Arthritis and its types

Arthritis is the inflammation of the joints. There are more than 100 different types of disorders. They primarily affect the skeletal muscles, bones, ligaments, tendons and the joints in both males and females of all ages. Some disorders are more likely to occur at a particular time of life or to affect one gender more than the other. These disorders not only limit mobility and affect the activities of daily living but also result in subtle systemic effects that lead to organ failure and death.

The different types of arthritis are grouped under different classifications:

1. Diffuse connective tissue diseases
a. Rheumatoid arthritis: Rheumatoid arthritis is an autoimmune disorder that causes the immune system to attack the joints, skin and vital organs of the body.
b. Juvenile arthritis: Rheumatoid arthritis in children is called Juvenile arthritis. There are more than 300,000 children diagnosed with juvenile arthritis in the United States.
c. Scleroderma: Scleroderma is a localized, systemic sclerosis affecting the connective tissue of the skin, blood vessels, muscles and internal organs.
d. Lupus erythematosus: Lupus erythematosus is also a chronic autoimmune disease. Discoid, systemic and drug related are their types.
e. Polymyositis: Polymyositis is a rare connective tissue disease that affects the muscles closest to the body, that is the shoulders and the hips.
f. Sjogren's syndrome: Sjogren's syndrome is an autoimmune disease affecting certain glands in our body. Eg: lacrymal gland, salivary gland.
g. Overlap syndromes: Overlap syndrome is a combination of two or more autoimmune diseases described above.
Polymyalgia, rheumatica and erythema nodosum are a few other minor autoimmune connective tissue diseases.

2. Arthritis associated with spondylitis (Spondyloarthropathies)
a. Alkylosing spondylitis: Alkylosing spondylitis is also called as rheumatoid spondylitis. It is the inflammation of the joints in the spine.
b. Reiter's syndrome: Reiter's syndrome is one form of reactive arthritis, which involves the inflammation within and around the joints, and particularly where ligaments and tendons attach to bones.
c. Psoriatic arthritis: Psoriatic arthritis is associated with psoriasis, the skin and the joints are inflammed.
d. Arthritis associated with inflammatory bowel disease.

3. Osteoarthritis: Osteoarthritis is also known as osteoarthrosis, or degenerative joint disease. They are of two types, they are primary and secondary.

4. Rheumatic syndromes associated with infectious agents:
a. Direct: They are inflammation of joints caused directly after a bacterial, viral, fungal or a parasitic infection.
b. Reactive: They are inflammation of joints that occurs after immunization or after bacterial or viral infections.

5. Metabolic and endocrine diseases associated with rheumatic states
a. Crystal associated conditions (gout, pseudogout)
b. Biochemical abnormalities (amyloidosis, hemophilia)
c. Endocrine diseases (diabetes, acromegaly)
d. Immunodeficiency diseases (AIDS)
e. Hereditary diseases (hypermobility syndromes)

6. Neoplasms: They are of two types;
a. Primary
b. secondary (metastatic, multiple myeloma, leukemia)

7. Neurovascular disorders
a. Charcot joints: Charcot's joints is a progressive degenerative disease of the joints. It is caused by nerve damage resulting in the loss of ability to feel pain in the joint and instability of the joint.
b. Compression syndrome: Carpal tunnel syndrome, rediculopathy, spinal stenosis are compression syndromes which involves the inflammation of joints.
c. Reflex sympathetic dystrophy: Reflex sympathetic dystrophy is also known as Complex Regional Pain Syndrome (CRPS), which is associated with extreme pain in the joints.
d. Raynaud's phenomenon: Raynaud's phenomenon involves discolorations of the fingers and/or the toes after exposure to changes in temperature (cold or hot) or emotional events.

8. Bone, periosteal, and cartilage disorders
a. Osteoporosis: Osteoporosis, mainly a disease of the bone that leads to an increased risk of fracture.
b. Osteomalacia: Osteomalacia is softening of bones due to bone mineralization. This is commonly found in children.
c. Hypertropic osteoarthropathy: Hypertrophic osteoarthropathy is caused by increased blood flow to the ends of the legs, causing overgrowth of connective tissue, and then new bone formation surrounding the joints and bones.
d. Diffuse ideopathic skeletal hyperostosis : Diffuse ideopathic skeletal hyperostosis is a form of degenerative arthritis that affects the joints and bones of the vertebral column.
e. Paget's disease of bone: Paget's disease is a metabolic bone disease that affects the pelvis, collar bone, legs, spine and arm.

9. Extra-articular disorders:
a. Juxtaarticular lesions(bursitis).
b. Epicondylitis, popliteal cyst.
c. Low back pain.
d. Intervertebral disc disorders.
e. Regional pain syndrome (metatarsalgia, cervical pain).

10. Miscellanous disorders associated with articular manifestations:
a. Palindromic rheumatism
b. Intermittent hydrathrosis
c. Sarcoidosis
d. Chronic active hepatitis.

Arthritis is a generic term which is used for over 100 different diseases which affect the musculoskeletal system especially the joints. Based on the part of the body affected and the type of the disorder, arthritis can be classified into different subtypes as mentioned above.

Upper and lower respiratory tract infection

Pneumonia and common cold are two different conditions affecting our respiratory system. Though they have a few similar symptoms there are a number of factors that differentiate pneumonia from common cold. They vary in their causitive organism, clinical manifestation, treatment, prevention and prognosis.

Let's compare pneumonia and common cold and learn the difference!

PNEUMONIA: Pneumonia is the inflammation of the lung parenchyma (lower respiratory tract infection) caused by infectious agents.

Causative agents: The causative agent varies with each type of pneumonia. Atypical pneumonia and bacterial pneumonia are the major classification which inturn has various subdivisions.

Bacterial pneumonia:
Streptococcal pneumonia - streptococcus pneumoniae
staphylococcal pneumonia - staphylococcus aureus
Klebsiella pneumonia - klebsiella pneumoniae
pseudomonas pneumonia - pseudomonas aeruginosa
Haemophilus influenza - haemophilus influenzae

Atypical pneumonia:
Legionnaires disease - legionella pneumophila
Mycoplasma pneumonia - mycoplasma pneumoniae
viral pneumonia - influenza virus types A, B, C
Pneumocystis carinii pneumonia - pneumocystis carinii
Fungal pneumonia - aspergillus fumigatus
Chlamydial pneumonia - cipittaci
tuberculosis - mycobacterium tuberculosis

Clinical manifestation: It typically starts with the sudden onset of fever usually above 100F, shaking chills, chest pain (pleuritic pain) aggrevated by coughing and breathing, nasal flaring, grunts, use of accessory muscles for respiration, head ache, myalgia and tachypnea. Bacterial pneumonia's manifestation varies with the organism which may include rash, pharyngitis, sore throat and nasal congestion.

Diagnosis: Pneumonia is diagnosed with history (recurrent, recent and untreated RTI's), physical examination(bronchial breath sounds will be heard on auscultation, increased fremitus on palpation, dullness on percussion), chest X ray and scans showing consolidation and dense areas, blood culture and sputum culture.

Treatment: Antibiotics is the first main treatment of choice which includes penicillin G, erythromycin, clindamycin, 2nd generation cephalosporins and bactrim.
Steam or moist inhalations with effective chest physio are effective to bring out the thickened secretions from the lungs.
Hospitalisation will be necessary for oxygen therapy and initial stabilisation. Some may need ventilatory support if it affects breathing.
Surgical measures like lobar pneumonectamy are also considered if they are attached to one particular lobe.

Prevention:
1.Treating upper respiratory condition is the best way to prevent pneumonia.
2.Do deep breathing and effective coughing exercises to bring out the secretions.
3.Take steam inhalation every week though you dont have any symptoms.
4.Avoid contact with infectious people.
5.Stop smoking.
6.Do not lie down in a particular position for a long time after surgery and older patients.
7.Promote oral hygiene.
8.Reduce alcohol intake.
9.Take nutritious diet.
10.Take vaccination against pneumococcal and influenza viral infections.

Prognosis: Prognosis is very poor with pneumonia especially if untreated. It is the fourth common cause of death in United States.

COMMON COLD: Common cold is as common as it's name denotes. It usually refers to the upper respiratory tract infection which affects the nose and throat.

Causitive agents: They are caused by contagious virus which sheds and spreads from person to person. The common viruses that causes this common cold are picornaviruses, cornaviruses, myxoviruses, paraviruses and adenovirus.

Clinical manifestation: Nasal congestion, sore throat, sneezing, mild chills with fever, stuffy nose, head ache, musle ache, malaise and cough are the common symptoms.

Diagnosis: They are confirmed usually with the presenting history and further investigations are done if the symptoms do not vanish in 2 weeks.

Treatment: There is no specific treatment for common cold. It is usually treated symptomatically. Increased fluid intake, adequate rest, taking vitamin and protein supplements, saline gargle, using analgesics, decongestants and cough expectorants.

Prevention:
1. Avoid contact with people affected with cold. Even a single droplet will cause infection.
2. Break the chain of infection by proper handwashing, proper disposal of tissues and covering the mouth and nose while coughing, sneezing etc.
3. Eat healthy food which includes fruits and vegetables.
4. Protect yourself in cold weather.
5. Avoid crowded areas.

Prognosis: There is no reported deaths due to common cold. Prognosis is usually good when you take measures.

Now you might have understood how critical and different is pneumonia from a common cold. Prevent yourself from both upper and lower respiratory tract infections and have a long life.

Eczema

Eczema is an inflammatory reaction of the skin caused by physical, chemical or biologic agents. The epidermis is inflammed or damaged by the repeated chemical or physical irritations. It falls under the classification of dermatitis that may be of irritant, non-irritant, allergic, phototoxic and photoallergic types. The type of eczema that arises after exposing to some kind of allergen is called as allergic eczema which is the most common type of eczema.

Eczema results from exposing to contact allergens or irritants.The common causes of irritant eczema are soaps, detergents, scouring compounds, and industrial chemicals. Pre-existing skin disease is the cause of non-irritant eczema. The predisposing factors of eczema include exposing to extremes of heat and cold, frequent contact with soap and water and the presence of any other skin conditions.

Eczema can affect anybody both adult and children alike. They also affect men and women equally since anybody can be allergic or sensitive to anything. It all depends on their own skin conditions. Men are more prone to produce eczematous reaction from the industrial chemicals because men tend to work in industries, while women are exposed to eczematous reaction when they come in contact with laundry or dish washing soaps and detergents.

Eczema begins when the causitive agent contacts the skin. The symptoms of eczema varies from person to person extending from itching to bleeding. The first reaction to eczema includes itching, redness, and burning, followed by edema, papules, vesicles, and oozing. Sooner the vesicles dries up, forms crust and finally peels. If the reaction occurs repeatedly, the person tends to scratch the skin which may lead to thickening of the skin and pigmentation. In course of time it may lead to bacterial infection.

The main aim of treating eczema is to rest the involved skin and protect it from further damage. Treatment for eczema includes,

* Application of bland, unmedicated creams or lotion over the inflammed skin to prevent them from further dryness.

* Application of a cool, wet dressing or Burow's solution over the vesicles to reduce itching and promote soothing.

* Applying a thin layer of topical corticosteroid in the form of cream or lotion.

* Medicated baths at room temperature may be prescribed for eczema which is over larger area of the body.

* A short course of systemic corticosteroids like prednisone may be advised for 7-10 days for those with severe conditions.

* Antibiotics may be prescribed if secondary infection occurs.

* Oral antihistamines may also be prescribed by certain doctors to control itching.

* Finely cracked ice added to the water can be applied over the affected area and also the fore head as a compress if fever occurs.

Tips to prevent eczema: It takes at least 4 months for an eczema to heal completely. Here are some of the tips that can prevent and as well as help in complete healing of eczema.

* Always keep your skin moist. Apply hydrophilic creams or petroleum jelly if you have a dry skin.

* Study the pattern and location of eczema and think over the things you touched that may have caused the problem.

* Try to avoid contact with those materials again.

* Avoid all kinds of external irritants like heat, soap, and rubbing.

* Avoid cosmetic creams or any topical lotion except the ones specifically prescribed for you.

* Wash your skin thoroughly immediately when you come in contact with any suspected irritants.

* Wear gloves while washing dishes or doing general cleaning. If you are using a rubber gloves make sure they are cotton-lined and don't wear them for more than 15 or 20 minutes at a time.

Since eczema is not a disease in itself, but body's reaction to certain stimulants, prevention is always better than cure. Always remember to avoid anything that causes a reaction to your body and take suitable precautions when you have to handle agents that might have adverse reactions on your body.

Prostatitis

Prostatitis is an inflammation of the prostate gland caused by infectious agents like bacteria, fungi, mycoplasma or by other problems like prostatic hyperplasia, urethral stricture. Microorganisms are carried to the prostate from the urethra. Prostatitis may be classified as bacterial or abacterial, depending on the presence or absence of microorganisms in the prostatic fluid. They can also be classified as bacterial or fungal or mycoplasmic prostatitis.

Prostatitis symptoms are perineal discomfort, burning sensation, urgency, frequency of urination, and pain with or after ejaculation. The symptoms of prostate problems affect the person more psychologically and adds stress to life. Prostatodynia is the medical terminology for pain in the prostate. It is manifested by pain on voiding or perineal pain without any evidence of inflammation or bacterial growth in the prostatic fluid.

The symptoms of prostatitis differs between acute bacterial prostatitis and chronic bacterial prostatitis. In acute bacterial prostatitis, the person may have sudden fever and chills, perineal, rectal or low back pain. Urinary symptoms such as dysuria (pain while urinating), frequency (passing urine very often), urgency (an urge to pass urine immediately or feeling of poor control), and nocturia (getting up more than once at night to pass urine) indicate prostatitis. On the other hand, some may have acute bacterial prostatitis and still be asymptomatic.

Chronic bacterial prostatitis may present with frequency, dysuria, and occasionally urethral discharge. But high fever and chills are uncommon. Chronic bacterial prostatitis is the major cause of relapsing urinary tract infection in men. Prostatitis is diagnosed with careful history and culture of the prostatic fluid or tissue. Three samples of urine/fluid is collected at three different stages of urination in three different container to check the origin of infection.

Prostatitis may lead to abscess formation and septisemia which is very dangerous to life. Swelling of the prostate gland due to prostatitis may cause urinary retention (stasis of urine) that may in turn lead to other complications like epididymitis (inflammation of the epididymis), bacteremia (bacteria in blood), and pyelonephritis (infection of the kidneys). Acute bacterial prostatitis can be treated with antibiotics and pain relievers, but chronic bacterial prostatitis is difficult to treat with antibiotics because the bacteria would have become resistant to all antibiotics.

Any type of prostatitis manifests with some kind of symptoms. If you notice any symptoms mentioned above, make sure you visit the doctor immediately. Prostatitis is curable and it is not a sexually transmitted disease and it is nothing to be embarassed of.

Dental hygiene

Dental hygiene is taken for granted because many of us do not know the facts about it. A good oral health is required for a good general health. There are a number of infections that are caused by poor dental hygiene, which involves not only the mouth but also respiratory, cardiac and gastrointestinal systems.

Facts about dental hygiene:

1. A complete dental hygiene can be achieved by spending about 3-5 minutes every morning and night. A complete dental hygiene means brushing the teeth, cleaning the tongue and gums, flossing and gargling.

2. It is proved that a good and healthy teeth can be maintained by using soft bristle tooth brush with fluoride paste. Teeth mush be brushed very gently in rotatory motion to avoid destruction of enamel and for the removal of food particles between the teeth.

3. Surveys state that only 35% of the American population know the exact technique of brushing and floss everyday which is the main cause of poor oral health.

4. Dental caries/decay, dental plaque, gingivitis, trench mouth, gingivostomatitis and periodentitis are some of the dental conditions that can be prevented by good dental hygiene.

5. Tooth decay is common in children due to their desire for chocolates and sweets which can be prevented by just making them brush or atleast rinse their mouth after they take them. This can even prevent them from losing their permanent tooth in later days.

6. About 90% of any dental infections can be prevented by just brushing the teeth before going to bed.

7. Choosing food is also very important for good oral hygiene. Fermentable carbohydrates and bacteria produces certain acids which dissolves the tooth enamel, thereby causing dental problems. Placing extremely cold foods like ice creams over the teeth or drinking cold sodas also has bad affects on the teeth.

8. Poor dental hygiene is the root cause for certain infections of the throat such as infective tonsilitis, many upper respiratory tract infections and also for cardiac conditions like rheumatic endocarditis/fever.

9. Dental hygiene shows the general health status. A dry and coated tongue indicates dehydration, bad breath indicates some infection of the throat or chest, sores in the tongue or buccal cavity indicate fever, vitamin deficiency and decreased immunity, white coated tongue may indicate candidiasis.

10. Poor dental hygiene not only indicates the problems of our body but also complicates many conditions like diabetes, pregnancy (by producing low birth weight and pre-term babies), worsens respiratory diseases, increases the risk of heart disease, causes strokes and heart attacks.

11. Visiting a dentist regularly is not going to do any good for your tooth unless you take good care of your teeth. But regular check ups will definitely spot the problems at an early stage and prevent complications.

12. Smoking, chewing tobacco and alcoholism causes poor oral hygiene and cancers of the oral cavity.

13. Smoking tobacco is one of the reasons for the tooth to fall at an early age because it destroys the supporting tissue that connects the teeth to the bone.

14. Milk and milk products not only give Calcium and potassium to mineralize the teeth but also increase the pH of saliva which protects the teeth from direct exposure to acids.

15. Chewing gums reduces bad breath and also cleans the gaps between the teeth.

Bladder and bowel incontinence

Bladder and bowel control are important functions of our body though many people do not realize that they can actually control this by their own personal approach a lot of the time. The inability to control bowel or bladder is called as incontinence. In other words, the involuntary elimination of urine or feces is called as incontinence. Incontinence curtails a person's confidence, causing embarrassment and isolation. About 15% of the elderly population have incontinence which is the main reason for their institutionalization in the United States.

Incontinence curtails a person's independence, causing embarrassment, isolation and often institutionalization of the elderly. About half the nursing home residents are either bowel or bladder incontinent or both.

There are different kinds of bladder incontinence. They are urge, reflex, stress, functional, and total incontinence. Each have their own reasons to cause incontinence. Urinary incontinence is exhibited as dribbling of urine on sneezing, coughing, lifting and in worst cases not knowing when they urinated. Bowel incontinence presents with constipation followed by small, frequent oozing of stools, accompanied with abdominal distention (bloating).

CAUSES FOR INCONTINENCE:

* Holding the bladder for more than 6 hours will cause urge or a strong perceived need to void resulting in incontinence.

* Any injury or lesion in the spinal cord that interupts cerebral control will result in incontinence.

* Weakened perineal muscles will permit leakage of urine when there is increased abdominal pressure (Eg: coughing or sneezing).

* Ageing is the next common cause of incontinence. This is because they have a mixer of problems like physical immobility, weak perineal muscles, poor eliminational cues, and various other medical conditions.

* Environmental barriers can also cause incontinence. (Eg: Inability to reach the toilet in time and use them without soiling themselves).

* It is caused when there is cognitive problems like delayed perception of need to void, poor verbalization of the need to void, and inability to learn to control urination.

* It is also caused when there is sudden psychological stress or impairment. Eg: Stupor.

* The medical condition in urinary system which may cause incontinence are urinary tract infection, detrusor instability, bladder outlet obstruction, neurologic impairment or bladder spasm/ contracture.

* Children suffer incontinence because they feel ashamed or scared to ask their teacher in front of other classmates which may result in wetting their pants before they reach the toilet.

* Elders have incontinence because of their inability to get to the bathroom, manipulate clothing, and use the toilet capacity can cause incontinence in any age. Decreased muscle tone and presence of increased residual volumes are a few other reasons that could cause incontinence.

* Various medications can alter eliminational patterns by affecting the volume of urine produced (eg:diuretics), altering sensitivity to bladder cues (eg: sedatives), and causing urinary retention (eg: antocholinergics).

* Incontinence may be caused temporarily in post natal women that can be corrected by kegel's exercises.

* Neurogenic factors like stroke, diminished or lack of sphincter control, diet, and immobility are the four common cause of bowel incontinence.

The involuntary leaking of urine or stools is the common symptom of incontinence. The symptoms may result after a urinary tract infection, detrusor instability, child birth, surgery in bladder/rectum or constipation. Urinary incontinence is classified as urge, reflex, stress, functional, or total incontinence.

The main goal in treating a incontinent person is bringing about regular eliminational patterns.

Promoting urinary continence: This is made successful if the person co-operates well and has an optimistic attitude. Skin integrity is maintained by washing, drying and use of moisture barrier ointment. Fluid intake is not restricted but voiding is scheduled. Fluids are administered 30 minutes before voiding attempt and the intake and output are strictly maintained. In addition, most of the fluids should be consumed before evening to minimize the the need to void frequently during the night.

*Bladder training: This approach for promoting urinary continence is useful for people with urge incontinence. A voiding schedule is formulated which specifies times for the person to try to empty the bladder using a toilet or commode. They are made to void every 2 hours initially and is not encouraged to void between the specified voiding time.

*Barrier free access to the toilet and modification of clothing help the person with functional incontinence to achieve continence.

*Habit training is used to keep the person dry by strictly adhering to the schedule. The caregiver takes the person to the toilet at scheduled time and this is more successful for stress, urge or functional incontinence.

*Biofeedback is a system through which the person learns consciously to contract excretory sphincters and control voiding cues. This is more useful for those with stress or urge incontinence.

*Pelvic floor exercises strengthens pubococcygeus muscle. The person is instructed to tighten the muscle for 4 seconds 10 times, 4 to 6 times a day.

*Clean intermittent catheterization is appropriate for those with urinary retention and distended bladder.

*Indwelling catheters is avoided in most cases to prevent infections. However, short-term use is needed during treatment of severe skin breakdown.

*External catheters like condom catheters are useful for male patients with reflex or total incontinence.

*Incontinence pads are used as a last resort. The pads must be changed frequently to avoid skin breakdown.

Promoting bowel continence: A bowel training program is helpful for people with bowel incontinence. A time is scheduled, preferably after breakfast. The reflexes are stimulated by rectal suppository(glycerine) 30 minutes before trying or by mechanical stimulation using a lubricated gloved finger. The stimulation will not be necessary once the bowel routine is established. The person should assume normal squatting position and bedpans should be avoided. A diet high in fiber with adequate fluid is required to promote regular bowel elimination.

As incontinence is symptom, it is hard for the person to miss out something that is happening in his own body. Once you realize there is something wrong, feel free to talk to your doctor about it because there are simple exercises that could solve this problem.

History plays a major role in diagnosing incontinence. The doctor and the nurse will enquire about the daily intake of fluids and the eliminational pattern, eating habits, perception of urination and defecation cues, about the intake of alcohol, any psychological problems, pregnancy and postpartum, ingestion of any regular medication, and the relationship of incontinence to other activities and factors. Presenting the above information will help the medical personal to identify the type of incontinence and treat them accordingly.

The main idea of treating incontinence is to promote continence and produce a regular eliminational patterns. It is achieved by various exercises like bladder training, habit training, pelvic floor exercices, eating a well balanced diet (rich in fiber), and improving physical activity. For no reasons fluids should be restricted. Severe and untreatable cases may need the use of clean intermittent catheterization, insertion of indwelling catheters, use of external (condom) catheters and incontinence pads for urinary incontinence and use of rectal suppository, stool softeners and digital evacuation for bowel incontinence.

Incontinence is normally an inability to control bowel and bladder and not a significant problem in human body. It is not a disease, it is just a symptom. If you feel you have incontinence, don't isolate yourself from social activities. Take necessary precautions and go on to lead a normal life.

Urinary tract infection

Inflammation of the urinary tract (bladder, urethra, prostate or kidney) is called urinary tract infection (UTI). The most common site of infection is the bladder. The normal urinary tract is sterile above urethra. UTI can present with or without symptoms. The pathogenic microorganism may be present in the urinary tract for several months or even years without symptoms.

Factors that contribute to cause urinary tract infection (UTI):
Bacteria in urine is the main cause of UTI. The normal bladder is capable of clearing itself from a large number of bacteria in two days. An infection occurs when the bacteria accesses the bladder, attaches, colonizes the epithelium of the urinary tract and is not washed out by voiding. They evade the host's defense mechanism and initiate inflammation.

Women are more prone to UTI than men because of the close proximity of urethra and anus. The majority of infections result from fecal organisms that ascend from the perineum to the urethra and bladder, and adhere to the mucosal surface. Pregnant women are even more prone to get UTI because of their urge to urinate frequently and incontinence. Poor hygiene after sexual intercourse is another important cause of UTI in women.

Men suffer UTI less frequently than women. The incidence of UTI increases with age and disability. Escherichia coli, Staphylococcus saprophyticus, Streptococcus faecalis, Proteus mirabilis and one or more species of Klebsiella, Enterobacter, Pseudomonas are the organisms that cause UTI.

Those with structural abnormalities of urinary tract, neurogenic bladder secondary to stroke or accident, or with autonomic neuropathy of diabetes will have inability to empty bladder completely. This is another important cause of UTI.

Elderly or post menopausal women are susceptible to colonization and increased adherence of bacteria to the vagina and urethra in the absence of estrogen. This is because of the poor glycogen content of epithelial cells and decrease in acidic pH.

Men become equally at risk as that of women when they reach their 50's. Prostatic hyperplasia or carcinoma, strictures of the urethra and neuropathic bladder are the other reasons of UTI in men.

The use of catheterization or cystoscopy (by not following aseptic measures) to evaluate and treat diseases of the urinary tract will also lead to UTI. Unconscious, stroke or comatosed patients, patients with fractured femur (those not ambulatory) or those who have undergone major surgeries are catheterized for longer time and they acquire infection through the indwelling catheter.

Men with confusion or dementia and those with bowel and bladder incontinence tend to have chronic bacterial UTI's because of the presence of residual urine or stasis of urine in bladder.

Urethrovesicle reflux is another important cause of UTI. The urine from the urethra flows back into the bladder bringing bacteria to bladder from urethra. This can happen with coughing, sneezing or straining.

Poor hygiene due to lack of knowledge is another reason for UTI. The urethra should be wiped first after urination or defecation (from front to back). Wiping from anus to urethra brings microorganisms from anus to the urethra and finally ascend.

Poor intake of fluids results in concentrated urine and stasis which again harbors bacteria and causes UTI. Bladder should be emptied every four hours to prevent UTI.

Computed Tomography (CT) scans

The CT/CAT scans stands for Computed Tomography which is the recent and modern diagnostic tool used by the medical professional team to identify and treat diseases. It is a machine which captures the images of the body that is to be studied in different cross sectional views and sizes. These images are examined in the computer monitor and printed. Any part of the body can be studied in depth including bones, blood vessels, soft tissues, brain or any internal organs. It uses powerful X- rays to capture images.

If you are planning to undergo a CT scan, it is everything you need to know about it. It includes the preparation, procedure, post-procedure and the uses of CT scan.

Preparation: Anxiety and fear of unknown will attack you if you are going for the procedure the first time. The procedure is painless but has little discomfort which is caused by lying still. A mild sedative will be administered before the procedure. An oral, intravenous or enema contrast will be administered. In case of oral contrast, you may experience metallic taste in the mouth, abdomnal fullness and some nausea. In case of intravenous contrast, a warm flushing sensation will be felt in the heart as well as metalic taste in the mouth which will last for few minutes. In case of enema or rectal contrast, you may feel the urge to expel it.

Rarely, people become allergic to these contrasts. Medical team will be readily available for your rescue in case of any anaphylactic reaction. If you experience any giddyness or breathing difficulty let the technician or the nurse in the room know. Then you will be positioned flat on the scanner. There will be a buzzing and whirling sounds coming from the machine.

Procedure: X-rays are passed through the body and images are captured. You may be asked to hold your breaths during the procedure. The procedure finishes within 15 to 30 minutes.

Post-procedure: After the procedure your results will be interpreted by the radiologist. The scan reports will be sent to the respective physician. You will be asked to drink a lot of fluids to excrete the contrasts.

Advantages:
1. It is an non-invasive procedure.
2. It has accurate results.
3. The procedure takes only a few minutes.
4. It has no side effects.
5. It can study any part of the body clearly and detaily.
6. It is cheaper compared to MRI.

Disadvantages:
1. It is expensive.
2. It emits radiation which might risk cancer in later days.
3. They are restricted to pregnant women and nursing mothers.

CT scans are proved to be the best diagnostic tool in recent times and the results are accurate. Hence make the best use of it.

Aspirin for teen acne

Understanding the causes of acne helps those that suffer from it have a better understanding of treating symptoms, and getting acne cleared faster and more efficiently. Acne is a common skin condition encountered by the adolescents and it affects both the sexes equally. The highest incidence is noted between the ages 14 and 17 for girls, and 16 and 19 for boys. It becomes more marked at puberty and during adolescence. Acne ia a follicular disorder affecting pilosebaceous follicles of the face, neck and upper trunk. They can present as whiteheads, blackheads, papules, pustules, nodules or cysts.

Acne appears to stem from an interplay of genetic, hormonal and bacterial factors. Each type is managed differently with different therapies. There is actually no predictable cure for the disease, but a combination of therapies will control the activity effectively. The basic treatment starts with skin hygiene, followed by dietary therapy, topical pharmacotherapy, systemic therapy and surgical treatment finally.

Aspirin, also called as acetylsalicylic acid is used as a topical treatment for acne. Aspirin is a non-steroidal anti-inflammatory drug and is used for treating many other problems as well. Aspirins are not used widely these days because of the difference in opinions about the effects and side effects of the drug. However, some doctors do prescribe aspirin for a few days because they are just applied topically over the skin lesions. The side effects like redness (erythema) and skin peeling should be immediately notified to the treating physician and the drug must be stopped on the first notice.

Aspirins act rapidly over the acne by reducing the inflammation at the site of application. They depress the sebum production and lead to the breakdown of the comedone plugs. The anti-inflammatory action suppresses the action of the organism causing inflammation. Initially there is some amount of redness and scaling noticed, soon the skin adjusts quickly to its use. Aspirin is available as over the counter and by prescription depending upon the combination and dosage used.

Instead of creams and gels, the aspirin tablets can be powdered and applied as face mask or used as a face wash. A few aspirin tablets should be powdered finely and made in the form of paste with water, then they are applied over the face, neck, upper back/chest (wherever required) as mask. They can be kept for 10-15 minutes and be washed with warm water. They have to be removed immediately if severe irritation or itching occurs. This can be applied once a week.

For face wash, a few aspirin tablets can be powdered coarsely and mixed with required amount of water (like a scrub) to wash the face. The face wash can be used once or twice a day daily. Again the adverse effects should be watched carefully. They are not advised for more than 12 weeks. It is better to consult your dermatologist before going for any such self treatments involving chemicals.

Most acne that arises during teenage are because of hormones and it resolves by its own without any treatment. But if it causes any problems like pain, pus discharge or scarring, its better to seek advice of the dermatologist and be treated accordingly. Washing the face daily (at least thrice) with plain warm water or mild cleansing soap will clear most of the acne.

Identifying COPD

Chronic obstructive pulmonary disease commonly called as COPD is a dreadful disease of the respiratory system. It is a combination of four lung diseases which includes chronic bronchitis, emphysema, bronchiectasis and asthma. It is not a communicable disease but it is an irreversible disease. It is said to be the fourth most common cause of deaths in United States and it affects over 25% of adult population.

SIGNS AND SYMPTOMS OF COPD: The clinical manifestation ranges from pink puffers to blue bloaters. The pink puffer is due to emphysema and the blue bloater is due to chronic bronchitis. The pink puffer state is due to redder complexion and the blue bloater state is due to cyanosis of the lips, nail and skin caused by increased carbon dioxide and decreased oxygenation to the lungs.

SIGN: The signs of COPD include,
1. On inspection, a typical COPD patient will
a. have a barrel chest (due to emphysema),
b. use their accessory muscles for breathing (sternocleidomastoid),
c. cyanosis,
d. Clubbing of fingers,
e. dyspnea,
f. shortness of breath,
g. tachypnea,
h. pursed lip breathing,
i. muscle wasting,
j. distended neck veins.
2. On percussion, the lung will sound dull or hyper-resonance instead of being resonant due to excessive mucus production and collection in the lungs.
3. On palpation, there can be,
a. palpable cervical lymph nodes (chronic bronchitis)
b. deviation of trachea (rarely)
c. asymmetrical chest wall movements (due to obstruction)
d. decreases tactile fremitus (emphysema)
4. On auscultation, you can identify a number of things like,
a. Wheezing and crackles (asthma)
b. cardiac dysrhythmias
c. tachycardia (due to increased effort to breath)
d. rales and rhonchi (due to congestion)
e. diminished breath sounds
f. prolonged expiration

X-rays show hyperinflation and congestion.

Arterial blood gas (ABG) will indicate respiratory acidosis and hypoxemia.

Pulmonary function test (PFT) will indicate decreased vital capacity, increased residual volume and slightly increased total lung capacity.

SYMPTOMS: A symptom is what the patient experiences and complaints due to a particular disease. The common symptoms are,
a. chronic cough
b. presence of sputum in cough
c. exertional dypnea
d. orthopnea
e. wheezing
f. tachypnea
g. shortness of breath
h. weight loss
i. fatigue
j. anorexia

Above are the classical signs and symptoms of COPD which are exhibited slowly as age increases. Avoid smoking, air pollution and occupational exposure to radiations/chemicals and avoid COPD!

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints.
Rheumatoid arthritis can also cause inflammation of the tissue around the joints such as the tendons, ligaments, and muscles, as well as other organs in the body.Rheumatoid arthritis is a chronic illness, meaning it can last for years, patients may experience long periods without symptoms. Typically, however, rheumatoid arthritis is a progressive illness that has the potential to cause joint destruction and functional disability.

The cause of rheumatoid arthritis is a very active area of worldwide research. The cause of rheumatoid arthritis is unknown. Some scientists believe that the tendency to develop rheumatoid arthritis may be genetically inherited.It is suspected that certain infections or factors in the environment might trigger the immune system to attack the body's own tissues.
Environmental factors also seem to play some role in causing rheumatoid arthritis. Recently, scientists have reported that smoking tobacco increases the risk of developing rheumatoid arthritis.

The goal of treatment in rheumatoid arthritis is
1.to reduce joint inflammation and pain,
2.to maximize joint function, and
3.to prevent joint destruction and deformity.
There is no known cure for rheumatoid arthritis.

Optimal treatment for the disease involves a combination of medications, rest, joint strengthening exercises, joint protection, and patient (and family) education. Treatment is most successful when there is close cooperation between the doctor, patient, and family members. Treatment is customized according to many factors such as disease activity, types of joints involved, general health, age, and patient occupation.

Two classes of medications are used in treating rheumatoid arthritis:

1. Fast-acting "first-line drugs" which includes NSAIDs (non steroidal anti-inflammatory drugs), COX-2 Inhibitors, Pain Medication (analgesics), Corticosteroids.
Acetylsalicylate (Aspirin), naproxen (Naprosyn), ibuprofen (Advil, Medipren, Motrin), and etodolac (Lodine) are examples of nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are medications that can reduce tissue inflammation, pain and swelling. NSAIDs are not cortisone. Aspirin, in doses higher than that used in treating headaches and fever, is an effective antiinflammatory medication for rheumatoid arthritis. Aspirin has been used for joint problems since the ancient Egyptian era.NSAIDs are usually taken with food. Additional medications are frequently recommended to protect the stomach from the ulcer effects of NSAIDs.

Corticosteroid medications can be given orally or injected directly into tissues and joints. They are more potent than NSAIDs in reducing inflammation, and in restoring joint mobility and function. Corticosteroids are useful for short periods during severe flares of disease activity, or when the disease is not responding to NSAIDs. However, corticosteroids can have serious side effects, especially when given in high doses for long periods of time. These side effects can be partially avoided by gradually tapering the doses of corticosteroids as the patient achieves improvement of the disease. Abruptly discontinuing corticosteroids can lead to flares of the disease or other symptoms of corticosteroid withdrawal, and is discouraged.

2. Slow-acting "second-line drugs" (also referred to as Disease-Modifying Antirheumatic Drugs or DMARDs) which includes gold, methotrexate, hydroxychloroquine (Plaquenil),Sulfasalazine (Azulfidine) and D-penicillamine (Depen, Cuprimine) promote disease remission and prevent progressive joint destruction, but they are not anti-inflammatory agents.
Both classes are mixed for certain patients to obtain relief. Some patients are treated by injecting certain drugs directly and locally into the joints.

Newer "second-line" drugs for the treatment of rheumatoid arthritis include leflunomide (Arava), and the "biologic" medications etanercept (Enbrel), infliximab (Remicade), anakinra (Kineret), and adalimumab (Humira). Leflunomide (Arava) is available to relieve the symptoms and halt the progression of the disease. It seems to work by blocking the action of an important enzyme that has a role in immune activation.

Etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira) are biologic medications. These medications intercept a protein in the joints (tumor necrosis factor, or TNF) that causes inflammation before it can act on its natural receptor to "switch on " inflammation.

Anakinra (Kineret) is another biologic treatment that is used to treat moderate to severe rheumatoid arthritis. Anakinra (Kineret) works by binding to a cell messenger protein (IL-1, a proinflammation cytokine).

Rituxan can be effective in treating autoimmune diseases like rheumatoid arthritis because it depletes B-cells, which are important cells of inflammation and in producing abnormal antibodies that are common in these conditions. Rituxan is now available to treat moderate to severely active rheumatoid arthritis in patients who have failed the TNF-blocking biologics.

Orencia (abatacept) is a recently developed biologic medication that blocks T-cell activation. Orencia (abatacept) is now available to treat adult patients who have failed a traditional DMARD or TNF-blocking biologic medication.

The Prosorba column therapy involves pumping blood drawn from a vein in the arm into an apheresis machine, or cell separator. This machine separates the liquid part of the blood (the plasma) from the blood cells. The Prosorba column is a plastic cylinder about the size of a coffee mug that contains a sand-like substance coated with a special material called Protein A. Protein A is unique in that it binds unwanted antibodies from the blood that promote the arthritis. The Prosorba column works to counter the effect of these harmful antibodies. The Prosorba column is indicated to reduce the signs and symptoms of moderate to severe rheumatoid arthritis in adult patients with long standing disease who have failed or are intolerant to disease-modifying anti-rheumatic drugs (DMARDs). The exact role of this treatment is being evaluated by doctors and it is not commonly used currently.

In some patients with severe joint deformity, surgery may be necessary that may range from arthroscopy to partial and complete replacement of the joint.

Some go for natural treatment which include Acupuncture / Acupressure, Biofeedback, Chiropractic, Magnets, Massage, Meditation, Tai Chi, Yoga.
Supplements such as fish oil, glucosamine, chondroitin, MSM are also used. It is not confirmed if these are effective.

complimentary medicine includes regular exercise, eating a nutritious diet and the stress management.Heat and cold applications are modalities that can ease symptoms after exercises.

Future treatments: Scientists throughout the world are studying many promising areas of new treatment approaches for rheumatoid arthritis. These areas include treatments that block the action of the special inflammation factors, such as tumor necrosis factor (TNFalpha) and interleukin-1 (IL-1), as described above. Many other drugs are being developed that act against certain critical white blood cells involved in rheumatoid inflammation. Also, new NSAIDs with mechanisms of action that are different from current drugs are on the horizon.

Studies involving various types of the connective tissue collagen are in progress and show encouraging signs of reducing rheumatoid disease activity. Finally, genetic research and engineering is likely to bring forth many new avenues of earlier diagnosis and accurate treatment in the near future. Gene profiling, also known as gene array analysis, is being identified as a helpful method of defining which people will respond to which medications. Studies are underway that are using gene array analysis to determine which patients will be at more risk for more aggressive disease. This is all occurring because of technology improvements. We are at the threshold of tremendous improvements in the way rheumatoid arthritis is managed.

Supportive therapies:

Medical rehabilitation plays an important role in its treatment. Team of rehabilitation helps patients manage everyday activities and work and live with chronic conditions. This team includes physical therapists, occupational therapists, psychologists, social workers and relaxation specialists. Led by rheumatologists, the team initiates and monitors rehabilitative therapies, including all elements of managing the patient's condition that do not involve traditional medical, drug and surgical procedures.

Treatment may include:
Physical therapy
Occupational therapy
Individualized home strengthening and stretching programs to improve range of motion, function and independence while protecting joints and reducing flare-ups
Integrative medicine (e.g., acupressure and acupuncture)
Manual therapy (e.g., massage and stretching)
Nutrition counseling
Sleep counseling
Patient education
Vocational counseling

Physical therapy can help alleviate the pain, stiffness and weakness associated with rheumatic diseases and to restore function, improve mobility and independence and prevent or limit permanent physical disabilities. The goal of occupational therapy is to help people regain, develop and build skills that are essential for independent functioning, health and well-being.

Assistive device can help a person with a rheumatic disease move better, manage pain or avoid fatigue. Such devices include:

*Braces (e.g., back braces)

*Canes

*Grab bars in showers and tubs

*Shoe inserts

*Special tools or gadgets that can help maintain an active, independent life without straining the joints (e.g., reaching aids)

*Splints

*Using luggage or grocery carts

Aquatic therapy: Warm water helps to loosen tight joints and muscles while the resistance of the water improves muscle strength.

Diet: people with rheumatic diseases require no special diet. Some general guidelines to follow include:
*Limit alcohol consumption.

*Control your weight. Excess weight puts added stress on joints in your back, hips, knees and feet - places where arthritis pain is commonly felt. Excess weight also can make joint surgery more difficult and risky.

*Eat a healthy diet. Eating a diet high in vegetables, whole grains and fruits helps you maintain a proper weight and good health.

Lifestyle Modifications
While there is much about having a rheumatic disease that is not under your control, managing a variety of lifestyle issues can help make your condition easier. These include:

*Apply cold to joints or painful areas for occasional flare-ups. Cold may dull the sensation of pain in the first day or two. Cold also has a numbing effect and decreases muscle spasms. *Do not use cold treatments if you have poor circulation or numbness.

*Apply heat to joints or painful areas. Heat will ease your pain, relax tense, painful muscles and increase the regional flow of blood. You may find it especially helpful before exercising. One of the easiest and most effective ways to apply heat is to take a 15-minute hot shower or bath. Other options are a hot pack, an electric heating pad on its lowest setting or a radiant heat lamp with a 250-watt reflector heat bulb. If your skin has poor sensation or if you have poor circulation, do not use heat treatment.

*Avoid actions that strain joints, including finger joints, if you have arthritis. Choose a purse with a shoulder strap rather than a clutch-style purse. Use hot water to loosen a jar lid and pressure from your palm rather than your fingers to open it.

*Avoid jobs or activities that require repetitive motions, heavy lifting or stress on joints. Other activities that should be avoided are ones that involve overuse or injury to a joint.

*Avoid stress and anxiety. These can cause changes in your body chemistry that can make your symptoms worse. Relaxation techniques or antidepressant drugs can help manage stress and anxiety. Hypnosis, guided imagery, deep breathing and muscle relaxation can all be used to control pain.

*Develop a support system to help you and your family best manage your condition.

*Eat a balanced, healthy diet that allows you maintain a proper body weight.

*Get enough exercise. This helps reduce pain, stiffness and stress while increasing your strength and flexibility.

*Get enough rest. Being tired and feeling pain are signs that it may be time to rest joints and muscles. The pain associated with rheumatic diseases can make getting a good night's sleep difficult. This prevents your body from producing the chemicals that help regulate pain.

*Keep a positive attitude. Make a plan with your doctor for managing your arthritis. This will help you feel that you are in charge of your disease, rather than vice versa. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and function better.

Foods for COPD

Any factor that interferes with normal breathing quite naturally induces anxiety, depression and changes in behaviour. Those with COPD find the slightest exertion exhausting and most of them find eating as a difficult task to be performed. They are fatigued by their constant shortness of breath which makes them anorexic and irritable when they look at food. They need some realistic goals to be set in order to cope up with the disease which includes the change in dietary pattern as well.

DIETARY TIPS FOR COPING WITH COPD:
1. The COPD patients have secretions in their lungs which should be brought out to improve breathing. A fluid intake upto 3000 ml per day is highly recommended unless there is no contraindication. This increased fluid intake will dilute the thick secretions.

2. They commonly have productive cough and bring out sputum. Protein is lost from the body through sputum. Protein should be supplemented more, either in the form of semi-solids or liquids.

3. Juices rich in viamin C can be given to fight infection.

4. Gas producing foods, spicy foods and extremely hot and cold foods should be avoided.

5. A diet rich in calories and protein is very good.

6. Take small frequent feeds. This avoids exertion and also prevents the stomach pushing the diaphragm which interferes with lung expansion.

7. Takefood in fowler's position (sitting upright). This aids easy breathing and make you eat quite comfortably.

8. Keep the room free of any powerful or bad odor. This will promote a good sense to eat. Any strong odor may irritate the respiratory tract.

9. Serve food attractively. Family members make sure you serve the food in a apealing way that the smell and sight causes good appetite to them.

10. Take food that you like and avoid food that you dislike.

11. Breathing through mouth will cause dryness and make the tongue get coated. Drink frequent fluids and clean your tongue which will improve your appetite.

12. Antioxidents from fresh vegetables and fruits is good. They help to repair damaged cells. The vegetables and fruits rich in antioxidents include all green, yellow and orange vegetables also berries, cherries, prunes, oranges, plums and grapes.

13. Recent researchers have proved red wine is good for lungs. It's said to have protective factor for lungs and also reverses certain condition that supresses immune system.

14. Red bell peppers are believed to loosen thick secretion and give a relief after the secretions are brought out.

15. Ginger and garlic can be added in making regular diet which improves the blood circulation to the lungs.

16. Fish oils and supplemental omega-2 fatty acids have been beneficial for persons with COPD though the exact mechanism of action is unknown.

17. Avoiding fatty foods is good in COPD because patiets with COPD already are obese with more abdominal fat which interferes with breathing.

18. Take food when you are more relaxed.

19. Take your main meal at the early part of the day which will keep you active through out the day.

20. Do not lie down as soon as you eat.

21. Take more fluids and semisolids than solids which will need more of your effort for chewing and digestion.

22. Restrict sodium intake which will cause fluid retention.

23. Take high fiber diet which helps to move food along the digestive tract, better controls blood glucose levels, and reduces the level of cholesterol in the blood.

24. If you are one cooking at home, cook something that is easy to do. Conserve your energy. Store extra food in the freezer and eat them when you feel tired.

25. Cut vegetables and fruits into smaller pieces and eat them slowly.

I hope these tips will be useful to you. Try to enjoy your food with the family everyday. Plan a dinner out atleast once every week.

Asthma

Asthma is a reversible obstructive airway disease that affects 17% of the American population. Although asthma can be fatal, more often it is just disruptive and affects day to day activities. Asthma can begin at any age, but in most cases it develops in childhood. Children usually develop allergic asthma which they outgrow by adolescence.

The common symptoms of asthma are cough, dyspnea and wheezing. These symptoms are manifested because of the narrowing of the airways. The symptoms and treatment of asthma depend upon the degree of airway narrowing. Asthma attacks frequently occur at night. The cause is not completely understood, but may be related to circardian variations, which influence the airway receptor thresholds. An asthmatic attack usually starts suddenly with coughing and a tight sensation in the chest. These symptoms are followed by slow, laborious, wheezy breathing. Generally expiration is always much more strenuous and prolonged than inspiration. This makes the asthmatics to sit upright and use every accessory muscle of respiration.

Obstructed air flow causes dyspnea. The cough at first is dry but soon it becomes forceful. Sputum, consisting of thin mucus containing small, round, gelatinous masses is coughed up with much difficulty. Later signs may include cyanosis (bluish discoloration) secondary to severe hypoxia, and symptoms of carbon dioxide retention, including sweating, tachycardia, and a widened pulse pressure. The symptoms of asthma may last from 30 minutes to several hours.

Other possible reactions that may accompany asthma include eczema, rashes, and temporary edema. The symptoms may occur periodically after exposure to a specific allergen, some medications, physical exertion, and emotional excitement.

Asthma symptoms can be reversed either spontaneously or by medical therapy. They can be effectively treated or controlled by medication therapy. There are five categories of medications that are used to treat asthma namely beta agonists, methylxanthines, anticholinergics, corticosteroids and mast cell inhibitors.

Beta Agonists:
Beta agonists are the initial medications used in the treatment of asthma because they dilate bronchial smooth muscles. They can also increase the ciliary movements and decrease the chemical mediators of anaphylaxis. The most commonly used beta adrenergic agents are epinephrine, albuterol, isoproterenol, metaproterenol and terbutaline. These medications are administered parenterally or by inhalation. Inhalation route is the best route of choice because it directly acts on the bronchioles and has only a few side effects.

Methylxanthines:
Methylxanthines, like aminophylline and theophylline are used in the treatment of asthme because of their bronchodilating effects. They relax the bronchial smooth muscles, increase movement of mucus in the airways and increase the contraction of diaphragm. Aminophylline is the IV form of theophylline and is administered intravenously. Theophylline is given orally.

Methylxanthines are not used in acute attacks because they are slow acting compared to beta agonists. There are several factors like tobacco smoking, heart failure, chronic liver disease, oral contraceptives, erythromycin and cimetidine which interfere with the metabolism of methylxanthines, particularly theophylline. Physician should be notified if any of the above mentioned condition exists before taking theophylline. Aminophylline should be administered very slowly, because giving them rapidly may cause tachycardia or cardiac dysrhythmias.

Anticholinergics:
Anticholinergic like atropine is not used in the routine treatment of asthma because of their systemic side effects such as dryness of the mouth, urinary hesitancy, blurred vision, palpitation and flushing. Atropine methylnitrate and ipratropium bromide have shown excellent bronchodilator effects with minimal side effects.They are administered by inhalation. Anticholinergics are particularly beneficial to asthmatics who are not candidates for beta agonists and methylxanthines because of underlying cardiac disease.

Corticosteroids: Corticosteroids are widely used in the treatment of asthma. These medicines can be administered intravenously (hydrocortisone), orally (prednisone), or by inhalation (dexamethasone, beclomethasone). The mechanism of action is not clear but they are thought to reduce inflammation and bronchoconstriction. Prolonged use of corticosteroids can result in serious side effects like peptic ulcers, osteoporosis, adrenal suppression, steroid myopathy and cataracts.

Inhaled corticosteroids are effective in the treatment of asthmatics with steroid dependent asthma. The advantage of this method of administration is the reduced side effects on other body systems. Throat irritation, coughing, dry mouth, hoarseness, and fungal infection of the mouth and pharynx may occur. Rinsing and gargling the mouth immediately after using inhaled corticosteroids will decrease the incidence of fungal infection. Any redness or presence of white patches in the mouth should be reported.

Mast cell inhibitors: Cromolyn sodium, a mast cell inhibitor is an integral part of the treatment of asthma. It is administered by inhalation. It prevents the release of chemical mediators of anaphylaxis, thereby resulting in bronchodilation and a decrease in airway inflammation. Cromolyn sodium is the most beneficial between attacks or while the asthma is in remission. It may result in the reduction of use of other medications and overall improvement in symptoms.

Status asthmaticus (severe and persistent asthma) is a medical emergency. The treatment is usually on an emergency room setting, and the person will be treated initially with beta agonists and corticosteroids. Oxygen therapy may be initiated for those who have dyspnea, cyanosis and hypoxemia.

These are the symptoms and treatment available for asthma. Identifying the early symptom and taking appropriate action will prevent emergencies.

Preventing burns at home

Approximately 2.5 million people experience burn injuries in the United states each year. Of this group, 200,000 require outpatient treatment and 100,000 are hospitalized. About 12,000 people die from burns and related inhalation injuries annually. About 40% of burn injuries happens at home. Having awareness and knowledge about prevention of fires and burns can reduce the number of accidents.

Young children and elderly persons are at high risk for burns. Among young children, infants (between age 1 and 3) are more prone for burns at home. This happens because toddlers are very curious and cannot identify the dangers around them. Elderly are prone because of their forgetfulness and poor eye sight. Cooking, heating, or using electrical appliances are usually involved. 75% of the burns that happen at home are because of the victim's own action.

Some of the common burns accident that happens at home are
1. Spilling hot water causing scalds in toddlers.
2. Playing with matches and fireworks in school age.
3. Electrical injury in adolescent males and chemical injury (suicidal attempt) in adolescent females.
4. Drug, alcohol and cigarette use in adults.

Here are some of the concepts through which you can prevent burns and ensure safety at home:

1. If you have an infant, do not carry him or her when you are drinking anything hot or while smoking because the child may turn and get hurt anytime.
2. Do not keep anything hot in their reach. For example: Hot soups, hot pans, hot iron etc
3. Do not let the children play with hair dryers, heating pads, microwave oven or toaster.
4. Never let the children handle stove (both electric or gas).
5. Lock all electric outlets with child safety outlets.
6. Never entertain children to play with match sticks or candles. Do not leave them unattended while they burst fire works or crackers. Make sure they are wearing goggles and shoes while enjoying fire works.
7. Teach them to stop, drop and role when their clothes catch fire.
8. Do not keep any cleaning solutions or any chemicals in their reach.
9. New moms should be careful heating bottles and feeding their newborn. Make sure the liquid is warm to drink. Heating it too high may burn the child's mouth.
10. Double check the gas stove whether they are turned off before going to bed.
11. Set the water heater at 120F, so that it is safe for you and the children at home. Check the temperature of water each time before giving bath for the children.
12. Check whether the smoke detectors are in working condition and change batteries at least once in every 6 months.
13. Build the house with the fire escape plan and learn the fire escape exits if you are living in an apartment.
14. Keep a fire extinguisher and learn how to use them.
15. Avoid smoking in bed.

Sinus headaches and migraine headaches

Headaches are terrible and they make the day miserable. Sinus headaches and migraine are two different types of headaches and they vary in their manifestation, pathophysiology and treatment. However, both are painful and can be eased by various techniques.

Sinus headaches: They are characterized by pain around the eyes (periorbital area) and facial parts especially in the mornings while awakening. They are sometimes confused with the migraine headaches, if the headache is single sided where only left or right sinus is infected. A careful history and diagnostic assessment will confirm the diagnosis.

Easing sinus headaches:

1. Sinus headaches are usually followed by common cold where the sinuses are blocked by thick mucus and are infected when left untreated. In order to loosen this thick secretion steam inhalation is the best treatment of choice. Boil water in a wide mouth vessel, remove them from the stove, add few drops of eucalyptus oil or vicks, place them in a comfortable and safe place, cover yourself with a blanket and start inhaling the steam through nose and exhale through mouth. This process will loosen secretion and relieve sinus pressure which directly will ease your headache. Hot shower, facial sauna and steam bath also works under the same mechanism to relieve pain.

2. Giving slight pressure over the painful eyebrows or cheek bone or teeth or even some parts of skull which are involved can relieve headache. Some try tieing towel or ribbon around the head to apply pressure but this is not advisable because it may interfere with blood supply.

3. Ice packs or ice compress can be applied to the temporal region which will cause vaso-constriction and there by relieve headache and reduce temperature (because they are accompanied with fever). Hot wet packs also soothe the affected area.

4. Gentle massages with vicks or tiger balm or axe oil do help.

5. Humidifier makes the air moist and when inhaled can thin the secretion which plugs the sinuses to certain extent and relieve pressure that causes headache.

6. Antihistamines like citrizine act as decongestant and sedative to relieve pressure and induce sleep.

7. Antibiotics like amoxicillin, ampicillin, septran DS or bactrim DS are used to treat the infection which in turn relieves headache.

8. Oral and topical decongestants like afrin or otrivin are prefered to loosen and drain out secretions.

9. Irrigating the sinuses also alleviates pain and infection.

10. If the above mentioned tips does not work and if the headache becomes a chronic problem, the exact cause is identified and surgery may be advised.

Migraine headache: This headache is preceded by a phase called aura where the person experiences visual disturbances (light flashes), some experience numb and tingling sensation over the hands or face, mild confusion, slight weakness of extremities and dizziness. The headache is throbbing and severe, usually associated with photophobia, nausea and vomiting. The person recovers from this headache after long hours of sleep with muscle contraction and muscle ache in the neck and scalp.

Migraine headaches can attack at any part of the day. It has a strong family history and usually affects the female gender.

Easing migraine headache:

1. If diet is the reason for this kind of headache, foods containing tyramine, monosodium glutamate, nitrates or milk products like cheese, chocolates and other processed foods should be avoided.

2. Oral contraceptives are believed to cause migraine headaches in some women. In such case, it can be discussed with your physician and proper decision can be taken.

3. Stress is considered the main reason reason for migraine headaches. A change in job or environment is advisable.

4. If habits like smoking or drinking is bringing about this headache, a lifestyle modification should be considered.

5. Certain medications like antihypertensives (hydralazine, diuretics), anti-inflammatory and monoamine oxidase inhibitors can provoke a migraine headache. If you are on such medications, it can be discussed with your doctor and appropriate decisions can be taken.

6. Having a regular sleep and meal pattern will definitely prevent and relieve this kind of headaches.

7. Ergotamine tartrate is the drug prescribed for migraine headaches which can be used orally, sublingually, intra-muscularly, sub-cutaneously, per rectum or by inhalation as well. It has its own side-effects and hence it has to be taken only with doctor's knowledge.

8. Sumatriptan is said to relieve moderate to severe migraine and is available in the form of subcutaneous injection which could be taken by the person himself.

9. Lying down quietly in a dark room with the head kept slightly elevated (30 degrees) can relieve an acute attack more easily.

10. Caffeine is said to arrest or reduce the severity of headache in 90% of migraine sufferers. Black coffee works good for many.

11. Different medication helps for different people. Analgesics, sedatives, antianxiety agents and antiemetics are wide range of medications that are administered to relieve headaches.

12. Propranolol, beta-blocker which halts the dilation of blood vessels in brain is believed to have antimigraine action.

Though headaches are the most common of all human physical complaints, it should be taken seriously. Headache is actually a symptom rather than a disease entity that may indicate other dreadful diseases. Seek treatment at the earliest because prevention is always better than cure.

Identifying hypertension

Hypertension is called as "the silent killer" because people with hypertension are often symptom free. Many people with hypertension are unaware of having the condition. In the olden days, hypertension was regarded as the disease of the rich, or the elderly, but this is no longer thought to be the case. Once hypertension is diagnosed, blood pressure should be monitored at regular intervals because hypertension is a lifetime condition. Hypertension can be defined as persistent levels of blood pressure in which the systolic pressure is above 140 mm Hg and the diastolic pressure is above 90 mm Hg. In the elderly population, hypertension is defined as systolic pressure above 160 mm Hg and diastolic pressure above 90 mm Hg.

Hypertension carries the risk of premature morbidity and mortality, which increases as the systolic and diastolic pressures rise. There are two types of hypertension, they are primary and secondary. Primary (essential) hypertension is the common type of hypertension seen in 90% of the hypertensive population. Primary hypertension has no identifiable medical cause. The reminder develop elevation in blood pressure with specific cause (secondary hypertension), such as narrowing of the renal arteries, certain medications, organ dysfunction, tumor, and pregnancy. People with blood group A are more prone for hypertension.

There are many other symptoms which can reveal hypertension other than high blood pressure on physical examination. Changes that are noted in retina of a person with high blood pressure may be hemorrhage, exudates, narrowed arterioles, and in severe cases papilledema. Persons with hypertension can be asymptomatic and remain so for many years. Symptoms, when they do appear, usually indicate vascular damage, with specific manifestations related to the organ systems served by the involved vessels. Coronary artery disease with angina, pathologic changes in kidneys (nocturia and azotemia), stroke or transient ischemic attack, and alteration in vision may be manifested depending upon the blood vessel that is affected.

The incidence of hypertension increases with the ageing process. Prolonged elevation of blood pressure eventually damages blood vessels throughout the body, most notably in the eyes, heart, kidneys, and brain. Therefore, the usual consequences of prolonged, uncontrolled hypertension are failing vision, coronary occlusion, renal failure, and strokes. Try to identify the symptoms of hypertension and get treated as early as you can. It may save your life, and may even make your life easier if treated promptly.

Skin cancer

Few centuries back, the word cancer was rarely heard and people were hopelessly distraught if they were diagnosed with it. But now it has become common among people. Skin cancer is the most common cancer affecting people now a days and it can be easily diagnosed. Diagnosing skin cancer is easy because any change in the skin can be easily observed by us. All we have to do is to seek quick treatment.

The environment to which human skin is exposed to plays a major role in skin cancer. Prolonged exposure to ultraviolet rays or direct sun, chronic friction or irritation, prolonged exposure to certain chemical agents or even cosmetics are known to have caused skin cancer. Exposure to radiation and radioactive elements is a well known cause for skin cancer. Even certain long term medications can cause cancer.

Rapidly growing warts, moles or any marked skin changes are some of the signs for skin cancer. Change in color, size or shape of the pre-existing lesion, pruritis and local soreness are some common symptoms that support the diagnosis of skin cancer. A waxy nodule, irregular with hues of tan, black or blue, lesion with oozing, bleeding or crusting is the characteristic appearance of skin cancer lesions. Skin cancer can be confirmed with skin biopsy.

If you notice any change in the existing lesion or a lesion that does not heal, immediately notify the physician. You may have to provide few information like how you had got it and how long you had it etc. For people living in tropical regions, it is advisable to avoid direct sunlight between 10am to 2pm especially. If you have to venture out, apply sun screens with high SPF. Avoid occupational hazards if you are working with chemicals and radiations. Use proper protection if you work in such areas. If you have a family history of skin cancers, quit the job if possible. Avoid wearing any tight ornaments that would cause friction and irritation. Avoid heavy make-ups which can have chemical irritants which can cause skin cancer. Get the moles or lesions removed by a doctor as early as possible.

First and foremost thing is not to panic but seek immediate medical attention. Just take appropriate treatment as fast as you can, because most of the skin cancers do not metastasize and they can be dealt with easily. Fatality depends on cancer type and stage and so earlier you seek treatment, the better.

How to treat ear infections?

Bacteria or fungal infections are the most common problems encountered in the ear. These infections can occur due to many reasons like water in the ear canal (swimmer's ear), trauma to the skin of the ear canal permitting entrance of organisms into the tissues, systemic conditions like vitamin deficiency and endocrine disorders, dermatosis such as psoriasis, eczema or seborric dermatitis, temporal bone osteomyelitis, obstruction of the eustachian tube caused by URI, barotrauma, following radiation therapy and perforation of the tympanic membrane.

The ear infection treatment depends upon the cause, the part of ear (outer, middle and inner) that is affected and the severity of infection. The principles of therapy is aimed at
1. Relieving pain or discomfort.
2. Reducing the swelling of the ear canal.
3. Eradicating the infection by medical or surgical measures.

The ear infections are otitis externa, malignant otitis externa, acute otitis media, serous otitis media and chronic otitis media. Wherever the infection may be, the treatment depends on the cause and the causative organism.

Ear infection treatments:
1. Ear infection always presents with pain, so it not uncommon for the infected person to require prescription analgesics for the first 48 to 92 hours.

2. If there is swelling of the tissues in the ear canal, it may be necessary to insert a wick to keep the canal open so that liquid medications like Burow's solution or antibiotics can be instilled.

3. Many are generally started with broad spectrum antibiotics to take care of any kind of infection caused by any organism.

4. If the organism does not respond as expected to the broad spectrum antibiotics, a pus swab is collected for culture and the specific organism and its growth is identified.

5. Appropriate antibiotics to treat infection, and corticosteroid agents to reduce swelling and soothe the inflamed tissue are started simultaneously.

6. Antifungal medication may be prescribed if they are needed.

7. If the infection has caused a sore, daily dressing should be made at the doctor's office by a nurse or a doctor.

8. The local wound care may involve debridement of the infected tissue, including the bone and cartilage depending upon the extent of infection.

9. Severe infections are treated with parenteral antibiotic treatment which includes the combination of an antipseudomonal agent and an aminoglycoside.

10. The dosage and duration of antibiotic therapy may depend upon the virulence of the bacteria and the physical status of the affected person.

11. If there is oozing of pus discharge, they are drained out by placing a tube and cleaned in a sterile way.

12. If the infection is in the middle ear, the ear is cleaned by visualizing through microscope and the pus discharge is sucked out by gentle suctioning instruments.

13. In case of block in the middle ear which is causing the infection, a surgical procedure called tympanotomy or myringotomy is done. The procedure takes only 15 minutes and is done under local anesthesia. Here an incision is made through the tympanic membrane microscopically to relieve pressure and drain the discharge present in the middle ear.

14. The next surgical treatment that is considered when other medical management fails is tympanoplasty. Tympanoplasty is surgical reconstruction of the tympanic membrane and ossicles. The purpose of this procedure is to reestablish middle ear function, close the tympanic membrane perforation, prevent recurrent infection and improve hearing. This is done under general anesthesia in a outpatient environment itself and the prognosis is very good.

15. Mastoidectomy is also another surgical management that is performed to remove cholesteatoma, gain access to diseased structures and create a safe, dry and healthy ear. They are performed as a two seating procedure. The second surgery may be done after 6 months to check the recurrence of cholesteatoma. This surgery is done under general anesthesia in an outpatient setting. A pressure dressing will be applied after this surgery which is removed only after 24 to 48 hours.

General instructions to avoid ear infections:
1. Avoid self-cleaning of the external auditory canal.
2. Do not use cotton tipped applicators like buds.
3. Avoid water entering into the ear while showering, shampooing and swimming.
4. Use lamb's wool or cotton ball covered with vaseline to prevent water contamination.
5. Prevent upper respiratory tract infections.

Treat ear infections seriously and take appropriate step to stop spread of infection. Otherwise infections may lead to further complications like permanent hearing loss, meningitis and even death.

Exercise program for Parkinson's disease

Parkinson's disease is a progressive neurologic disorder affecting the brain centers that are responsible for control and regulation of movement. It is characterized by slowness of movement or impaired movement, tremor, muscle weakness and muscle stiffness or rigidity. These symptoms can be overcome only when the muscle or the affected part is continuously exercised.

The main goal of "exercises" in Parkinson's disease is

* To improve mobility.
* To attain independence in activities of daily living.
* To develop a positive coping mechanism.

All three goals can be achieved and maintained when through exercise programs. Exercises for Parkinson's disease are started slowly, and the frequency and amount of time needed for work out is increased everyday. In this way, the person is not tired or exhausted, but will show more interest and see improvement everyday. A progressive program of daily exercise will increase muscle strength, improve coordination, reduce muscle rigidity, and prevent contractures that occurs when muscles are not put in use.

There are different exercises that helps to achieve different goals. For example, walking, riding a stationary bike, swimming, and gardening are all the exercises that helps to improve joint mobility. Stretching exercises (stretch-hold-relax) help loosen the joint structures. Postural exercises are important to counter the tendency of the head and the neck to be drawn forward and down. There is a special walking technique that should be learnt to offset the shuffling gait and the tendency to lean forward.

WALKING TECHNIQUE IN PARKINSON'S DISEASE:

Arm swing is the main thing for a normal walking. People affected with Parkinson's disease will have problem in balancing their body while in motion because of the rigidity of the arms. The first and foremost exercise that should be learnt when a person is diagnosed with Parkinson's disease is walking exercise. There are three things that are expected to be kept in mind while walking. They are keeping an erect body posture, watching the horizon, and using a wide based gait (walking with feet seperated).

They are also taught to concentrate to swing the arms and raise the feet. Heel-toe is the technique used for walking, since it helps in taking longer strides. They are instructed to do this walking exercise with marching music because this provides sensory reinforcement.

Breathing exercises is advised simultaneously with the walking exercise. Deep breathing exercises helps in relaxing, thereby prevents frustration and fatigue. Doing the activities of daily living like bathing, combing not only meets self care but also gives a sense of self esteem.

Tying a rope on the foot end of the bed and getting up by holding on to the rope is also an exercise that can be done several times a day. Persons with Parkinson's disease find it difficult to get in and out of the bed. This exercise will provide assistance in pulling oneself out of the bed or turn position as well as keep the muscles active.

Nextly, the exercises are concentrated to meet the nutritional and eliminational needs on their own. Those with Parkinsonism have poor hand coordination in taking the food to the mouth as well as difficulty in chewing and swallowing. They are made to exercise their hand in a fashion that they take the food to the mouth without dropping. They are also taught to exercise the tongue in such a way they chew and swallow food consciously which prevents them from aspiration and subsequent complications like pneumonia.

The steps in exercise involves taking the food to the mouth, placing the food on the tongue, close the lips and teeth, lift the tongue up and then back and finally swallow. They are encouraged to chew the food on one side of the mouth and then on the other. The bowel elimination is improved when there is enough exercise through walking. There are a number of assistive devices that helps to squat for defecation as well as to exercise the thighs and calves.

There are exercises to improve communication. A speech-language therapist teaches these exercises and help people with Parkinson disease to utter the words slowly and correctly. Speech improvement exercise teach them to speak short sentences clearly by taking a few deep breaths before speaking.

Faithful adherence to the exercise program helps to delay the progress of the disease and keep the person occupied (that other wise can lead to depression). Encouragement and reassurance given by the care giver for every single exercise they do helps to maintain their active participation in them. Exercise in parkinsonism is not just a therapeutic program but also a social and recreational program. Hence, plan an exercise program through out the day and stay active.

How to treat alcohol and drug addiction?

According to world health organisation (WHO) a drug is defined as any substance that, when taken into the living organism may modify one or more of its functions. When any drug or alcohol takes on a much higher priority in an individual and alters the person's physiological, behavioural and cognitive pattern then it is referred to as addiction. Common substances that are classified as psychoactive substances are alcohol, opioids, cannabinoids, cocaine, amphetamines, hallucinogens, sedatives, hypnotics, inhalants, nicotine, and other stimulants (e.g. caffine).

Alcohol treatment:

Alcohol treatment can be broadly divided into two types and they are often interlinked with each other. The basics of alcohol treatment is detoxification and alcohol treatment dependence.

Detoxification is the first major step in alcohol treatment. Treatment of alcohol withdrawal symptoms is called as detoxification. The best way to do detoxification in alcohol treatment is to stop alcohol suddenly. The drug of choice in alcohol treatment of detoxification is benzodiazepines. Chlordiazepoxide and diazepam are the most frequently used benzodiazepines. The drugs used are decreased steadily everyday before being stopped. Vitamins (thiamin and nicotinic acid) should be supplemented during this course of alcohol treatment. Hydration is the next important aspect that should be taken care.

Alcohol treatment for dependence can be achieved by several methods like
1. Alcohol treatment for dependence by behavior therapy: The most commonly used behavior therapy is aversion therapy and it can be used in combination with other methods like relaxation techniques, assertiveness training, self control skills and positive reinforcements.

2. Alcohol treatment for dependence by psychotherapy: The person is educated about the risks of continuing alcohol use and the importance of resuming personal responsibilities. This can be achieved by supportive and individual psychotherapy.

3. Alcohol treatment for dependence by group therapy: Group therapies are usually done by voluntary self help groups and the approach is partly religious in nature. Many are benefited through this because they are non- professional in nature.

4. Alcohol treatment for dependence by deterrent agents: The deterrent agents are called alcohol sensitizing drugs. Disulfiram is the commonly used effective drug. It produces unpleasant reaction when taken with alcohol. The disulfiram-ethanol reaction is life threatening and is characterized by flushing, tachycardia, hypotension, tachypnea, palpitation, headache, sweating, shock, convulsions, myocardial infarction, confusion and coma.

5. Alcohol treatment for dependence by other medications: Some of the other drugs used for alcohol treatment are benzodiazepines, antidepressents, antipsychotics, lithium, carbamazepine, and narcotics. These drugs are used only if there is special indication.

Drug treatment:

1. Opioid addiction: Morphine and heroin are the common drugs that causes drug dependence. Other opioids are codeine, thebaine, papaverine, nalorphine, hydromorphone, methadone, pethidine, and levallorphan. They are mainly administered intravenously for potency but they can be smoked or chased.

Drug treatment of opioid disorders: Drug treatment starts with proper diagnosis made by history, physical examination (pin point pupils), and laboratory tests. Detoxification of opioids is done abruptly and is followed by management of withdrawal symptoms. Drugs used to manage withdrawal symptoms are methadone, clonidine, naltrexone with clonidine, and other agents like levo-alpha-acetyl-methadol, buprenorphine, and lofexidine.

After detoxification phase the drug treatment for opioid addiction is continued by maintenance therapy using methadone and opioid antagonists. Individual psychotherapy, behaviour therapy, family therapy, group therapy, and psychotropic drugs are also included depending upon the persons needs. As relapse rates are high psychosocial rehabilitation is highly advised in both occupational and social levels.

2. Cannabis addiction: Cannabis produces very mild physical dependence and withdrawal syndrome. All active ingredients are called as marijuana or marihuana.

Drug treatment of cannabis disorder: As the withdrawal symptom is very mild, the management is usually supportive and symptomatic treatment. Psychotherapy and family therapy are important if there is psychic dependence.

3. Cocaine addiction: Cocaine can be administered orally, intranasally, or parentrally. They are sometimes used in combination with heroin or amphetamines.

Drug treatment of cocaine disorder: Drug treatment is seperate for cocaine overdose and cocaine chronic use. In cocaine overdose, the treatment consists of oxygenation, muscle relaxants, and IV thiopentone. In cocaine chronic use, bromocriptine and amantadine is used to reduce cocaine cravings.

4. Amphetamine addiction: Amphetamines are used medically for certain conditions to heighten energy and produce more capacity to work but continuous use leads to addiction.

Drug treatment of amphetamine disorder: Amphetamines intoxication is treated symptomatically with antipyretics, diazepam, halloperidol and antihypertensives. Acidification of urine with oral NH4CL 500mg facilitates the elimination of amphetamines. Antidepressants and supportive psychotherapy are helpful in treating amphetamine dependence.

5. LSD addiction: Lysergic acid diethhylamide is a powerful hallucinogen. Although tolerance and psychological dependence occurs with LSD use, no physical dependence or withdrawal syndrome is reported.

Drug treatment of LSD disorder: The drug treatment consists of symptomatic management with anti-anxiety, antidepressants along with supportive psychotherapy.

6. Barbiturate addiction: Barbiturates are sedative, hypnotic and anxiolytic agents that causes marked physical and psychological dependence.

Drug treatment of barbiturate disorder: Pentobarbital substitution therapy is suggested for the treatment of withdrawal syndrome. Supportive treatment should be followed after detoxification phase.

7. Benzodiazepines and other sedative-hypnotic addiction: Benzodiazepines and sedative-hypnotic are prescription drugs that are used to treat many conditions.

Drug treatment of Benzodiazepines or sedative-hypnotic disorders: The treatment is usually symptomatic. Flumazenil is a benzodiazepine receptor antagonist that is commonly used in detoxificaion followed by supportive treatment.

8. Inhalants addiction: Petrol, glues, aerosols, thinners, varnish removers are commonly used as inhalants.

Drug treatment of inhalant disorders: There is no specific treatment for this disorder and is usually associated with schizophrenia.

Though the above mentioned treatments are available for drug and alcohol addiction, the key factor is the addict's whole-hearted desire to recover from the addiction and will power to resist any cravings to drug and alcohol.