Chronic bronchitis and COPD is a common pulmonary disorder amongst the Indian population. We see smokers, non-smokers and females, with prolonged complaints of dyspnoea on exertion, while walking into our outpatient department. A simple history and clinical examination can establish the diagnosis easily. What follows next are the facts, which a must for even anyone to know about this peculiar disorder.
Bronchitis can be called inflammation of the linings of bronchial tubes. These are the small tubes that pass air to your lungs and carry air from it. Individuals who have bronchitis frequently suffer from a cough along with the release of thick mucus. They are likely to suffer wheezing, chest pain and shortness of breath. There are two types of Bronchitis – acute and chronic.
Acute bronchitis may result from cold or other respiratory issues but improves within a couple of days without creating further discomfort. Chronic bronchitis is a more threatening condition, which develops progressively instead of striking all of a sudden. It can be described as recurrent episodes of bronchitis which tend to last for a long time. The constant inflammation of the airways results in an increased amount of sticky mucus present in the airways. And, this creates a hurdle when the air is passing in and out of the lungs. The blockage in the wind stream deteriorates after some time, bringing about breathing challenges and generates more mucus in the lungs.
Chronic bronchitis disease occurs when the coating of the bronchial tubes become inflamed and irritated constantly. The constant disturbance and swelling can harm the airways and cause the development of sticky mucus, making it troublesome for air to travel through the lungs. This prompts breathing challenges that continuously escalate and cause discomfort. The inflammation is likely to harm the cilia, which are the hair-like structures that assist in keeping the air passage free of irritants. When the cilia don’t perform appropriately, the airways turn into a breeding ground for bacterial and viral contaminations.
Contaminations normally trigger the underlying aggravation and swelling that leads to acute bronchitis. Chronic bronchitis is, however, mostly caused by cigarette smoking. In reality, more than 90 percent of those with the infection may have been smokers or have a history of smoking. Breathing in tobacco smoke also temporarily affects the cilia, so continuous smoking for a long period of time can cause serious damage to the cilia. Chronic bronchitis may worsen over a period of time due to these habits.
Second-hand smoke can also add to the cause of chronic bronchitis. Other causes incorporate long term exposure to air pollution, chemical and industrial dust and toxins and dangerous gases. Chronic lung diseases may further harm the lungs and aggravate constant bronchitis symptoms.
After an extensive period of aggravation and disturbance in the bronchial tubes, chronic bronchitis can result in several symptoms and it includes a relentless and heavy cough that releases mucus from the lungs. As time passes, the production of mucus increases gradually and it starts building up in the bronchial tubes creating discomfort in the air flow, which leads to causing more difficulty in breathing.
Being aware of the signs of a COPD exacerbation can go a long way in preventing the disease from worsening, and can also decrease the life-threatening risks that occur with a sudden onset of COPD symptoms.
A lung infection caused by a virus or bacteria, such as a cold or some other illness, can lead to COPD exacerbations. COPD symptoms can also suddenly worsen due to constant exposure to these harmful pollutants.
Many individuals do not bother about the symptoms of chronic bronchitis and misunderstand by thinking it as smoker’s cough. Nonetheless, it’s essential to contact your specialist immediately on the off chance that you have even the slightest doubt about having bronchitis. Neglecting the symptoms and treatment for chronic bronchitis significantly raises the danger of serious lung damage, which can prompt respiratory issues or heart failure.
According to Schechter, oxygen therapy is effective in prolonging life. Patients with COPD need to monitor levels at home, especially at night, and not solely rely on a test at the doctor’s office to determine if they may require oxygen therapy.
Rehabilitation is beneficial: People with COPD can also benefit from rehabilitation therapy, which includes being aware of COPD and the right diet to follow. Schechter says rehabilitation therapy should also involve physical activity and exercise training
“The physical conditioning is geared to people who have lung disease, and it can improve the patient’s endurance. Even though lung function may not improve, the person with COPD is able to be more physically active,” says Schechter.
Depression and denial are common: “Some patients may be embarrassed about having COPD, which leads to depression and denial,” says Schechter. “Many feel duped by cigarette companies and feel that they brought the problem (COPD) on themselves.”
Schechter urges patients with COPD who smoked to stop worrying. “Smokers are not self-destructive, lazy or unmotivated.” People smoke because they are addicted to nicotine, he says.
It is important to keep in mind that the more you know about COPD, the easier it is to control it.
Arthritis by definition is the inflammation of one, two or more joints. When one joint is involved, it is called monoarthritis. When two or three joints are involved it is called oligoarthritis. When four or more joints are involved it is called polyarthritis. There are more than 100 types of arthritis, but the most common type is osteoarthritis (OA) and rheumatoid arthritis (RA). Osteoarthritis (OA) is a progressive, painful joint disease that usually involves the neck, lower back, hips, knees or small joints of the hands.
The prevalence of osteoarthritis (OA) rises with age and as the world’s population continues to age, it is estimated that degenerative joint disorders such as osteoarthritis will impact at least 130 million individuals around the globe by the year 2050. Fifteen percent of individuals over the age of 60 are believed to suffer from this disorder. Women are more prone to osteoarthritis than men.
Osteoarthritis is thought to be the most prevalent of all musculoskeletal pathologies, affecting an estimated 10 percent of the world’s population over the age of sixty. Osteoarthritis ranks fifth among all forms of disability worldwide. Women are more prone to osteoarthritis than men. One in twenty men and one in twelve women will develop an inflammatory autoimmune rheumatic disease during their lifetime.
It is the most common type of arthritis. It is most often seen in adults over 40s or older. It is more common in women and people with family history of this disorder. However, it can occur at any age, due to injury or due to any other joint-related conditions, such as rheumatoid arthritis or gout. In osteoarthritis, the smooth cartilage lining of the joint is primarily affected. Due to which movement becomes more difficult leading to pain and stiffness. Once the cartilage lining begins to thin out and roughen, the tendons and ligaments need to work harder. Due to which swelling and the formation of bony spurs occur. Severe damage to cartilage leads to bone rubbing on bone, changing the shape of the joint and making the bones out of their normal position. The most commonly affected joints are spine, hands, hips and knees.
It usually starts when a person is between the ages of 40 and 50 years. Women are three times more prone than men. Rheumatoid and osteoarthritis are entirely two different disorders. Rheumatoid arthritis happens when the body’s immune system targets affected joints causing pain and swelling. The outer covering (synovium) of the joint is affected first. Then the disease spreads across the joint, leading to further swelling & change in the joint’s shape. This causes cartilage and the bone to break down. The tissues and organs in the body are also affected by rheumatoid arthritis
The cause of arthritis depends on the type of arthritis. Common causes include
RA and SLE are due to immune system dysfunction. Genetic markers increase the risk of developing RA.
Most types of arthritis are a result of a combination of factors. Some people are genetically more prone to certain arthritic conditions. Additional factors like infection, smoking, previous injuries and physically demanding occupations, interact with genes to increase the risk of arthritis.
Diet and nutrition play a very important role in the treatment of arthritis. Foods which increase inflammation like refined sugar and animal-derived foods can make symptoms worse.
Gout is a type of arthritis which is linked to diet and is caused by elevated levels of uric acid. High-purine foods like red wine, seafood and meat, increase the gout symptoms.
Arthritis limits the functions of the affected joints. Arthritis causes joint inflammation and results in swelling, joint stiffness, pain, redness, and warmth. The inflamed joint can be tender with or without pain. When large joints like knee joints are involved, there is a limitation of movement due to cartilage loss and joint damage. When smaller joints in the fingers are affected by arthritis, there will be loss of strength of hand grip.
Rheumatic disease is not limited to the joints. It can affect various other organs of the body. Symptoms can include gland swelling (swollen lymph nodes), fever, fatigue, weight loss, feeling unwell, and abnormalities of organs like the heart, lungs, or kidneys.
Certain risk factors have been linked with arthritis. Some of these are modifiable while others are not.
During a physical examination, the doctor examines all joints for pain, redness, swelling, warmth and movements. Depending on the type of arthritis suspected by the doctor, the following tests may be suggested.
The analysis of body fluids helps pinpoint the type of arthritis you may have. Fluids commonly analyzed include blood, urine and joint fluid. To obtain a sample of your joint fluid, your doctor will cleanse and numb the area before inserting a needle in your joint space to withdraw some fluid (aspiration).
These types of tests detect problems within the joint which cause the symptoms. Examples include:
X-rays are used to see bone, cartilage loss, bone spurs and bone damage. X-rays do not detect early arthritic damage, but help to see the progress of the disease.
Computerized tomography (CT) scan takes X-rays from various angles and combines them to produce cross-sectional views of internal structures. In CTs both bone and the surrounding soft tissues are noted.
Magnetic resonance imaging (MRI) combined radio waves along with strong magnetic field to produce cross-sectional images to view details of soft tissues of tendons, cartilage and ligaments.
Ultrasound is used to produce images of cartilage, soft tissues, and fluid-filled structures like bursae. Needle placement for joint aspirations and injections can also be guided by ultrasound.
Arthritis treatment focuses on relieving the symptoms and also improvement of the joint function. Arthritis can be treated with several different methods, or can be treated by combinations of different treatment modalities.
The medications vary depending on type of arthritis. Common medications used for arthritis include:
Physical therapy is useful for many types of arthritis. Exercises are used to improve the range of motion and strengthen the muscles that surround the joints. In some cases, splints or braces may be necessary.
If conservative measures don’t show any improvement the doctor would suggest surgery.
Arthritis by is inflammation of one, two or more joints and cause pain and swelling.
Types of arthritis are osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and reactive arthritis.
Age, Sex, Genetic factors, Obesity, Joint injuries, Infection, Occupation
In this blog, you will get an insight into the causes & symptoms of Appendicitis. Also, learn about the best Appendicitis treatment in India.
The appendicitis is an inflammation of the appendix. An appendix is a small, worm-shaped pouch present at the beginning of the large intestine. It is usually 5 to 10 cm long. The function of the appendix is unknown but some scientists say that it acts as a storehouse for good bacteria. Others believe that it is a useless remnant from human evolution. The position of the appendix varies between individuals.
Appendicitis is a medical emergency that requires immediate attention. It is also the most common cause of abdominal surgery. Appendicitis can occur at any age and equally affects both the men and women. However, it is slightly more prevalent in men who are 15 to 25 years old. Recent studies have shown a reduction of the number of cases of appendicitis in western countries. The incidence in Asian and African countries may be lower. But actual figures from these countries are not available. The prevalence of appendicitis is low in cultures where a high-fiber diet is consumed regularly.
Appendicitis occurs when a blockage of the appendix causes it to be infected and inflamed. The appendix becomes swollen, infected and painful in this situation. The inflammation can also spread to the body structures surrounding the appendix.
The resulting pain and symptoms can mimic other conditions like urinary tract infection or stomach ulcer. However, appendicitis is an emergency condition that requires immediate treatment. Diagnosis of appendicitis relies heavily on the experience of the doctor. The diagnosis is made from the physical signs of the patient and investigations. Pain in the right lower region of the abdomen is the most common symptom associated with appendicitis. Investigations like ultrasound and laboratory tests are carried out for further evaluation and for clear observation of appendicitis. Treatment of appendicitis involves medications to control the infection and removal of the appendix by surgery. Surgical removal of the appendix is called an appendectomy. If appendicitis treatment is delayed, then the patient may develop complications like perforation, abscess and peritonitis.
Appendicitis symptoms form a classic triad of stomach pain, vomiting and fever. But this typical presentation may not be presented in all cases.
Abdominal pain is the most common symptom of appendicitis. Typically, the pain starts in the middle of the abdomen and later shifts to the lower right side, where the appendix is usually located. The pain may worsen if the area where the appendix is located is pressed or while coughing or walking. In acute appendicitis, the affected individual experiences excruciating pain that causes him to bend his body by folding his legs to the chest.
The anatomic position of the appendix varies considerably between individuals. The location of the pain associated with appendicitis and the associated symptoms can also vary accordingly. An inflamed appendix near the urinary bladder may irritate the bladder and cause painful urination. If the appendix extends behind, inflammation can irritate the nerves and muscles behind and cause difficulty in walking.
Appendicitis symptoms vary among different individuals and according to the duration of the inflammation. Depending on the duration of symptoms and the presence of complications appendicitis may be classified as acute, chronic, recurrent or complicated appendicitis.
Acute appendicitis occurs when symptoms appear suddenly and with a severe intensity. It lasts for 24 to 48 hours. This is the most common reasons for abdominal surgery in appendicitis.
It occurs when the inflammation of the appendix remains undiagnosed and the symptoms last for up to 3 weeks. The symptoms may appear and disappear. Usually, chronic appendicitis is diagnosed when the intensity of pain increases and the patient presents like acute appendicitis.
It is diagnosed when a patient has multiple episodes of lower abdominal pain due to appendicitis.
If left untreated, the infected or inflamed appendix will either burst or perforate spilling the infectious material in the abdominal cavity. Complicated appendicitis occurs when an appendix bursts due to increased pressure within it or when the appendix loses all its blood supply and becomes gangrenous. An appendicular abscess is formed when pus collects within a sac in the region near the appendix.
An appendix with abscess can also perforate or explode. The infectious material can spread within the abdominal cavity and cause peritonitis (inflammation inner wall of the abdomen).
Appendicitis is diagnosed by a doctor by taking a patient’s history, physical examination and by conducting investigations.
During the physical examination, the doctor checks the vital signs such as blood pressure, body temperature, rate of respiration and heartbeat. The doctor would also conduct a detailed examination of the abdomen and locate the site of pain. Patients with appendicitis have fever, increased heart rate, pain in the right lower abdomen, and reduced movement of the intestines.
Medications are prescribed to patients with mild appendicitis. Some of the medications, which your doctor may prescribe you if you have mild appendicitis, are:
Appendicitis treatment primarily consists of surgical removal of the appendix (appendectomy). The surgeon will remove the appendix by using one of the two methods: open or laparoscopic surgery.
a) Open appendectomy
During an open appendectomy, a single incision is made in the lower right area of the abdomen to remove the appendix. However, this technique has been widely replaced by laparoscopic surgery.
b) Laparoscopic appendectomy
Laparoscopic surgery requires smaller incisions and is less invasive. The surgeon makes three small incisions (each 1/4 – 1/2 inch) and inserts a laparoscope (a tiny telescope connected to a video camera) through a cannula into one of the incision. It helps the surgeon to have a magnified view the internal organs on a television monitor. Several other cannulas are inserted through the other incisions and the appendix is removed. Laparoscopic surgery nvolves smaller incisions and the recovery period is shorter.
Pain medications and antibiotics may be prescribed after the surgery.
If a patient is scheduled for an appendectomy, he or she has to follow these suggestions to prevent complications:
No long-term complications are associated with an appendectomy. You can resume your work 2 to 6 weeks after the surgery. However, it is important to follow a healthy lifestyle for a good health.
No. Mild appendicitis can be treated with antibiotics and painkillers. However, patients with severe appendicitis need surgical removal of the appendix to prevent further complications and infections.
You should consult a physician, a general surgeon, or a gastroenterologist for appendicitis.
Appendicitis may happen around second or third trimester of pregnancy. It may cause a fetal loss due to exposure to infectious fluids. The diagnosis and treatment remain the same for a pregnant patient and any other patient. However, additional care will be required. The surgeon, general physician, and gynecologist will closely monitor the patient.
Meckel’s diverticulitis, pelvic inflammatory disease (PID), inflammatory diseases of the right upper abdomen, right-sided diverticulitis, kidney diseases, and ectopic pregnancy are some of the conditions that mimic the symptoms of appendicitis.
Acquired Immuno Deficiency Syndrome (AIDS) is a disease caused by human immunodeficiency virus (HIV). HIV damages the immune system and decreases the ability of your body to fight against infections and diseases.
In the early 1980s, doctors described unusual infections and cancers among gay men. These men developed unusual pneumonia caused by Pneumocystis carinii and cancers like Kaposi sarcoma and died due to a severe deficiency in their body’s immune defenses. By September 1982, CDC had named this condition as AIDS or acquired immune deficiency syndrome and proposed that it causes a defect in the cell-mediated immunity of the body. Later, the disease was also shown to affect intravenous drug abusers and patients suffering from hemophilia. In 1984, the human immunodeficiency virus was discovered as the cause of AIDS by scientists Luc Montagnier and Robert Gallo.
Clinically, HIV infection progresses through 3 stages, namely, acute primary infection, stage of clinical latency and AIDS. Throughout these stages, the immunity of the individual progressively decreases, and the number of immune cells present reduces.
When the immunity of the individual infected with HIV becomes extremely weak, specific immune cells in his body known as CD4 cells decrease below 200 cells/mm3, and he develops AIDS. AIDS is the most serious phase of HIV infection. In this phase, the patient suffers AIDS symptoms like severe, life-threatening infections, cancers and neurological complications of AIDS.
HIV infection is diagnosed by testing for antibodies against HIV in the blood of the patient. A few tests which detect the presence of viral DNA and CD4 cell counts are used to guide AIDS treatment.
According to worldwide the statistics published by the World Health Organisation, by the end of 2016, 36.7 million people were infected with HIV. Additionally, 1.6 million deaths occurred due to causes related to AIDS. The African continent has the highest number of people affected. Currently, AIDS is described as a pandemic, a disease which has spread across continents. People in developing countries are most affected, as HIV infection increases the chances of acquiring infections like tuberculosis and dying due to AIDS-related complications.
AIDS also affects the economy of the country because a majority of the individuals affected are in the productive age group. Studies have reported that ninety-five percent of individuals with HIV infection live in developing countries. Poverty, the presence of other severe illnesses, unavailability of appropriate medical care and ignorance aggravates the burden of AIDS in these nations.
AIDS is caused by the human immunodeficiency virus (HIV). These viruses are called retroviruses and belong to a genus called Lentivirus. There are two types of HIV: HIV-1and HIV-2.
HIV-1 is the most common virus present worldwide. It accounts for 95% of all the infections. HIV-1 has several subgroups, M, N, O, and P. Among these, subgroup M is the most widely prevalent.
HIV- 2 is less commonly prevalent. It has been reported from Western Africa, European countries like Portugal and France and India. It causes disease which progresses slower than that caused by HIV-1.
When these viruses enter the human body, they attach to immune cells called as CD4 T-cells. The virus has certain spikes called glycoproteins on its surface which interact with receptors on the surface of CD4 T-cells. CD4 T-cells are a type of white blood cells, which play an important role in the immune system. They attack harmful microorganisms and protect us from infections and disease.
The attached viruses enter into the CD4 cells and multiply within these cells. These cells become damaged by the multiplying virus. Therefore, the number of CD4 T-cells progressively decline to result in weakening of the immune system.
A strong immune system is required for defending the human body against infections. AIDS occurs when the infecting HIV causes the immunity of the body to be deficient. Consequently, AIDS symptoms include several infections which are otherwise not found in healthy individuals. These infections are called opportunistic infections. The degree to which the immune cells are destroyed also determines the risk of developing opportunistic infections.
The immune system also protects the body against cancers by eliminating mutated cells which can multiply indefinitely. The defense against cancer is also weakened in AIDS, and the patient suffers from several cancers.
The virus can also enter the brain very early on in the infection and multiply within the immune cells in the brain. These immune cells, the macrophages and monocytes of the brain, act as reservoirs for HIV infection and can cause progressive neurological damage.
In the initial stages, infection with HIV may not show any symptoms. As the immunity of the body progressively declines, symptoms of HIV infection begin to appear. It takes several years for the progression of the disease from initial infection to full-blown AIDS.
Symptoms of HIV infection depend on the stage of illness and the CD4 count of the individuals. There are three stages of HIV infection, which include:
Acute primary infection is the earliest stage of HIV infection. It usually develops within 2 to 4 weeks after the person is infected with HIV. During this stage, the virus multiplies rapidly and spreads throughout the body. The risk of spreading the disease is highest during this stage. Individuals may experience flu-like symptoms such as fever, headache, and rash during this stage.
Stage of clinical latency is the second stage of HIV infection. It is also called as asymptomatic HIV infection or chronic HIV infection. In this stage, the virus continues to multiply slowly, but the patient does not have any specific signs or symptoms. Some individuals may have persistent swelling of their lymph nodes. If no proper treatment is received during this stage, the infection may progress to AIDS. This stage may last up to 10 years in patients not receiving any treatment.
AIDS is the most severe stage of HIV infection. During this stage, the immune system is severely damaged. An HIV positive person is said to have AIDS when he or she has an AIDS-defining illness or a CD4 cell count less than 200 cells/mm3.
An AIDS-defining illness is a critical illness that occurs in HIV infected individuals. A significant drop in the immune cells that defend the body against infections and cancers occur in this stage. These may be opportunistic infections or cancers that occur due to reduced immunity.
Opportunistic infections are those infections that occur at a higher frequency in patients with the defective immune system.
Apart from this AIDS can also cause wasting syndrome. Patients experience prolonged diarrhea, fever and drastic weight loss.
AIDS dementia complex is a group of neurological complications of AIDS. It results in mental changes like confusion, forgetfulness and changes in physical activity like abnormalities of walking.
If no proper treatment is received during this stage, the patients typically survive for not more than 3 years.
Lack of adequate knowledge about HIV and its modes of transmission is the primary factor that increases the chances of exposure to HIV. Infection with HIV can occur in any individual regardless of their sexual orientation, race, gender, occupation or social status. However, certain practices and lifestyle behaviors may increase the likelihood of acquiring HIV infection. These practices are called as risk factors because they increase the risk of HIV infection.
Unsafe or unprotected sex means any sexual activity without the use of condoms. Unsafe sex is the leading risk factor for acquiring HIV infection. When you involve in unsafe vaginal, oral, or anal intercourse with an infected person, exchange of body fluids that contain HIV occurs. The virus enters your body from the sexual fluids.
The risk of AIDS is very high in an individual who has multiple sex partners as it increases the probability of having intercourse with an infected individual. Monogamous relationship with an uninfected individual protects you from acquiring HIV infection.
Presence of sexually transmitted diseases (STD) such as syphilis, herpes, and gonorrhea increases the risk of contracting HIV as it causes changes in genital tissues and increases the susceptibility of HIV transmission. Individuals who have other sexually transmitted diseases like gonorrhea are more likely to have HIV infection
Unsafe injection practices involve using the same syringe, needle or injection vial for several individuals, re-using single-use syringes, and improper disposal of used needles and sharp instruments. According to World Health Organization (WHO), nearly 5% of HIV infections took place due to unsafe injection practices. Using contaminated syringes and needles increase the risk of transmission of HIV from an infected person to a healthy individual.
Individuals who inject illicit drugs are more likely to share their needles. Studies have shown that individuals who inject drugs are 28 times more likely to develop HIV infection. The needles used by infected individuals, for injecting drugs, are hollow and can carry a significant amount of infected blood. When an uninfected individual uses the same needle, the virus is injected into the body along with the infected blood.
Unhygienic medical practices such as handling blood and body fluid samples without wearing personal protective equipment, reusing syringes and needles, inadequate disinfection techniques and improper waste management increase the risk of HIV infection among patients, and healthcare professionals.
Serological tests are the most common methods to diagnose HIV infection. In this test, the pathologist looks for the presence of antibodies to the virus in the infected person’s blood. It is important to undergo early testing if you have been exposed to HIV.
The antibodies to HIV usually develop 3 to 12 weeks after exposure to the virus. Early testing helps the affected individual to seek proper treatment and minimize the risk of transmission of HIV to healthy individuals by avoiding high-risk behaviors.
Serological tests for diagnosing HIV infection are
Enzyme-linked immunosorbent assay (HIV-ELISA) is a test used to detect HIV infection. HIV-ELISA detects antibodies in the blood to HIV. The pathologist will put a small amount from your blood sample to the ELISA plate and then adds an enzyme to it. Then he or she will observe how your blood and the antigen react. If your blood has HIV antibodies then the color of the ELISA plate changes. The intensity of the color change depends on the number of antibodies present in your blood sample.
HIV-ELISA is categorized into 1st, 2nd, 3rd, and 4th generations according to the advancements at each stage. Currently, 3rd and 4th generation HIV- ELISAs are most widely used. Fourth-generation HIV-ELISA can detect both antibodies and antigens. Therefore, they may detect the infection at an earlier stage.
HIV card tests are used for quick detection of the antibodies in the blood. These are rapid and give results within 20 minutes. They are easy to perform and can be used in field situations.
HIV- Chemiluminescent assay is a variation HIV-ELISA and is performed using automated instruments. These tests are highly sensitive and use the principle of chemiluminescence.
It is a blood test used to detect multiple HIV antibodies in the blood. The procedure for the western blot test requires a strip containing a series of proteins on a specialized blotting paper. The blood sample is made to react with the paper strip. An enzyme is used to cause color change and detect antibodies. If the person is HIV infected, several colored bands appear on a strip.
It is used to monitor the treatment progress or detect early HIV infection. It measures the amount of HIV present in your blood. It can be done using methods that detect the genetic material of the virus. These include reverse transcription-polymerase chain reaction (PCR), branched DNA assay (bDNA) and nucleic acid sequence-based amplification assays (NASBA).
Window period of HIV is the period that immediately follows the initial infection with HIV during which the infection is not detected by the tests used. During the window period, the patient is highly infected but the tests for HIV are negative. Most people develop antibodies to HIV between 3 to 12 weeks of infection. For fourth-generation ELISA, the window period is usually 4 weeks. Viral load tests may detect HIV nucleic acid by an average of 14 days. Due to the window period, if the test for HIV is initially negative following exposure, the test must be repeated after 2-3 months.
Although there is no cure for AIDS/ HIV, medications can reduce the multiplication of the virus and treat the complications of HIV. The medications used in AIDS are known as antiretroviral therapy. They decrease the number of virus in the body, improve your immune system and treat the complications associated with AIDS.
The doctor will check your viral load and CD4 cell count before prescribing the treatment. During the treatment, the viral load is checked every 3 months and CD4 count is monitored every 3 to 6 months to evaluate the effectiveness of the treatment.
Individuals who are infected with HIV have to take combinations of several anti-retroviral medications. A minimum of three drugs belonging to different classes is used. These combinations are called HAART or highly active antiretroviral therapy.
These drugs may also be used to prevent the transmission of HIV infection from an infected pregnant mother to the baby. For this reason, the WHO advises all pregnant women to be tested for HIV. Additionally, ART is also used to reduce the chances of HIV infection in healthcare workers following an accidental prick with an infected needle.
Anti-HIV medications can interact with others. These drug interactions can cause unwanted effects on your body so inform your physician if you are taking any other medications.
Sometimes HIV undergoes mutation while multiplying in the body and develops resistance to the medications. In such condition, the HIV medications which previously controlled HIV may not be effective and the person may need new drugs to control the propagation of HIV in the body. Poor patient adherence to HIV medications also increases the risk of drug resistance and causes treatment failure.
There is no vaccine against HIV infection. You can minimize the chances of acquiring HIV infection or AIDS by following these suggestions:
No. HIV is spread through the exchange of body fluids as in sexual contact, sharing needles, and blood transfusions or from mother to child during child birth. Staying in the same house as an HIV infected individual does not spread AIDS.
No. HIV is not transmitted by the bite of a mosquito or any other insects.
If you had unprotected sex, shared an injection, or suspect an exposure, then you should take the test.
Anti-HIV medications should be taken soon after a positive HIV test. However, consult your doctor and follow his or her instructions
to receive safe and proper treatment.
Acne is a skin condition that many people experience during their lifetime. It is commonly known as “acne vulgaris.” It is often seen in teenagers and younger adults due to hormonal imbalance. About 70 – 85% of the people affected by acne fall under the age group of 10-32 years. It affects girls (during 13 to 17 years of age) more than boys ( during 15-20 years of age). It usually disappears in the mid-twenties and may be present on and off for several years.
It occurs when hair follicles in your skin get clogged with dead skin cells, oil, and dust. It causes oily skin, spots and sometimes sore skin that is painful to touch and hot skin. It usually develops in different areas of the body such as:
Acne typically appears on your face, shoulders and upper back because these areas have sebaceous glands that produce excessive oil. It can be persistent and troubling. The acne can be of various types such as blackheads, whiteheads, pimples, papules, pustules, nodules, and cystic lesions.
Acne can vary from mild to severe forms. It can be divided into the following categories depending on its severity.
Mild Acne: People with this acne have comedones (whiteheads or blackheads). They are caused due to clogging of pores in the skin. Blackheads have skin pigment melanin that reacts with oxygen present in the air and hence looks black (it does not contain dirt). Whiteheads have a white or yellowish head and are closed pores. The acne will increase when more oil or sebum is produced in the skin and bacteria will multiply and lead to the inflammatory type of acne. If someone only has a few pimples, then it is considered as “mild acne.”
Moderate Acne: People with this type of acne have noticeably more pimples on their skin. When these pimples inflame, they are called papules or pustules. Papules are small bumps, and pustules are pimples filled with yellow pus.
Severe Acne: People with this type of acne has a lot of pustules or papules on the skin along with nodules and scars on their skin. These nodules are often painful and reddish.
Many effective treatments are available for acne. The bumps and pimples on skin heal slowly and may or may not leave a scar behind. Recurrence of acne is a major problem. The risk of problems caused by acne can be lowered by starting an early treatment. Severe cases of acne can cause emotional distress and depression in few patients.
Scarring can be seen in acne if it is severe. The wounds caused by acne are commonly found in the deeper layers of the skin. Some people have apparently visible indented scars (pockmarks) on their face while others only have small, flat scars that are hardly noticeable on their face.
The treatment of acne is a slow process and may take from months to years. Topical treatments may take up to three months to start working, but they have good results after they start working. Three medications that are proven to be effective on acne are benzoyl peroxide, retinoids, and also antibiotics. These medications target the acne by acting on different factors. In most of the patients, two of the below drugs can be used as an effective treatment for acne.
1) Benzoyl peroxide: It targets surface bacteria, P. acnes that often aggravate acne. Dryness or Irritation of skin is a common side effect. If it is not used as per the instructions or excessive application on the skin can cause peeling of the skin.
It must be used in wash formulations or lower concentrations. It is available as a face wash or leave-on gel. Few products that contain benzoyl peroxide (in low concentrations) may be advised by your doctor to treat acne.
2) Retinoids: Most of the patients are suitable candidates for retinoid therapy. They are vitamin A derivatives which act by breaking up of comedones (both whiteheads and blackheads). They help in preventing the formation of first lesions of acne and thus help prevent the clogging of pores. To prevent the formation of new bumps of acne, they must be applied to the entire affected area of the skin. The common side effects of this therapy are excessive dryness of the.
Isotretinoin: It is usually prescribed as an oral retinoid. It is used in patients with severe scarring or acne. This helps in shrinking of the size of oil glands (the anatomic origin of the acne). The acne diminishes if the oil glands are inactive. The course usually is given for five to six months. The common side effects are skin dryness; patients can also have elevated liver enzymes or blood lipids. Risk of the devastating birth defect is usually seen when given to pregnant women or women of childbearing age (women planning to get pregnant).
3) Hormone Therapy: It is helpful especially for those women with acne which flare up during menstruation cycle. The hormone therapy consists of
A medication that blocks the effect of male hormones (at the level of oil glands and hair follicle) known as spironolactone
Low-dose progesterone and estrogen (usually seen in birth control pills)
4) Antibiotics: Topical or oral antibiotics are used to treat acne. Erythromycin and clindamycin are applied on the skin or taken orally to prevent the accumulation of surface bacteria on the skin and often the inflammation of the skin is reduced. Antibiotics are most effective when used in combination with retinoids or benzoyl peroxide. It helps in preventing antibiotic resistance.
Antibiotic creams: If acne is caused by bacteria, it may be treated with stronger antibiotic creams advised by your doctor. Acne present on the back and chest is usually of bacterial origin.
Oral antibiotics: Tetracyclines are effective in treating acne. Other oral antibiotics that are useful in the treatment of acne are Amoxicillin, cefadroxil, and other sulfa drugs. Doxycycline can cause esophagitis (irritation of the esophagus) and an increased tendency to sunburn. Long-term use of tetracyclines can cause induce bacterial resistance and weaken the immune system.
5) Oral contraceptives: Low dose oral contraceptives can treat acne.
6) Spironolactone: This drug blocks hormone receptors such as androgen hormone receptors. It can cause menstrual irregularities, breast tenderness, and increased potassium levels in the bloodstream. It is generally well-tolerated in young women and in women with resistant acne.
7) Cortisone Injections: Doctors inject a form of cortisone to make large cysts and pimples to flatten out fast.
8) Light Treatments: Special lights and devices are used in the treatment of acne alone or in conjunction with photosensitizing dyes. These treatments can be effective and are safe. The best option is laser treatment of acne and is considered as an adjunct to conventional therapy.
9) Chemical Peels: Chemical peels (such as the superficial peels with glycolic acid) have supportive benefit. They do not substitute for regular therapy.
10) Treatment of Acne Scars: In some patients, acne leaves them with permanent scarring on the skin. Surgical procedures to elevate deep acne scars can be done. Smoothing out of shallow acne scars can be done by laser resurfacing.
11) Self-Care Measures: Many self-care measures can prevent acne and are helpful in having better skin.
12) Exercise: Regular exercise may not improve acne. But it can improve your self-esteem and boost your mood. Take a shower after the exercise as sweat can also clog the pores and worsen your acne.
Acne is a disorder of the follicle. It is evolving from the buildup of bacteria, dead skin cells, and the increasing amounts of sebum or oil that blocks up the pores
Acne prone skin is caused mainly due to two factors such as heredity and hormones. The dead cells on the skin build up on the follicle wall, clogging the follicle causing the skin to be acne prone.
The oil glands in the skin are “switched on” by hormones. This explains both the development of acne during puberty, as well as hormone-related acne flares associated with menstrual and pre-menstrual breakouts. Sebum or oil “coats over” the dead cells of the skin, forming plugs in the lower part of hair follicle called microcomedones.
Stress actually can cause hormone fluctuations. They can cause sudden surges of oil and inflammation of follicles that can lead to sudden breakouts of acne-causing acne flares.
The role of food in acne is relatively minimal. It is essential to have a balanced diet. Greasy food as such does cause acne.
Honorary Gynaecologist (IVF and Infertility specialist)
Infertility, Assisted Reproductive Technologies, Embryology and Stem cells
M.D., Ph.D., D.G.O., D.F.P.
Telephone: (+91) 24447831 / 24447832 / 24451515 / 24447000 / 24447500
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Undergraduates and postgraduate teaching experience for 25 years at King Edwards Memorial Hospital (KEM Hospital) and Seth G.S. Medical Hospital and College. Examiner for M.B.B.S., M.D. for several times in Maharashtra, Goa.
Guide for M.Sc and Ph.D. in Applied Biology, University of Bombay.
Editorial Board: The National Medical Journal of India.
Hinduja IVF Centre
P.D.Hinduja National Hospital and Medical Research Centre
Veer Savarkar Marg,
Mahim, Mumbai-400 016 India.
Tel. : (+91) 24447831 / 24447832 / 24451515 / 24447000 / 24447500
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Honorary Obstetrician and Gynaecologist
Breach Candy Hospital,
Nepeansea Road. Mumbai
Honorary Obstetrician and Gynaecologist
Department of Obstetrics & Gynaecology.
Jaslok Hospital & Research Centre
15. Dr. G. Deshmukh Marg,
Phone No. 24933333/ 24939595.
Editor of The Book “Assisted Reproductive Technologies, Current Methods and Future Directions” by Oxford University Press, New Delhi, 2001.
On editorial Board “The National Medical Journal Of India”.