Learning

A normal, healthy spleen is up to 12 cm long and 70 g in weight. An enlarged spleen may be up to 20 cm long and can weigh more than 1,000 g. Several things can cause your spleen to enlarge, including inflammation, fat storage, pooled blood, benign or malignant growths and overproduction of cells. Some causes are temporary and others may indicate a chronic or progressive condition.

Symptoms

An enlarged spleen typically causes no signs or symptoms, but sometimes it causes:

• Pain or fullness in the left upper belly that can spread to the left shoulder
• A feeling of fullness without eating or after eating a small amount because the spleen is pressing on your stomach
• Low red blood cells (anemia)
• Frequent infections
• Bleeding easily

When to see a doctor

See your doctor promptly if you have pain in your left upper belly, especially if it’s severe or the pain gets worse when you take a deep breath.

Causes

A number of infections and diseases can cause an enlarged spleen. The enlargement might be temporary, depending on treatment. Contributing factors include:

• Viral infections, such as mononucleosis
• Bacterial infections, such as syphilis or an infection of your heart’s inner lining (endocarditis)
• Parasitic infections, such as malaria
• Cirrhosis and other diseases affecting the liver
• Various types of hemolytic anemia — a condition characterized by early destruction of red blood cells
• Blood cancers, such as leukemia and myeloproliferative neoplasms, and lymphomas, such as Hodgkin’s disease
• Metabolic disorders, such as Gaucher disease and Niemann-Pick disease
• Pressure on the veins in the spleen or liver or a blood clot in these veins
• Autoimmune conditions, such as lupus or sarcoidosis

How the spleen works

Your spleen is tucked below your rib cage next to your stomach on the left side of your belly. Its size generally relates to your height, weight and sex.

This soft, spongy organ performs several critical jobs, such as:

• Filtering out and destroying old, damaged blood cells
• Preventing infection by producing white blood cells (lymphocytes) and acting as a first line of defense against disease-causing organisms
• Storing red blood cells and platelets, which help your blood clot

An enlarged spleen affects each of these jobs. When it’s enlarged, your spleen may not function as usual.

Risk factors

Anyone can develop an enlarged spleen at any age, but certain groups are at higher risk, including:

• Children and young adults with infections, such as mononucleosis
• People who have Gaucher disease, Niemann-Pick disease, and several other inherited metabolic disorders affecting the liver and spleen
• People who live in or travel to areas where malaria is common

Complications

Potential complications of an enlarged spleen are:

• Infection. An enlarged spleen can reduce the number of healthy red blood cells, platelets and white cells in your bloodstream, leading to more frequent infections. Anemia and increased bleeding also are possible.
• Ruptured spleen. Even healthy spleens are soft and easily damaged, especially in car crashes. The possibility of rupture is much greater when your spleen is enlarged. A ruptured spleen can cause life-threatening bleeding in your belly.

Diagnosis

An enlarged spleen is usually detected during a physical exam. Your doctor can often feel it by gently examining your left upper belly. However, in some people — especially those who are slender — a healthy, normal-sized spleen can sometimes be felt during an exam.

Your doctor might order these tests to confirm the diagnosis of an enlarged spleen:

• Blood tests, such as a complete blood count to check the number of red blood cells, white blood cells and platelets in your system and liver function
• Ultrasound or CT scan to help determine the size of your spleen and whether it’s crowding other organs
• MRI to trace blood flow through the spleen

Finding the cause

Sometimes more testing is needed to find the cause of an enlarged spleen, including a bone marrow biopsy exam.

A sample of solid bone marrow may be removed in a procedure called a bone marrow biopsy. Or you might have a bone marrow aspiration, which removes the liquid portion of your marrow. Both procedures might be done at the same time.

Liquid and solid bone marrow samples are usually taken from the pelvis. A needle is inserted into the bone through an incision. You’ll receive either a general or a local anesthetic before the test to ease discomfort.

A needle biopsy of the spleen is rare because of the risk of bleeding.

Your doctor might recommend surgery to remove your spleen (splenectomy) for diagnostic purposes when there’s no identifiable cause for the enlargement. More often, the spleen is removed as treatment. After surgery to remove it, the spleen is examined under a microscope to check for possible lymphoma of the spleen.

Treatment

Treatment for an enlarged spleen focuses on the what’s causing it. For example, if you have a bacterial infection, treatment will include antibiotics.

Watchful waiting

If you have an enlarged spleen but don’t have symptoms and the cause can’t be found, your doctor might suggest watchful waiting. You see your doctor for reevaluation in 6 to 12 months or sooner if you develop symptoms.

Spleen removal surgery

If an enlarged spleen causes serious complications or the cause can’t be identified or treated, surgery to remove your spleen (splenectomy) might be an option. In chronic or critical cases, surgery might offer the best hope for recovery.

Elective spleen removal requires careful consideration. You can live an active life without a spleen, but you’re more likely to get serious or even life-threatening infections after spleen removal.

Reducing infection risk after surgery

After spleen removal, certain steps can help reduce your risk of infection, including:

• A series of vaccinations before and after the splenectomy. These include the pneumococcal (Pneumovax 23), meningococcal and haemophilus influenzae type b (Hib) vaccines, which protect against pneumonia, meningitis and infections of the blood, bones and joints. You’ll also need the pneumococcal vaccine every five years after surgery.
• Taking penicillin or other antibiotics after your surgery and anytime you or your doctor suspects the possibility of an infection.
• Calling your doctor at the first sign of a fever, which could indicate an infection.
• Avoiding travel to parts of the world where certain diseases, such as malaria, are common.

A note from Bhavishya Clinic

An enlarged spleen is a symptom that healthcare providers need to investigate. Whether or not it’s causing you discomfort, it indicates an underlying condition that may need treatment. When it’s temporary, an enlarged spleen won’t harm your overall health. But chronic swelling could damage and endanger your spleen. Your healthcare provider will treat it by treating the underlying cause.

What is Down Syndrome?

Down syndrome is a disorder caused by a problem with the chromosomes — the pieces of DNA that have the blueprint for the human body. Normally a person has two copies of each chromosome, but a person with Down syndrome has three copies of chromosome 21. The condition also is called trisomy 21.  

In a few cases, the extra copy is part of another chromosome (translocation), or found in only some of the person’s cells (mosaicism). 

The extra DNA makes the physical and mental characteristics, which include a small head that is flattened in the back; slanted eyes; extra skin folds at the corners of the eyes; small ears, nose and mouth; big-looking tongue; short stature; small hands and feet; and some degree of mental disability.  

Down syndrome affects an estimated 1 in 800 births. It’s the most common chromosome problem seen in live births. 

Symptoms

In addition to the characteristic physical features and decreased mental abilities, other health problems frequently are seen. These include: 

• Hearing deficits 
• Heart problems 
• Intestinal abnormalities 
• Eye problems 
• Low levels of thyroid hormone 
• Skeletal problems such as joint instability 
• Poor weight gain in infants 
• Kidney and urinary tract anomalies 

People may develop leukemia more often than those without the disorder, and they are more likely to develop infections, problems with the immune system, skin disorders and seizures. 

Infants usually develop more slowly than other children of the same age, although a wide variation is seen. Language development is typically much slower, as is motor development. Their body strength may seem a little weak. For example, most toddlers walk between 12 and 14 months of age, but toddlers walk between 15 and 36 months. 

Diagnosis

Down syndrome frequently is suspected at birth based on physical appearance. The diagnosis usually is confirmed by a blood test to examine the chromosomes. Additional testing may be done, including chest X-rays, echocardiography and an electrocardiogram, to check for heart problems. Sometimes X-ray studies of the gastrointestinal tract are done as well. 

In some cases, Down syndrome is suspected during pregnancy from the results of a fetal ultrasound and blood test that measures the levels of three chemicals (a “triple-screen” test) in a pregnant woman’s blood. If these results are abnormal, further tests can be done to help diagnose it.

Expected Duration

Down syndrome continues throughout life.

Prevention

There is no way to prevent it. However, the chance of having a child with Down syndrome increases as the age of the mother increases. 

Treatment

There is no treatment to reverse the genetic abnormality that causes Down syndrome. However, many of the associated medical and developmental conditions can be treated to: 

• enhance the person’s quality of life 
• improve the child’s development, and  
• increase his or her life expectancy. 

Many health care professionals may be involved in assessing and planning the course of treatment for a child with Down syndrome. Surgery may be required for cardiac or gastrointestinal problems. 

Physical therapy and integrated special education services help children with Down syndrome to make the most of their abilities and reach their potential. Children with Down syndrome usually respond very well to sensory stimulation, exercises to help their muscle control, and activities to help their mental development. School helps children with Down syndrome to learn social, academic and physical skills that may allow them to attain a very high level of functioning and independence.

When To Call a Professional

Most cases of Down syndrome are detected early in life. Call your doctor if you suspect that your child has Down syndrome that has not been diagnosed or if you have questions about your risk of having a child with Down syndrome.

Prognosis

The outlook for a person with Down syndrome varies with the accompanying medical and developmental conditions. The outlook continues to improve, as educators and health care professionals recognize the importance of early interventions to promote both health and development. Advances in medical treatments have greatly improved the life expectancy for people with Down syndrome, with the majority living past age 55.

Theme of International Day of Older Persons: Resilience of Older Persons in a Changing World

The overall umbrella theme for the United Nations International Day of Older Persons in 2022 is “Resilience of Older Persons in a Changing World.” This theme will be celebrated by the NGO Committees on Ageing in New York, Geneva and Vienna – each with a unique and complementary approach to the overall theme.

Objectives

• To highlight the resilience of older women in the face of environmental, social, economic and lifelong inequalities
• To raise awareness of the importance of improved world-wide data collection, disaggregated by age and gender
• To call on member states, UN entities, UN Women, and civil society to include older women in the center of all policies, ensuring gender equality as described in the Secretary-General’s report, Our Common Agenda

Common health conditions associated with ageing

Common conditions in older age include hearing loss, cataracts and refractive errors, back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression and dementia. As people age, they are more likely to experience several conditions at the same time.

Older age is also characterized by the emergence of several complex health states commonly called geriatric syndromes. They are often the consequence of multiple underlying factors and include frailty, urinary incontinence, falls, delirium and pressure ulcers.

Background

On 14 December 1990, the United Nations General Assembly designated October 1 as the International Day of Older Persons (resolution 45/106). This was preceded by initiatives such as the Vienna International Plan of Action on Ageing, which was adopted by the 1982 World Assembly on Ageing and endorsed later that year by the UN General Assembly.

In 1991, the General Assembly adopted the United Nations Principles for Older Persons resolution 46/91. In 2002, the Second World Assembly on Ageing adopted the Madrid International Plan of Action on Ageing, to respond to the opportunities and challenges of population ageing in the 21st century and to promote the development of a society for all ages.

The composition of the world population has changed dramatically in recent decades. Between 1950 and 2010, life expectancy worldwide rose from 46 to 68 years. Globally, there were 703 million persons aged 65 or over in 2019. The region of Eastern and South-Eastern Asia was home to the largest number of older persons (261 million), followed by Europe and Northern America (over 200 million).

Over the next three decades, the number of older persons worldwide is projected to more than double, reaching more than 1.5 billion persons in 2050. All regions will see an increase in the size of the older population between 2019 and 2050. The largest increase (312 million) is projected to occur in Eastern and South-Eastern Asia, growing from 261 million in 2019 to 573 million in 2050.

The fastest increase in the number of older persons is expected in Northern Africa and Western Asia, rising from 29 million in 2019 to 96 million in 2050 (an increase of 226 per cent). The second fastest increase is projected for sub-Saharan Africa, where the population aged 65 or over could grow from 32 million in 2019 to 101 million in 2050 (218 per cent). By contrast, the increase is expected to be relatively small in Australia and New Zealand (84 per cent) and in Europe and Northern America (48%), regions where the population is already significantly older than in other parts of the world.

Among development groups, less developed countries excluding the least developed countries will be home to more than two-thirds of the world’s older population (1.1 billion) in 2050. Yet the fastest increase is projected to take place in the least developed countries, where the number of persons aged 65 or over could rise from 37 million in 2019 to 120 million in 2050 (225%).

Change the Way You Think About Age!

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.