Screening and Prevention of Disease Conditions:

As we know “Prevention is always better then cure”. A primary goal of health services is to prevent disease or to detect early so that early interventions can be made. A primary goal of screening is early detection of the risk factor or the disease at a stage where it can be cured. Screening would be effective if it’s going to carry out in conditions as heart diseases, cancer, lung diseases which results in high death rates in each part of world. Screening of risk factors for lung diseases and cancer as smoking can be identified early, it puts on to your life when quitted at the start of your symptoms. Also identifying these risk factors and providing counseling helps. There are several conditions where screening is considered helpful in early diagnosis of diseases. Such conditions may or may not run in families. But, the conditions like breast cancer, colon cancer, poly-cystic kidney disease and many more may run in families if presented in early age group. These conditions can be ruled out or treated in other members if screening can be done in its earliest.

Here are few diseases whose screening methods are simple and effective by some means:

• Breast Cancer Screening in females: Mammography at age of 40 then every 1-2 years

• Cervical Cancer screening: Pap smear at age of 21 or within 3 years of onset of sex, then every 3hrs until age 65.

• Colon Cancer Screening: Colonoscopy at age 50 and every 10years. If family history is present then 10 year early to the age group of member diagnosed. If more than 3 members start from age of 25 and be done every 1-2 years.

• Diabetes: >45 years or earlier if additional risk factors present. Then every 3years.

• Blood Pressure, height, weight: >18 years and yearly

• Cholesterol: men >35; Women> 45 years of age and every 5years.

Some Questions of Medication

As we grow older above the age of 30, we begin to lose a part of our “organ reserve.” In youth, our hearts van pump ten times the amount of blood required to sustain life, our kidneys can excrete six times the waste products that we produce in our bodies each day, and every other organ has similar reserve powers that fortunately are very seldom required. After age30, we begin to lose this reserve at a rate of 1 or 2 percent each year. We don’t even notice the loss, unless we are in a situation in which we really need it. Loss of reserve power means that it is more difficult to restore the equilibrium of the body after a severe insult to a body function.

As we age, our bodies detoxify drugs at a slower rate. In medical terms, the drug is metabolized more slowly. A little goes along way. In essence, we can get the same effect for a lower dosage; the regular dose of a drug can become an overdose. The first rule that a good doctor observes with an older patient is to keep the dose low.

Side effects of medications can simulate disease, and unwary doctors and patients often mistake a drug reaction for an underlying medical problem. A small dose of codeine may cause severe fatigue and sleepiness, a little digitalis may cause profound nausea and vomiting, a diuretic to remove fluid from the ankles may cause dizziness and kidney problems. The second rule that a good doctor observes is to suspect that the whole problem might be a minor drug reaction, cured simply by removing the offending drug. The largest problems come from the anti-inflammatory drugs, such as aspirin, naproxen, piroxicam, ibuprofen, indomethacin, and meclofenamate. These drugs frequently cause bleeding from the stomach and often cause hospitalization or even death. Older people are at three times the risk of younger ones.

Entirely new side effects can appear in the elderly. A sleeping pill may keep the patient awake. A tranquilizer may excite the patient or cause severe depression. These paradoxical reactions are not fully understood, but they are very common. Again, the good doctor and the thoughtful patient or relative will suspect the drug first.

Skin Fungus Treatment

Anti-Fungul Preparation
Fungal infections of the skin are not serious, so treatment is not urgent. In general, the fungus needs moist, undisturbed areas to grow and will often disappear with regular cleansing, drying, and application of a powder to keep the area dry. Cleansing should be performed twice daily.
If you need a medication, there are effective non-toxic agents available. For athlete’s foot use one of the zinc undecylenate creams or powders, such as Desenex. In difficult cases, tolnaftate (Tinactin) is very effective. This agent is useful for almost all sin fungus problems, but it is more expensive.

Dosage
For athlete’s foot, use as directed on the label. For other skin problems, selenium sulfide is available by prescription in a 2.5% solution. Over the counter, a 1% solution is available as Selsun Blue shampoo. Use the shampoo as a cream and let it dry on the lesions; repeat several times a day to compensate for the weaker strength.

Side Effects
There are very few. Selenium sulfide can burn the skin if used to excess, so decrease application if you notice any irritation. Selenium may discolor hair and will stain clothes. Be very careful when applying any of these products around the eyes. And don’t take them by mouth.

Watch Your Salt Intake

Too much sodium (salt) in the system tends to retain fluid in the body, increasing the blood pressure and predisposing to problems such as swelling of the legs. The heart has to work harder with the increased amount of blood volume. Thus, it is good to decrease salt intake, the average person in United States takes in about 12 grams (g) of sodium each day, one of the highest intakes in the world. Our convenience foods and our fast foods are usually loaded with salt.  Salt is in ketchup, in most sauces, and in hidden form in many foods. You need to read the labels to find it: look for “sodium,” not “salt”, the recommended amount is 4 grams a day of salt for a typical person. You will get plenty without adding anything. Under a doctor’s advice, patients with problems of high blood pressure, heart failure, or some other difficulties may need to reduce salt much more radically.

Do you have the typical craving for junk food? Don’t despair, there are healthy snacks! One of our favorites: popcorn, butterless, hot-air cooked, sprayed with butter-flavored PAM, and sprinkled with a little Parmesan cheese. Even better, try popcorn with olive oil instead of butter, unsalted peanuts in the shell, or French bread basted with olive oil and toasted with oregano or garlic.

Obesity and Its Consequences

Obesity is defined as excessive collection of fat (adipose tissue) in the body. Fat tissues which are widely present in adipose tissue in our body are used to store excess energy. It releases stored energy as free fatty acids for the use of other sites. This energy can be used for humans to survive starvation for as long as months. Due to the adaptation of sedentary life style these fats get deposited in our various body parts and result in many adverse health consequences.

Measures of Obesity:

• BMI (Body Mass Index) = wt. kg/ Ht2 m.

                Normal = 19-25
                Overweight= 25-3
                Obesity >30
                Morbid Obesity >40

• Waist to Hip ratio= > 0.9 (W); > 1 (M)
• Anthropometry (skin fold thickness) = mostly used in children <5>

BMI is the most important indicator used widely.

Consequences of Obesity:

The definitive cause of obesity is unknown some says it may be due to genetical inheritance or due to the high intake of foods more than required. Obesity can result from increased energy intake, decreased energy expenditure, or a combination of the two. Thus, identifying the etiology of obesity should involve measurements of both parameters. This results in many adverse health conditions as

• Diabetes Mellitus
• Reproductive Disorders: Male- hypogonadism, Gynecomastia; female- Polycystic Ovarian Syndrome
• Heart Disease: Coronary Disease, Stroke, Heart Failure, Hypertension associated
• Pulmonary Disease: may cause increased work in breathing, Severe Obesity results in Obstructive Sleep Apnea ( snoring while sleeping)
• Gallstones: Obesity is associated with enhanced biliary secretion of cholesterol, super saturation of bile, and a higher incidence of gallstones, particularly cholesterol gallstones.
• Cancer: In males cancer of the esophagus, colon, rectum, pancreas, liver, and prostate; obesity in females is associated with higher mortality from cancer of the gallbladder, bile ducts, breasts, endometrium, cervix, and ovaries.
• Bone, joint and cutaneous disease: Osteoarthritis, Gout.

Treatment:

• Behavior modification: Eating Habits, Counseling regarding weight loss.
  
• Diet: Reduced Caloric Intake. A deficit of 1000 kcal/d should cause a loss of 1 kg per week. Advantages of very low calorie diets are the greater rate of weight loss compared to less restrictive diets. In patients on such diets, blood pressure, blood glucose, cholesterol, and triglyceride levels fall, and pulmonary function and exercise tolerance improve. Sleep apnea may improve within a few weeks. Complications of very low energy diets are: fatigue, constipation or diarrhea, dry skin, hair loss, menstrual irregularities, orthostatic dizziness, and difficulty concentrating.
  
• Exercise: It plays a major role in decreasing obesity and is valuable to sustain diet. Daily means of light exercise or jogging keeps oneself healthy and prevents from other health conditions as heat diseases.
  
• Drugs: Despite modest short-term benefits from several agents, medication-induced weight loss is not a cure and is often associated with rebound weight gain after the cessation of drug use. The use of these drugs has their own side effects too. This makes it hard to prescribe for long term use in cases of Obesity.
  
• Surgery: In response to typically ineffective treatment using diet, exercise, and available drugs, surgical approaches are increasingly being employed. The potential benefits of surgery include major weight loss and improvement in hypertension, diabetes, sleep apnea, CHF, angina, hyperlipidemia, and venous disease. Two procedures in common use today are the vertical-banded gastroplasty and the Roux-en-Y gastric bypass.

The Marketing of Medical Services

Increased competition in medicine is here. With nostalgia, we note a certain loss of dignity. Hospitals compete with other hospitals for patients. Health insurance plans compete with other plans. Doctors compete with doctors. There are advertisements and direct marketing to consumers (patients).

You need to be aware of these changes because once-conservative institutions are now trying to influence your choices. A new event, the hospital “chain” with facilities in many cities and national marketing practices, has developed. Payment for spectacular new technologies, such as the artificial heart, may be internally justified, at least in part, because it calls attention to the merits of particular companies. Marketing directors, or their equivalent, have been hired at many hospitals, even small ones. The hospital public relations director interacts with media, and regular press releases as well as attractive brochures are prepared.

To an extent, the marketing educates and aware of the features of the alternative choices you might make. But beware of hype and jargon. Guidelines from this blog might be more effective means of finding good-quality care than slick brochures and press releases.

Oral Poisoning and Home Treatment

Although poisons may be inhaled or absorbed through the skin, for the most part they are swallowed. The term ingestion refers to oral poisoning.

Most poisoning can be prevented. Children almost always swallow poison accidently. Keep harmful substances, such as medications, insecticides, caustic cleaners, and organic solvents like kerosene, gasoline or furniture polish out of the reach of children. The most damaging are strong alkali solutions such as drain cleaners (Drano and others), which will destroy any tissue with which they come in contact.

Treatment must be prompt to be effective, but accurate identification of the substance is as important as speed. Don’t panic. Call the doctor or poison control center immediately and get advice on what to do. Attempt to identify the substance without causing undue delay. Always bring the container with you to the emergency room. Life-support measures take precedence in the case of the unconscious victim, but the ingested substance must be identified before proper therapy can be instituted.

Suicide attempts cause many significant medication overdoses. Any suicide attempt is an indication that help is needed. Such help is needed even if the patient has “recovered” and is in no immediate danger. Most successful suicides are preceded by unsuccessful attempts.

Home Treatment

All cases of poisoning require professional help. Someone should call for help immediately. If the patient is conscious and alert and the ingredients swallowed are known, there are two types of treatment: those in which vomiting should be induced, and those in which it should not. Vomiting can be dangerous if the poison contains strong acids, alkalis or petroleum products. These substances can destroy the esophagus or damage the lungs as they are vomited. Neutralize them with milk while contacting the physician. If you don’t have milk, use water or milk of magnesia.

Vomiting is a safe way to remove medications and suspicious materials. It is more effective and safer than using a stomach pump and does not require the doctor’s help. Vomiting can sometimes can be achieved immediately by stimulating the back of the throat with a finger (don’t be squeamish!), or by giving two to four tea spoons of syrup (not extract) of ipecac, followed by as much liquid as the patient can drink. Vomiting follows usually within 20 minutes, but because time is important, using your finger to induce is sometimes quicker. Or you can try both methods. Mustard mixed with warm water also works. If there is no vomiting in 25 minutes, repeat the dose of syrup of ipecac. Collect the vomitus so that it can be examined by the doctor.

Before, after, or during first aid, contact a doctor. Many communities have established poison control centers to identify poison and give advice. These are often located in emergency rooms. Find out if such a center exists in your community, and if so, record the telephone number both on the accompanying decision chart and in front of this book. Quick first aid and fast professional advice are your best chance to avoid a tragedy.

If an accidental poisoning has occurred, make sure that it doesn’t happen again. Put poison where children cannot reach them. Flush old medications down the toilet.

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The Problem of the Multiple Problems

Most of the major diseases of our time are more common in the older patient. Diabetes, atherosclerosis, osteoarthritis, cancer, and the other major problems are more common with increasing age. And the older patient, with less organ reserve, may have several problems at once, thus creating special difficulties.

If you already have one significant medical problem, a second one is more serious than if it occurred when you were in good health. Because the simple rules do not apply as well in this situation, you have to use more judgment. In general, a combination of problems is more serious than the sum of the problems dealt with by themselves.

One problem can easily complicate another. High blood pressure can increase kidney failure, which can increase blood pressure. A problem of breathlessness caused by the heart can complicate breathlessness caused by lung disease. Arthritis can increase inactivity, which leads to promise in which all aspects of the situation are considered. You need a doctor to help you in these decisions much more often than in the uncomplicated, isolated illnesses of relative youth.

GOD Bless Pakistan - Happy 63rd Independence Day

Today is the great day in the history of Pakistan and is most important for every Pakistani. We’re having this lucky morning in the Holy Ramadan right after 63 years, when it was in the same Holy month and lucky enough to give us a separate homeland against countless sacrifices of our forefathers. In this perspective I would wish my nation a very Happy Independence Day, but truly speaking we’re not in a condition to celebrate this day as it supposed to be!



But, situation is not much different today as it was in 1947, because we’re going through a crucial time again as the nation is tackling with several situations like worst ever flood in the history of Pakistan that effected more than 150 million people and weak law and order situation. We are fighting hard to reclaim the peace and prosperousness in our lives as we did 63 years before and this is reminding us the sacrifices and hard efforts of that time. Today, I’m proud of my nation but ashamed of my president Zardari, because he is enjoying his luxurious life in Europe at the cost of flood victims. O ALLAH please forgive us and show him right path to accompany and help his poor people. I appeal to those Pakistanis who are well settled abroad to step forward and donate for their people.

I pray that ALLAH give us courage, patience and power to reunite and fight back to the normal and may ALLAH bless us all. In the end, I must say that we should all help our brothers and sisters as much as we can in this time of need and pray for all those who are not among us, may their souls rest in heaven.

Head Trauma and Treatment:

Head is the most important part of our body and the slightest trauma is to be observed carefully. It may cause severe symptoms and result. The commonest cause of the Head Trauma is Road Traffic Accident.

There are different mechanisms of Injury to Head:

· Closed Head Injury

· Impact of the brain on the skull may result in hemorrhage( collection of blood in Brain)

· Penetrating Injury

· Secondary Causes: may be due to the infections affecting brain, edema, due to poor blood supply to brain.

Clinical Presentation:

· Nausea, Vomiting, Loss of Consciousness are the most common complaints which should be acted promptly after a head trauma.

· Occurrence of Lucid Interval ( i.e. patient lose and gain consciousness which suggest hematoma)

· Amnesia ( related to the severity of the blow)

· Skull Fractures increase risk of hemorrhage and meningitis.

· On examination: We should look for the wounds and other injuries and also the neck region.

· Bleeding should be looked for- may be from eyes, from inside the ear or behind the ear, nose.

· Neurological examination should also be tested. Based mainly on the history of the level of consciousness. We must look for any abnormal signs in the patient accordingly as unable to move hand/legs; deviation of mouth; seizure; unable to speak; unable to remember the incident and serial examination of eyes/ears/nose done simultaneously.

Management:

· Initial step would be to assess the level of consciousness.

· Have to be careful regarding the neck trauma.

· Immediately at the hospital CT scan without contrast should be done as it identifies hemorrhage and contusion.

· Skull and facial X-rays

· Cervical Spine X-rays to rule out fracture or dislocation.

· Awake, alert patients are observed in the hospital for 24 hours with hourly assessment to detect deterioration.

· Surgical emergency evacuation done in cases of hemorrhage.

Constipation and Treatment

A natural diet is recommended with natural vegetable-fiber residue, to the use of any laxative. But if you must use a laxative, the most attractive alternatives are psyllium as a bulk laxative or milk of magnesia to hold water in the bowel and soften the stool.

Bulk (Psyllium Containing Laxative)

Metamucil and Effer-Syllium contain substances refined from the psyllium seed. They can help both diarrhea and constipation. Psyllium draws water into the stool, forms a gel or thick solution, and thus provides bulk. It is not absorbed by the digestive tract but only passes through; thus, it is a natural product and essentially has no contraindications or side effects. It has been recommended as a weight-reduction aid when taken before meals because it induces a feeling of fullness that may reduce appetite; however, it doesn’t seem very effective in this role.

Dosage

One teaspoonful, stirred in a glass of water, taken twice daily is a typical dose. A second glass of water or juice should also be taken. Psyllium is also available in more expensive, individual-dose packets, for times when you don’t have a teaspoon. The effervescent versions mix a bit more rapidly and taste better to some people.

Side Effects

If the bulk laxative is taken without sufficient water, the gel that is formed could conceivably lodge in the esophagus (the tube that leads from the mouth to the stomach). Sufficient liquid will prevent this problem.

Your Doctor Can Save You Money on Drugs

Your doctor plays a major role in the cost of drugs by choosing the drugs to be prescribed. For example, if you have an infection due to bacteria, you may be given tetracycline or erythromycin. Tetracycline costs about twenty cents a capsule, whereas erythromycin costs about $9. At the doctor’s option, a steroid prescription for asthma may be prednisone at 14 cents per tablet or methylprednisolone at $1 or more per tablet. Medically, such drug choices are between agents of similar effectiveness. If your doctor prescribes a drug by its trade name, in many states the pharmacist must fill the prescription with that particular brand-name product. The brand-name product frequently costs many times more than its “generic” equivalent. Does your doctor know the relative cost of alternative drugs? Many doctors do not.

The drug-prescribing habits of different doctors can be divided into two groups: the “additive” and the “substitutive.” With each visit to an “additive” doctor, you receive a medication in addition to those you already have. With a “substitutive” doctor, the medication you were previously taking is discontinued and a new medicine is substituted. Usually the “substitutive” practice is advantageous to your health as well as your pocketbook.

Most of the time, medication can be taken by mouth. Sometimes medication is given by injection because of the physician’s uncertainty that you will take the medication as prescribed; by injecting it, there is no question that the medication has been taken. However, as a thoughtful and reliable patient, you can assure your doctor that you will comply with an oral regimen. Taking medication orally is less painful, less likely to result in an allergic reaction, and far less expensive. There are exceptions, but whenever possible you should take medication by mouth rather than by injection.

If it is clear that you must take medication for a prolonged period, ask the doctor to allow refills on the prescription. With many drugs, it is not necessary to incur the expense of an additional doctor visit just to get a prescription written. However, under some circumstances, the doctor may prefer to examine you before deciding whether the drug can safely continued or is still required. Ask your doctor if refills on the prescription are permitted.

The careful doctor will ensure that you fully understand each drug that you are taking, the reasons you are taking it, the side effects that may arise, and the expected length of time that you will taking the medication. A daily medication schedule will be arranged so that it is convenient as well as medically effective. If the program is confusing, ask for written instructions. It is crucial that you understand the why and how of your drug therapy. Do not leave the doctor’s office for the pharmacy without understanding your medication.