SYSTEMIC LUPUS ERYTHEMATOUS

         SYSTEMIC LUPUS ERYTHEMATOUS

What is Systemic Lupus Erythematous?

 It is an autoimmune disorder characterized by inflammation of blood vessels and connective tissue resulting in multi system involvement .The clinical manifestations are variable and the course unpredictable. Childhood SLE is usually more severe and has a poorer prognosis than adult SLE. the hallmark of SLE is the presence of antinuclear antibodies. The female predominance characteristic of adult SLE usually not apparent in young children.

   What can be the causes of it?

(i)Genetic factors 
(ii)Environmental agents
(iii)Infectious agents
(iv)Ultraviolet rays
(v)Dietary factor
(vi)Effect of drug or chemical agents

 SLE is predominately a disease of women with frequency in 1in 700 among women between ages of 20-64 anf female to male ratio of 9:1,so age and gender is also a factor for systemic lupus erythematous.

What is diagnosis criteria for it?

  1  Positive immunoserology(antibodies to dsDNA/smith nuclear antigen) 

 2 Positive findings of  antiphospholipid antibodies(IgG/IgM anticardiolipin)   

 3 Lupus anticoagulants 

4  Positive antinuclear antibody test

5 Veneral disesase research laboratory test(VDRL)

What can be the symptoms of this disease? 

The symptoms of SLE is can be checked by physical examination of  the patient as a lot of signs of it can be identified through it, for example:

(i)The malar rash which is virtually pathognomic of SLE, may not be apparent initially.It involves the cheek, bridge of nose and lower eyelids but spares the nasolabial folds .

(ii)Discoid lesions are rare in childhood onset SLE.

(iii)Oral ulcerations may involve the buccal mucosa or palate and characteristically painless
(iv)Some children may have frontal alopecia.
(v)Arthritis is usually mild and always non erosive.
(vi)Renal involvement is a dreaded complication of SLE and one the commonest causes of mortality in children.

•  Neurological features may include psychosis ,seizures and chorea .There may be no correlation between the severity of clinical involvement and findings on neuroimaging .

• Hematologic abnormalities include a Coombs' positive hemolytic anemia,leukopenia,lymphopenia and thrombocytopenia . In addition there may be coagulation abnormalities due to secondary antiphospholipid antibody syndrome .Cardiac manifestations may include pericarditis,myocarditis or verrucous(Liebman-sacks) endocarditis.                                               

 Serological diagnostic values in diagnosis of this disease

+Almost all patients with SLE have demonstrable antinuclear antibodies.Presence of anti-double stranded DNA antibodies is highly specific of SLE.The titers of these antibodies usually correlate with disease activity .

+Anti-histone antibodies are characteristic of drug-induced lupus(e.g following phenytoin,isoniazid,hydralazine) but in such cases anti dsDNA antibodies are usually absent and serum complement level is not decreased.

+Anti-ro antibodies are believed to play a role in the development of congenital heart block characteristic of neonatal lupus syndromes.These heart blocks are permanent.Anti-Sm antibodies are a marker for CNS lupus.

 What shall be the treatment and therapies for such disease?

• Glucocorticoids and hydroxychloroquine form the main stay of therapy of lupus .

• Prednisolone is started in doses of 1-2 mg/kg/day and gradually tapered over several months ,according to disease activity.

• Arthritis usually responds to NSAID's.

• Life threatening complications (such as nephritis,myocarditis) may warrant use of intravenous pulses of methlyprednisolone(30mg/kg/day)for 3-5days 

• Rituximab, monoclonal antibody to CD20 has also been found to be effective in such situations .

• Use of monthly pulses of IV cyclophosphamide has considerably improved the long term outcomes

• Infections must be treated aggressively with appropriate antimicrobial s and the steroid dose hiked up during such episodes .

                                                         -BY DR. RAVI RANJAN

                                                        -BY DR. TANYA SHARMA 

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BRONCHIAL ASTHMA

                            BRONCHIAL ASTHMA

What is Bronchial Asthma ?

  "Bronchial asthma is a disease characterized by an increased responsiveness of the airways to various stimuli .It manifests by widespread narrowing of the airways causing paroxysmal dyspnea ,wheezing or cough.The diffuse obstruction to the airflow is reversible in a large majority of cases,either spontaneously or in response to treatment .Bronchial reactivity is a necessary component of asthma".

What can be the risk factors of it?

 

+Viral infections:more frequently it triggers airway narrowing as viral infections interfere with integrity of mucous surfaces by opening up tight inter-epithelial cell junctions and induce shedding of epithelium.

+Weather change:sudden change in the weather might result in:-

(i)loss of heat and water from lower airways.

(ii)sudden release of airborne allergens in atmosphere resulting in severity of asthma. 

+Emotional factors:emotional stress operated through the vagus nerve ,initiates smooth muscle contractility of bronchi.

+Endocrine factors:some endocrine changes including puberty may increase symptoms of asthma. 

What could be the clinical

 The clinical features of asthma are variable.

(1)Acute asthma usually begins with cold and spasmodic coughing.

(2)Dyspnea with prolonges expiration and wheezing.

(3)Sweating profusely,cyanosis may develop and may get fatigued easily and feel restless.

(4)feeling of airhunger and wheezing sound while breathing out.

(5)Loss of appetite

(6)Complaints like tightnes of chest and chest hurting.

(7)In chronic cases chest becomes barrel shaped.

Which criteria tells us about diagnosis of asthma?

 A prolonged whistling sound heard at the mouth during expiration (that is wheezing),a recurrent attacks of wheezing indicate Bronchial Asthma .

Cough,which is associated with asthma generally worsens during exercise.Chronic spasmodic cough may associates with asthma.

INVESTIGATIONS

• Absolute eosinophil counts
• chest x-ray film
• allergy test: skin test and radioallergosorbent allergen specific IgE have limited usefulness.
• spirometry  

 Pharmotherapy

 Use of medications that relax smooth muscle and dilate the airways and that decrease inflammation and thereby prevent severness of disease

 The medications used for longterm treatment of asthma includes bronchodilators,steroids mast cellstabilizers ,leukotriene modifiers and theophylline.

Drugs such as salbutamol can be used as bronchodilators ,inhaled steroids like beclamethasone and montelukast like can be used in children above 12 years of age.

  

 Management

The effective long term management of asthma involves :

(i)identification and elimination of factors causing asthma such as passive smoking,allergic disorders,inadequate ventilation at home leading to dampness,cold air ,cold food ,smoke,dust and pets in family.

(ii)wet mopping of floor should be done in home because dry dusting increases exposure to house dust.

(iii)adolescents should be refrain from smoking

(iv)exposure to strong or pungent odors such as wet paint,disinfectants and smoke should be minimized.

Monitoring and modification of treatment

After starting of treatment patients should be seen every 4-12 weeks.on each visit a detailed history regarding frequency of symptoms,sleep disturbance,physical activity,need for bronchodilators. 

 
!SAY NO TO SMOKING!

                                                                                                                
                                                                 -BY DR. RAVI RANJAN
                                                          -BY  DR.TANYA SHARMA                                           

 

 

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DIABETES MELLITUS

                               DIABETES MELLITUS

“Diabetes mellitus is increase amount of glucose inside the body because body doesn't produce enough amount of insulin for utilizing the glucose.”

    CAUSES :
Hypo-function of beta-cells inside the 
pancreas,smoking,alcohol,hypertension ,obesity, age is also a factor for the disease, genetic cause or heredity and it also depend on the topical region of living on the basis of race and backgrounds.

PATHOGENESIS(mechanism):
Diabetes mellitus is a condition in which functioning of pancreas is mainly associated as disturbance of insulin production and working takes place in this particular Heterocrine(having both endocrine and exocrine function) gland which  play a major role in human body. Pancreas works for some of the major processes such as controlling the blood sugar levels and also controls metabolism of our body. 
Pancreas consists of three cells which are involved in controlling of blood sugar levels.
             

1. Alpha cells= secretion of Glucagon is done by these cells when blood glucose levels are low
2. Beta cells=secretion of Insulin is done by these cells when blood glucose levels are high
3. Delta cells=these cells release a special enzyme called Somatostatin which maintain the levels of insulin and glucose release.

      So the conclusion is that if  beta cells doesn’t secrete enough Insulin and our cells stop responding to the insulin produced by the body then these are the signs of diabetes mellitus starting to show its effect on the organs of the human body.

CLASSIFIED INTO TWO TYPES 

1.TYPE I Diabetes mellitus

2.TYPE II Diabetes mellitus 

TYPE I{JUVENILE DIABETES}

It is insulin dependent diabetes mellitus in which our immune system attack the beta cells of pancreas and due this no insulin or less amount of insulin is produced that is why a person have to depend on insulin to control the blood sugar.

CAUSE: 
When the immune system and the body system fighting against infections due to this the immune cells destroy the beta cells of pancreas or by the genetical and environmental factor such as viral infectionsj

SYMPTOMS

• weight loss
• blurred vision
• fatigue
• dehydration
• mood swings
• specific smell in urine
• polyphagia
• dysuria

 TREATMENT: Insulin injections intravenously depends on the dose required in patient body (insulin injections  dose is decided by the doctors as per the laboratory tests)

TYPE II{ ADULT ONSET DIABETES}

  It is non-insulin dependent diabetes in which body produce enough amount of insulin but body resists to the effect of insulin that is why also called as insulin resistant diabetes but if a person do not take enough diet and medications to treat the type 2 diabetes it can progress and can lead to type 1 diabetes which happens due to decreasing ability of pancreas to produce insulin for the body.

CAUSE:Genetics ,overweight and environmental factors.

SYMPTOMS

• Slow healing 
• hearing impairment
• cataract
•  hypertension
• ketone bodies in urine
• neuropathy
• retinopathy
• sleep apnea
  
  

TREATMENT: 

•  Anti-diabetic drugs 
• Regular exercises
• Diet (eating food in 3-4 hour intervals in small portions)
• Control blood pressure and cholesterol level

“Blood glucose levels should be between 80 to 130mg/dl before the meals (fasting) and less than 180 mg/dl before taking meals.”


 DIAGNOSIS

• Blood glucose measurements 
• Fasting glucose tests
• Oral glucose tolerance test
• Urine culture (for ketone bodies)

           "TIPS:PRECAUTION IS BETTER THAN CURE!"

•                                                                -By DR.RAVI RANJAN

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NEURO AIDS

                                          Neuroaids                                                             The neurological implications of the HIV infection caused by direct influence of the virus on the nervous system          

         Causes:   By HIV virus

 1. The atypical aseptic meningitis - It develops acutely during the acute febrile phase of HIV infection. The clinical picture is presented by general infections (temperature to 39 C, chills, intense headache, weakness,sopor, sometimes there are hallucinations) and meningeal syndromes (the stiff neck, hyperesthesia and kernig’s signs are possibles)

 Treatment: In absolute majority of cases the meningitis passes without treatment in 2-4weeks. The treatment is symptomatic


2. The HIV associated encephalopathy( the aids dementia)- It is the chronic encephalitis .the clinical picture of the encephalopathy includes the progressing depression of intelligence. First of all the memory and attention is affected, it becomes difficult to read and solve complex problems. When encephalopathy progresses, the motor disorders like tremor , ataxia may be present and disorder of behaviour like apathy, abulia join.

Pathological changes: The brain atrophy, expansion of the brain ventricles.

3.The peripheral HIV neuropathies - Include the distal sensory polyneuropathy and antiretroviral toxic neuropathy. In typical cases the symptoms are bilateral ;they begin gradually with the pain

,burning sensation and morbid numbness . They are the most express in the area of the soles. The Clinical implications of the distal sensory polyneuropathy and anti-retrovirus toxic neuropathy are similar and it’s difficult to differentiate them.

Treatment:anti- CMV therapy, correction of metabolic wastes.
                              
                                                                    By Dr. RAVI RANJAN

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