Author name: sukum

Patient with severe anemia (HB 1.8 g/dL) only with Leukonychia is treated, responded well on treatment and improved now.

Low Hemoglobin with Leukonychia – Anemia

Anemia is a condition in which the blood carries too few red blood cells. Because red blood cells carry oxygen to all tissues of the body, anemia can make it difficult for tissues to get the oxygen they need. This can cause many problems.

There are two main types of anemia:

• caused by decreased or defective production of red blood cells
• caused by increased destruction of red cells in the blood

Common types of anemia include:

• iron deficiency anemia, caused by blood loss or a shortage of iron in the diet
• vitamin deficiency anemia, caused by too little vitamin B12 or folic acid in the diet or an inability to absorb these vitamins from food
• anemia of chronic disease arises as a result of cancer, HIV/AIDS, Crohn’s disease, and other chronic conditions that interfere with the production of red blood cells
• aplastic anemia, an uncommon but potentially deadly condition caused by the inability of the bone marrow to make red blood cells
• anemia due to bone marrow diseases such as leukemia or myelofibrosis affect the bone marrow’s ability to make blood cells.
• hemolytic anemia occurs when the body destroys red blood cells faster than it makes them
• sickle cell anemia occurs in people who inherit genes for a type of hemoglobin that forces red blood cells to assume a crescent, or sickle, shape.

Anemia is very common. About 12% of women between the ages of 12 and 49 years have at least mild anemia, mostly from iron deficiency caused by blood loss during menstruation. Up to 20% of pregnant women develop it during their pregnancy.

Mild anemia may not produce any symptoms. It is most often detected through a routine blood test, such as a complete blood cell count.

Anemia Symptoms

The condition can cause a variety of symptoms. These include:

• tiredness
• shortness of breath
• feeling lightheaded
• headaches
• faster heart rate and breathing rate

Symptoms of anemia vary depending on how low the red blood cell count has dropped.

Anemia Treatment

Treatment depends on the type of anemia an individual has, its cause, and how severe it is. Treatments may be as simple as getting more iron, folic acid, or vitamin B12 in the diet or from supplements to taking medicines and possibly even procedures or surgery to stop blood loss.

1. Start off with confidence and assurance as start determines the end.

1. Starting off with a smile and a confident communication voice can be the first step in achieving a good patient relationship.
2. Referring to the patient by their name, or asking them how they were doing could make the patient comfortable in the first instance.
3. If the doctor is accompanied by a colleague, he or she should be introduced to the patient so the patient is not confused with the presence of other doctors in the room.
4. Sitting at eye level and maintaining good positive eye contact can also help the patient feel more confident with respect to the doctor.

2. Be a good listener As Active listening to your patient’s chief complaint and medical problems can sometimes be the ultimate route to the diagnosis.

1. Most of the time the patients speak up about tiny bits of medical history and important events while describing their conditions, and if the doctor is actively listening, that would give the patient more of a positive receptive field and encourage him or her to talk more freely.
2. This will help the doctor build a positive relationship with the patient which is of utmost importance when it comes to treatment acceptance and patient compliance.
3. Patiently waiting for the patient to finish and avoidance of any interruption is essential here. The unnecessary interruption will lead to a slightly more dominant approach from the doctor’s end and that can sometimes pull the patients back and they may be hesitant to talk ahead.
4. This process of patiently listening to the individual will also give the doctor some time to take down running notes which can help in treatment planning and providing the right care.

3. Talking in the patient’s language As Most of the time as medical professionals we are used to using medical terms so often in our practice, that we stick to the same practice and that can leave our patients confused at times.

1. After listening to the patient’s chief complaint, the process of explaining the reasons for the medical condition the patient is suffering and the suggested treatment should be explained in crisp and easy language which will be suggestive of all the important things the doctor aims to tell the patient.
2. Using the same language as the patient will make the patient all the more comfortable. In this process, the doctor can also aim at asking some important and relevant questions which can help in getting more information.
3. In terms of these questions, for instance, the doctor can ask more descriptive and open-ended questions which will give the patient more scope to describe the chief complaint rather than closed-ended questions which will prompt the patient to just answer a “yes” or “no”.

4. An empathy-driven approach As Just handing the diagnosis to the patient and walking away or giving away the prescription and asking the patient to leave the desk, will not only leave the patient uncertain about the diagnosis and treatment but will also leave a bad taste in the practice and the quality of healthcare.

A good and effective doctor-patient relationship will involve a lot of passive hand-holding by the doctor in order to guide the patient on the right path. And that can be done by using the approach of developing empathy toward the patients. As doctors, it is important that we listen to our patients and understand their points of view even if we have different opinions with respect to them.

5. Communication is not just talking As To develop a good rapport and help the patient understand the treatment and medication condition better the doctors can use the following approaches too to facilitate better communication.

Hand-outs for visual understanding:

• Short videos explaining common medical conditions
• Follow-up instruction sheets for better understanding
• Informative pamphlets or e-pamphlets for patient education
• Sending short informative videos/e-posters and messages on regular basis for patient education and for staying in touch with the patients
• Use of social media platforms

Effective communication with patients is an extremely important part of the role of doctors to provide high-quality healthcare. A good doctor-patient relationship can increase job satisfaction and that in turn will help the doctors work and function better. Also, it can be a very big source of motivation and reassurance to the ailing patient. It will mentally help the patient come to terms with the medical condition he or she is suffering and that will in turn help in a better and faster recovery.

What is Bell’s palsy?

It is an unexplained episode of facial muscle weakness or paralysis. It begins suddenly and worsens over 48 hours. This condition results from damage to the facial nerve (the 7th cranial nerve). Pain and discomfort usually occur on one side of the face or head.

It can strike anyone at any age. It occurs most often in pregnant women, and people who have diabetes, influenza, a cold, or another upper respiratory ailment. Bell’s palsy affects men and woman equally. It is less common before age 15 or after age 60.

It is not considered permanent, but in rare cases, it does not disappear. Currently, there is no known cure for Bell’s palsy; however, recovery usually begins 2 weeks to 6 months from the onset of the symptoms. Most people with Bell’s palsy recover full facial strength and expression.

What are the symptoms?

These are the most common symptoms:

• Disordered movement of the muscles that control facial expressions, such as smiling, squinting, blinking, or closing the eyelid
• Loss of feeling in the face
• Headache
• Tearing
• Drooling
• Loss of the sense of taste on the front two-thirds of the tongue
• Hypersensitivity to sound in the affected ear (hyperacusis)
• Inability to close the eye on the affected side of the face

These symptoms may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

What are the possible causes of Petechiae?

Several things can lead to petechiae, ranging from simple and reversible causes to serious illnesses:

• Endocarditis: Endocarditis is an infection in the lining of the heart. Other signs include fever, chills, fatigue, body aches and shortness of breath.
• Infection: Illnesses from bacteria, such as strep throat with scarlet fever, or Rocky Mountain Spotted fever (spread by ticks) can cause petechiae. So can viral infections, such as cytomegalovirus or hanta virus. Other signs of infection may include fatigue, fever, sore throat, swollen glands and tonsils, body aches, nausea and vomiting.
• Injury: Damage to the skin can cause petechiae. Examples include a car accident, bite, friction on the skin or even sunburn.
• Leukemia: Leukemia is cancer in the blood and bone marrow. Other signs of this disease may include weight loss, swollen glands, easy bleeding or bruising, nosebleeds and night sweats.
• Medications: Some medications may cause petechiae, including certain antibiotics, antidepressants and medications that thin the blood.
• Mononucleosis: Also called mono, this viral infection is common among young people. It often causes fatigue, headache, sore throat, swollen glands and tonsils, and fever.
• Straining: When you strain, you can break blood vessels under the skin. Examples include when you’re throwing up, lifting something very heavy or giving birth.
• Thrombocytopenia: With thrombocytopenia, you have low levels of platelets, which help your blood clot. It may also cause easy bruising, bloody noses or gums, blood in pee or poop, and yellowish skin and eyes.
• Vasculitis: Vasculitis is inflammation (swelling) in the blood vessels. It also causes fever, headache, weight loss and nerve problems (pain, weakness or numbness).
• Viral hemorrhagic fevers: Viral hemorrhagic fevers, such as Ebola and Dengue fever make it hard for the blood to clot. Other symptoms may include high fever, easy bruising or bleeding, body aches and weakness.
• Vitamin C deficiency: When your body doesn’t get enough vitamin C, you can develop scurvy. Other signs include swollen gums, achy joints, easy bruising and shortness of breath.

MDI without spacer

• Remove the cap and shake the inhaler.
• Take a deep breath and breathe out (exhale) all the way.
• Place the inhaler in your mouth. Close your lips around it.
• As you breathe in deeply, press down on the inhaler to release the medicine. Hold your breath for a count of 10, or as long as you can comfortably. Then slowly breathe out.

MDI with spacer

• Remove the caps from the inhaler and spacer and shake the inhaler.
• Take a deep breath and breathe out (exhale) all the way. Put the spacer between your teeth and close your lips tightly around the spacer.
• Spray 1 puff into the spacer by pressing down on the inhaler. Then slowly breathe in as deeply as you can. If you breathe in too quickly, you may hear a whistling sound in the spacer.
• Take the spacer out of your mouth. Hold your breath for a count of 10, or as long as you can comfortably. Then slowly breathe out.

On World Lung Day, 25 September 2022, the Forum of International Respiratory Societies (FIRS), of which GOLD is a founding member, calls on governments worldwide to address stark global inequalities in respiratory health.

The COVID-19 pandemic may have subsided, but its impact highlights a global lung health crisis that has not gone away.

Respiratory illnesses affect people in all countries, but disproportionally in low- and middle-income countries (LMICs) where resources for research, prevention, and management are scarce. To address such inequity, we must look beyond medical care to the social and environmental determinants of health such as tobacco use, air pollution, climate change and poverty.

Five respiratory diseases are the commonest causes of illness and death worldwide – chronic obstructive pulmonary disease (COPD), asthma, acute respiratory tract infection or pneumonia, tuberculosis (TB) and lung cancer.

What are Resting Tremors?

Characteristically resting tremors occur at rest, the classic slow, rhythmic tremor of Parkinson’s disease typically starts in one hand, foot, or leg and can eventually affect both sides of the body. The resting tremor of Parkinson’s disease can also occur in the jaw, chin, mouth, or tongue.

In addition, some people with Parkinson’s disease can experience a feeling of internal tremor, which is not necessarily noticeable to others.

Tremor is very common in Parkinson’s. It affects about 80% of people with Parkinson’s. Although many lay people, and even those with Parkinson’s disease themselves, think of tremor as being the main problem in Parkinson’s, it isn’t for most. For most people with Parkinson’s, tremor is not debilitating. However, a tremor is annoying. It also attracts attention, so that people tend to keep their bad hand in a pocket, or to sit on it during conferences. Since it disappears with movement, it turns out that tremor does not interfere severely with activities of daily living.

What is the Prognosis?

Resting Tremors are not considered as a life-threating condition.  Although many cases of tremor are mild, tremor can be very disabling for other people.  It can be difficult for individuals with tremor to perform normal daily activities such as working, bathing, dressing, and eating.  Tremor can also cause “social disability.”   People may limit their physical activity, travel, and social engagements to avoid embarrassment or other consequences.  

The symptoms of essential tremor usually worsen with age.  Additionally, there is some evidence that people with essential tremor are more likely than average to develop other neurodegenerative conditions such as Parkinson’s disease or Alzheimer’s disease, especially in individuals whose tremor first appears after age 65.

Unlike essential tremor, the symptoms of physiologic and drug-induced tremor do not generally worsen over time and can often be improved or eliminated once the underlying causes are treated.

• Dengue is a viral infection transmitted to humans through the bite of infected mosquitoes. The primary vectors that transmit the disease are Aedes aegypti mosquitoes and, to a lesser extent, Ae. albopictus.
• The virus responsible for causing dengue, is called dengue virus (DENV). There are four DENV serotypes and it is possible to be infected four times.
• Severe dengue is a leading cause of serious illness and death in some Asian and Latin American countries. It requires management by medical professionals.
• There is no specific treatment for dengue/severe dengue. Early detection of disease progression associated with severe dengue, and access to proper medical care lowers fatality rates of severe dengue to below 1%.
• Dengue is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas.
• The global incidence of dengue has grown dramatically with about half of the world’s population now at risk. Although an estimated 100-400 million infections occur each year, over 80% are generally mild and asymptomatic.
• Dengue prevention and control depends on effective vector control measures. Sustained community involvement can improve vector control efforts substantially.
• While many DENV infections produce only mild illness, DENV can cause an acute flu-like illness. Occasionally this develops into a potentially lethal complication, called severe dengue.