crushing, squeezing, tightening, or pressure in your chest.
* Nausea, dizziness, sweating, a racing heart, or shortness of breath.
* They know they have angina and their chest discomfort is suddenly more intense, brought on by lighter activity, or lasts longer than usual.
* Angina symptoms occur at rest.
* They have sudden sharp chest pain with shortness of breath, especially after a long trip, a stretch of bedrest (for example, following an operation), or other lack of movement that can lead to formation of a blood clot in the leg.
* Chest-wall pain persists for longer than 3 to 5 days.

A person’s risk of heart attack is higher if they have a family history of heart disease, smoke or use cocaine, have high cholesterol, high blood pressure, or diabetes.


Make healthy lifestyle choices to prevent chest pain from heart disease:

* Achieve and maintain normal weight.
* Control high blood pressure, high cholesterol, and diabetes.
* Avoid cigarette smoking and secondhand smoke.
* Eat a diet low in saturated and hydrogenated fats and cholesterol, and high in starches, fiber, fruits, and vegetables.
* Get at least 30 minutes of moderate intensity exercise on most days of the week.
* Reduce stress.

Dry cough an upper respiratory tract infection

Cough is initiated when irritant receptors in the mucousmembrane of the respiratory tract are stimulated. Coughis by far the most common respiratory symptom, andis characteristic in heavy smokers. Frequently, cough istriggered by the presence of sputum in the respiratorytract, and is useful in helping to clear infection from thebronchial tree. A wide variety of inhaled irritants in additionto cigarette smoke (e.g. noxious gases or cold air) maystimulate coughing, and this is more likely if the airwaysare already irritable because of inflammation as a consequenceof infection.

Similarly, the irritant receptors in thebronchial tree may be stimulated by tumours, inhaledforeign bodies, allergens and the asthmatic response,pulmonary oedema and external compression by lymphnodes. In non-smokers the most frequent causes of chroniccough are asthma, sinus disease and oesophageal reflux.With neurological disease laryngeal function may beimpaired or oesophageal motility abnormal (e.g. achalasia),and cough may be due to repeated aspiration.

A characteristic persistent dry cough canoccur with ACE inhibitors. Cough after drinking canalso indicate an oesophagobronchial fistula. In somepatients cough is worse at night, particularly in asthma orpulmonary oedema. Prolonged coughing reduces venousreturn, causes a transient fall in cardiac output and cerebraloxygenation, and leads to cough syncope. Damage tothe recurrent laryngeal nerve, commonly at the left hilumdue to bronchial carcinoma, leads to vocal cord paralysisand an inability to produce a normal explosive cough,which becomes ‘bovine’.

A dry cough, sometimes following an upper respiratorytract infection and often persisting for weeks or months,for which no cause can be found, is a common clinical problem.


In healthy subjects the bronchial tree produces approximately100 mL of mucus each day; this is carried upwards by ciliary action and is then unconsciously swallowed. This ‘escalator’ is a normal part of the mechanism for clearingdebris and pathogens from the bronchial tree. Indisease processes causing the production of excess mucus,irritant receptors are stimulated and sputum is coughedup.

Sputum is not described reliably by patients and it isalways best to inspect it. Sputum may be clear, white ormucoid, as in chronic bronchitis, or purulent, in which casepus is mixed with mucus and the sputum is yellow or green.Sputum may contain blood, which may be bright red (e.g.pulmonary infarction), a rusty colour (acute pneumonia)or pink (pulmonary oedema due to left heart failure). Inasthma the sputum may contain mucus plugs.

Microscopically,sputum may contain bacteria, pus cells, eosinophils(as in asthma and pulmonary eosinophilia) or malignantcells. It is helpful to know the volume of sputum producedeach day, and this can be particularly large: greater than20 mL in bronchiectasis, cystic fibrosis, and lung abscesswhen there is a bronchopulmonary fistula. Clinicalprogress can be monitored by documentation of sputumvolume. Occasionally patients with alveolar cell carcinomaproduce very large volumes of clear watery sputum (bronchorrhoea). Anaerobic infection results in foul smelling sputum.

Natural Cure in Bronchitis

Bronchitis is a disease of the lungs. It is an inflammatory disease. The pathogenic agents which determine Bronchitis are viruses, bacteria or fungi. Bronchitis is also influenced and worsen by the weather. So it is recommended to avoid wet weather and winds.

A natural cure includes different oils, a well balanced diet which means fruits, vegetables and honey.

One of the most recommended oils is the oil of wild oregano. It is very good in the battle against viruses, bacteria or fungi that release Bronchitis. This oil can be liquid or in capsules. If it is liquid it can be taken by adding three or four drops in a cup of hot tea.The capsules contain 450 milligrams of oil of wild oregano and it is recommended to take it twice daily between meals.

Regarding the diet it is recommended for the patients with Bronchitis to eat homemade soup and spicy foods, like garlic, curry, cayenne. This kind of food fortify the immune system and helps to kill germs and loosen mucus.

One of the Bronchitis symptoms is the persistent cough. It becomes very frustrating for the patients. It was showed that sipping cool water can suppress the cough. But there must be paid very much attention not to be cold water because it can cause spasm.

Mustard, ginger and olive oil are also good in the natural cure of Bronchitis. To brake up the mucus it is recommended to mix 1/2 teaspoon of mustard powder and 1/2 teaspoon of ginger powder with 1 to 2 teaspoons of olive oil. The patients have to rub their chest with this preparation before bedtime.

Zinc is a powerful antioxidant and antibacterial element which is very helpful in bringing the blood flow to the bronchial lining. The effect is easing the cough and it also helps to suppress the inflammatory response.

Inhaling cooled air for few minutes can be the solution to break up an episode of anoying cough. Bronchitis is recently diagnose to asthmatics and this method of inhaling cooled air can help stop an asthma attack.

Fruits are very healthy in general. In Bronchitis are very good especially the enzyme rich foods like papaya, pineapples and kiwi. They help to break down solidified mucus. There is also a very special fruit called huo-han-kuo which grows exclusively in the pharmaceuticals preparations and it is a natural expectorant and anti-tussive.

The lungs function can be strengthen by the intake of blueberries, red peppers and spinach. Their color indicates that they are very rich in antioxidants. Also when the spinach is cooked fat extracts lutein a very benefic antioxidants.

For external use it is also recommended the mint oil and the almond oil. These oils must be used for the massage of the chest and of the feet. Scientists showed that there are some places on feet connected to the lungs.

Propolis is a phitonutrient that kills viruses, bacteria and fungi which are involved in Bronchitis. Propolis is found in raw honey

For more resources on bronchitis or especially about chronic bronchitis please click this link

Physiotherapy and Early Shoulder Management

Physiotherapists and orthopaedic surgeons spend significant amounts of time and effort treating shoulder injuries and conditions, of which there are many. The shoulder, an unstable joint with a very large range of movement, the greatest in the body, is vulnerable in many situations to injury or mechanical stresses. Its instability means it can be relatively easily dislocated in a fall or activity at end range. We use the arm to save ourselves if we fall, making fractures common and heavy or overhead work over time leads to rotator cuff tears.

Physiotherapists pay close attention to the shoulder as there are many different operations, fractures and degenerative conditions which can affect this area and have an important role in the management of shoulder conditions after elective surgery or trauma, ensuring adherence to the surgical and rehabilitation protocols. On initially seeing the patient a useful strategy is to quickly go over the presenting problem from the beginning as this can indicate errors or misunderstandings which can then be corrected. Physiotherapists should also give the patients an opening so that they can feel they have told their story.

After operation or injury the weight of the arm hanging from the shoulder may need to be supported in a sling to reduce pain and allow damaged tissues to rest. The broad arm, triangular bandages are cheap but not comfortable around the neck and difficult to customise to the patient’s specific needs. Putting some foam round the strap at the neck may help slightly but a better solution is to use a Velcro based sling such as the Seton sling. Seton slings are greatly preferred by patients, are more comfortable and are easier to adjust to the specific requirements of the shoulder condition.

When fitting the Seton sling the elbow should fit right back into the gutter with the sleeve folded back slightly if necessary to allow the hand to be clear of the sling. There may be a small Velcro strap to place across the upper forearm to keep the gutter closed but this should not be tight or it can cut in to the tissues, especially if there is a lot of thick swelling such as after humeral fracture. The long strap is then taken from the elbow side of the sling over the opposite shoulder and down to the wrist. Tightening this up is where it gets trickier.

Due to the materials from which the slings are made there is a degree both of elasticity and friction against surfaces when they are adjusted. As the sling is adjusted and tightened up the elbow is often not well supported by the sling at all and patients are usually aware that the support is not that good. The physiotherapist can easily feel that the sling is not giving the correct support and if they just tighten up the strap it solely tightens up at the front but does not improve the support of the arm. This needs another strategy.

Two people are needed to adjust the sling in co-operation, a helper and the patient. The patient is asked to relax the arm as much as they can while the helper lifts the weight of the arm at the elbow, holding it there as they pull the strap from its attachment at the back of the gutter up and over the shoulder, then fixing it there with one hand. Continuing to hold onto the strap which has been pulled forwards the helper unstraps the Velcro fastening of the main strap and tightens it up. Checking the support of the elbow now will show it to be much better supported.

Sling management advice is useful for washing and dressing, for which the sling can come off. Putting clothes on should be using the affected arm first and the arm needs to be kept in by the body during the process with no active lifting of the shoulder. For washing if the patient keeps the arm bent by the tummy and bends forward they can get access to wash their armpit easily.