Need of patient education about osteoarthritis.

Helping the patient to understand about osteoarthritis is important. It is a progressive wear and tear disease of old age. Poor understanding of the disease will lead to negative attitude in patients. For example ignorance about the disease may lead to lack of activity which further aggravate the disease. Patient education is an essential component of  treatment due to the following reasons.

Psychological and social factors will alter the effect of disease, proper education of the patient regarding the disease and effect will reduce the pain, distress, disability and it will improve the treatment compliance.

To protect the affected joint from excessive loading

1. Reduce the weight.

2. Patient should consume low fat, carbohydrate rich low calorie food for weight reduction.

3. Avoid inappropriate daily and occupational activities example knee lifts.

4. Use walking sticks.

5. Wear shock absorbing footwear.

6. Correct the disparity in leg length with shoe rise.

7. Tubular loose knee support may reduce the pain.

8. Use wedge insoles.

9. Proper advice should be given to maintain the normal joint function.

10.Advice aerobic fitness such as walking and swimming to maintain the joint motion and stability.

11. Do muscle strengthening exercise.

12. Regular physical activity.

13. Avoid over activity on good days because that may increase the pain and reduction of activities on subsequent days.

Proper modification of work place and home activities are required.

Advice regarding sexual activities should be given to the patient and the partner with hip osteoarthritis.

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Diagnosis of Ebola fever

Ebola viral fever is a dreaded fever with high mortality  rate, Early diagnosis of the disease is important for initiation of treatment. Following are the laboratory features. 

Laboratory findings

1. Decreased blood count initially.

2. Increase in neutrophil count later.

3.Fall in Platelet counts (sometimes much below) 50,000/µL.

4. Laboratory evidence of DIC is present but its clinical significance not known.

5. Increased  liver enzymes  alanine and aspartate aminotransferases.

7. Elevation of serum bilirubin.

8. The serum amylase level may be increased  indicating pancreatitis.

9. Deterioration of renal function can occur especially with low blood pressure .

Diagram of Ebola virus

Diagnosis

Most of the acutely sick patients will have high levels of viral load in the blood.

Methods of detection of virus include

1. ELISA is a sensitive diagnostic test.

2. Virus isolation and reverse-transcription PCR is useful.

3. Recovering patients develop antibody to ebola virus ( IgM and IgG antibodies ) that are detected by ELISA test.

4. The indirect fluorescent antibody test with paired sera is an effective test.

5. Quarantine or geographic spread is detected by Real-time PCR.

6. Skin biopsies is useful for postmortem diagnosis.

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Beneficial effect of exercise in osteoporosis

Osteoporosis is characterized by low bone strength. This condition is more common in females after cessation of periods (postmenopausal). The disease is associated with increased risk of fracture in various sites of body.

The main aim of treatment is strengthening of bone and muscles, prevent fall and fracture. The beneficial effects of exercise in osteoporosis patients are discussed below.

Exercise in young individuals help to attain maximum bone mass and strength.In elderly weight bearing exercise help to prevent the bone loss, but it wont increase the bone mass. The benefits decreases if they stop excise. There will be better effects if the exercise is done for longer period. Exercise should be done at least 3 times a month.

Exercise also help to improve the following

The strength of nerves and muscles.

Improve the coordination.

Improve the balance 

Thus help to reduce the fall.

Various exercise programs for osteoporosis
Selection of exercise program depends on the  physical condition and preference of the patient.

1. Walking program

5. Use of gym equipment.

2. Dancing

3. Racquet sports.

4. Cross country skiing

If the patient cannot do the above mentioned ones swimming and water sports are advised, but this has low effect on bone. This will help to strengthen the muscles.

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Causes of low back pain and alarming features in lowback pain

Low back pain is a common compliant in the population. At one time or another many of us experience low back pain. It may persist for few days or last for few months. Common causes of low back pain vary according to age.

15 to 30 years

Poor posture

Disc prolapse

Trauma

Fracture

Ankylosing spondylitis

30 to 50 years

Poor posture

Degenerative disc disease

Disc prolapse

Discitis

More than 50 years

Postural causes

Degenerative disc

Osteoporotic fracture

Cancer

Multiple myeloma

Following are the dangerous features in low back pain

Less than 20 years and more than 55 years

Non mechanical pain

Chest pain

Past history of cancer

HIV infection

Patients on steroids

Weight loss

Weakness of legs

Structural deformities.

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Serum cholesterol testing and its interpretation

Incidence of high serum cholesterol is increasing worldwide. This is due to alterations in lifestyle and food habits. High serum cholesterol is a risk factor for many disease. It increase the risk for heart disease and stroke.The interesting factor is that it is a controllable risk factor. 

Normal value

Total serum cholesterol

Desirable level ­<200mg/dl

Borderline­ level 200 to ­239mg/dl

High risk level > 240mg/dl

Fasting stating is preferred for LDL cholesterol checking. HDL and total cholesterol can be measured non fasting state. Cholesterol level is determined by lipid metabolism. Which in turn is affected by heredity, diet,liver kidney and thyroid disease.

Conditions where you get high serum cholesterol

1. Primary disorders of cholesterol metabolism.

• Polygenic hypercholesterolemia
• Familial hyperlipidemia.

2. Secondary causes of elevated cholesterol.

• Uncontrolled diabetes mellitus
• Hypothyroidism
• Biliary obstruction
• Anorexia nervosa
• Nephrotic syndrome
• Drugs ­corticosteroid
• Conditions with low serum cholesterol
• Severe liver disease
• Hyperthyroidism
• Severe acute and chronic illnesses
• Malnutrition and malabsorption
• Familial causes

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Causes of Loss of Appetite (anorexia)

Loss of appetite is called anorexia. A variety of disease can cause anorexia. It may be associated with significant weight loss. Anorexia should be differentiated from early satiety or painful swallowing. 

Following are the important cause of anorexia

Depression : Patients will have depressed mood ,disturbed sleep and inertia

Drugs : Certain drugs are well known to produce anorexia following are the common agents Digoxin, narcotics, diuretics, amphetamines, antidepressants (SSRIs), and antihypertensives (especially ACE inhibitors)

Anorexia nervosa : Patients usually avoid food than anorexia due to alteration in body perception. Seen in females they are usually very thin, hypothermic and will have constipation.

Congestive heart failure : Occur only in advanced heart failure. Patient will have leg edema and breathlessness.

Hepatitis : In patients with hepatitis anorexia occur prior to clinical jaundice. Patient will have associated right sided abdominal pain.

Cancer : Prominent in gastric and pancreatic cancer and in cancer with liver metastases. In these patients weight loss is out of proportion to anorexia.

HIV infection : Anorexia occur as a part of disease or due to opportunistic infection or due to side effects of drugs.

Uremia : Waxy oedema  sallow colour and  decreased urine output are seen.

Addison disease : It is due to deficiency of hormone cortisol. Patients will also have fatigue or tiredness low blood pressure increased skin pigmentation especially of palmar creases and buccal mucosa.

Mesenteric ischemia : patients will develop abdominal pain after food intake due to poor blood supply to intestine, so they avoid eating. Features of systemic vascular disease is found.

Hypothalamic lesion : Certain lesions of hypothalamus such as tumors can cause visual field defect and anorexia .

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