Monday, June 26, 2017

Introduction to Multivitamin Supplements and Understanding Megavitamin therapy.

A vitamin is one of a group of organic substances, present in minute amounts in natural foodstuffs that are essential for normal body metabolism.

There are 13 vitamins that a human  body needs. They are
  • Vitamin A
  • B vitamins (thiamine, riboflavin, niacin, pantothenic acid, biotin, vitamin B-6, vitamin B-12 and folate)
  • Vitamin C
  • Vitamin D
  • Vitamin E
  • Vitamin K
Each vitamin has specific function in the body and if there is a low levels of certain vitamins, there may be certain health problems and illness. 

Fat soluble and Water soluble Vitamins
Vitamins are either fat-soluble or water-soluble.

Fat-soluble vitamins are stored in the fatty tissues of the body and the liver. Fat-soluble vitamins are easier to store than water-soluble ones and can stay in the body as reserves for days, some of them for months.

Fat-soluble vitamins are absorbed through the intestinal tract with the help of fats (lipids).

Vitamins A, D, E, and K are fat-soluble.

Water-soluble vitamins do not get stored in the body for long - they soon get excreted in urine. Because of this, water-soluble vitamins need to be replaced more often than fat-soluble ones.

Vitamins C and all the B vitamins are water-soluble.

The best way to get enough vitamins is to eat a balanced diet with a variety of foods. In some cases, you may need to take vitamin supplements.

Vitamin Supplements; The best way to get enough vitamins is to eat a balanced diet with a variety of foods. In some cases, however vitamin supplements are indicated in some people in order to prevent or treat deficiencies.

Multivitamin and mineral supplements are easily available in different pharmacies so it is important to understand the need and indications for these supplements and to avoid dangerous overdoses. 

Indications For Vitamin Supplements: In otherwise healthy people, most scientific evidence indicates that multivitamin supplements do not prevent cancer, heart disease, or other ailments, and regular supplementation is not necessary. 
However, there may be specific groups of people who may benefit from multivitamin supplements for example,:
  • people with poor nutrition
  • couples planning for pregnancy 
  • During pregnancy & breast feeding
  • elderly individual
  • people living in sun deprived areas need vitamin D supplements. 
  • vegetarians etc

Sunday, June 25, 2017

Approach to a Patient Presenting With Pain

Pain is the most common symptom that brings a patient to a physician’s attention.
Management depends on determining its cause, alleviating triggering and potentiating factors, and providing rapid relief whenever possible.

Pain may be of somatic (skin, joints, muscles), visceral, or neuropathic (injury to nerves, spinal cord pathways, or thalamus) origin. Characteristics of each of the types are summarized below:

Somatic pain

  • Nociceptive stimulus usually evident
  • Usually well localized
  • Similar to other somatic pains in pt’s experience
  • Relieved by anti-inflammatory or narcotic analgesics

Visceral pain

  • Most commonly activated by inflammation
  • Pain poorly localized and usually referred
  • Associated with diffuse discomfort, e.g., nausea, bloating
  • Relieved by narcotic analgesics

Neuropathic pain

  • No obvious nociceptive stimulus
  • Associated evidence of nerve damage, e.g., sensory impairment, weakness
  • Unusual, dissimilar from somatic pain, often shooting or electrical quality
  • Only partially relieved by narcotic analgesics; may respond to antidepressants or anticonvulsants.

Acute Asthma - Assessment

Make an initial assessment of the severity of acute asthma based upon a combination of

  • clinical features, 
  • peak flow measurement and 
  • pulse oximetry 

This is as outlined as below.

Moderate exacerbation of asthma
• Increasing symptoms.
• Peak fl ow 50–75 % best or predicted.
• No features of acute severe asthma (below).

Acute severe asthma
Any one of the following:
• Inability to complete sentences in 1 breath.
• Respiratory rate ≥25/min.
• Heart rate ≥110/min.
• Peak flow 33–50 % best or predicted.

Understanding Hallucinations And Delusions

While dealing with psychiatry patients it is important to understand what having odd ideas mean and to  decide if a patient has delusions, hallucinations or a major thought disorder , because if present the helps in making a proper diagnosis and then a good treatment plan.

Patients may be reluctant to reveal odd ideas.
Ask gently:
“Have you ever had any thoughts which might now seem odd; perhaps that there is a conspiracy
against you, or that you are controlled by outside voices or the radio?”

Hallucination: is defined as a perception in the absence of external stimulus and these may be visual, auditory, tactile etc involving almost any of the five senses.
There are many different causes. It could be due to a mental illness like in schizophrenia or a nervous system disorder like Parkinson's disease. Tactile or visual hallucinations (without auditory hallucinations) suggest an organic disorder (e.g alcohol withdrawal).

Hypnagogic hallucinations and hypnopompic hallucinations are considered normal phenomena. Hypnagogic hallucinations can occur as one is falling asleep and hypnopompic hallucinations occur when one is waking up.

A pseudo-hallucination is one in which the person knows the stimulus is in the mind (e.g a voice heard within him- or herself, rather than over the left shoulder). They are more common, and does not indicate a mental illness, but they may be a sign that a genuine hallucination is waning.

Few treatments are available for hallucinations. However, for those hallucinations caused by mental disease, a psychologist or psychiatrist should treat the underlying medical illness.

Delusions are firm beliefs that do not change, even when a person is presented with conflicting evidence. If the belief arrives fully formed, and with no antecedent events or experiences to account for it, it is said to be primary, and is suggestive of schizophrenia

Sunday, June 18, 2017

Paracentesis - Procedure Technique

is a procedure to take out fluid that has collected in the abdomen the peritoneal fluid. This fluid buildup is called ascites Ascites may be caused by infection, inflammation, an injury, or other conditions, such as cirrhosis or cancer. The fluid is taken out using a long, thin needle put through the belly. The fluid is sent to a lab and studied to find the cause of the fluid buildup.
Removal and analysis of peritoneal fluid is important in evaluating patients with new onset ascites or ascites of unknown etiology. It is also indicated in patients with known ascites who have a decompensation in their clinical status.

Relative contraindications include

  • bleeding diathesis, 
  • prior abdominal surgery,
  •  distended bowel, or 
  • known loculated ascites.
Preparation Before the Procedure; 
  • Prior to performing a paracentesis, any severe bleeding diathesis should be corrected.
  • Bowel distention should also be relieved by placement of a NG tube, and the bladder should also be emptied before beginning the procedure. 
  • If a large-volume paracentesis is being performed, large vacuum bottles with the appropriate connecting tubing should be obtained.