Deep Vein Thrombosis

deep vein thrombosisIntroduction:

Deep vein thrombosis is a condition in which a blood clot forms in one or more of the deep veins usually in the legs. A potentially life threatening complication may occur if this clot detaches and travels to the lungs leading to pulmonary embolism.


DVT (Deep vein thrombosis) results from conditions that impair venous return, lead to endothelial injury or dysfunction, or cause hypercoagulability. The conditions leading to DVT and the risk factors include:

  • Occult cancer.
  • Immobilized patients.
  • Adults over the age of 60 years
  • Recent history of a major surgery or trauma
  • Prolonged sitting like long travels
  • Family history of blood clots.
  • Pregnancy or delivery in last 6 months
  • Obesity
  • Fracture of the pelvis or legs.
  • Taking oral contraceptives or hormonal replacement therapy.
  • Certain autoimmune disorders
  • Cigarette smoking.

Clinical Signs And Symptoms:

The clinical features of deep vein thrombosis include:

  • Swelling in the affected leg. ( Rarely both legs are involved)
  • Changes in skin color
  • Pain in the leg
  • Warmth and tenderness over the affected part
  • Positive Homan’s sign ( Calf discomfort elicited by ankle dorsiflexion with the knee extended)


The two main tests done to diagnose DVT along with the are :

  • D-dimer blood test.
  • Doppler ultrasound exam of the legs.

Continue reading “Deep Vein Thrombosis”

Give Statins to All People With Diabetes

Give Statins to All People With DiabetesExperts: Give Statins to All People With Diabetes

New guidelines from the American Diabetes Association recommend greater statin use.

By Steven Reinberg

HealthDay Reporter

TUESDAY, Dec. 23, 2014 (HealthDay News) — New guidelines from the American Diabetes Association (ADA) call for giving the cholesterol-lowering drugs known as statins to all people with diabetes to help prevent heart disease.

These new standards bring the association in line with the American College of Cardiology and American Heart Association, which also recommend giving low- or high-dose statins to all people at risk for heart disease including people with diabetes.

“We agree that the decision to start a statin should be based on a patient’s risk,” said Dr. Richard Grant, a research scientist at Kaiser Permanente Division of Research and chairman of the ADA’s professional practice committee.

“It turns out that patients with diabetes have the same risk as people with heart disease, so all of our patients need to be on statins,” he said.

However, Grant said some people with diabetes may not need statins. These include younger, healthier patients and very old patients who have other medical conditions that shorten their life expectancy.

Heart disease is the No. 1 killer of people with diabetes, Grant said. People with diabetes are two to four times more likely to have a heart attack or stroke than people without diabetes, he said.

The increased risk of heart disease in people with diabetes is what was behind the rationale for this year’s recommendations on statins, blood pressure and exercise, according to Grant.

“In the old days, all we thought about was sugar, and nowadays we recognize that the leading killer in diabetes is heart disease,” he said. “You have to be aggressive in controlling risks.”

He added that the ADA standards are updated each year to give doctors the latest guidance for diagnosing and treating both type 1 and type 2 diabetes

The ADA recommends a moderate statin dose for people with diabetes who are under 40, or 40 to 75 without any other risks for heart disease. A high statin dose is recommended for people with diabetes who have heart disease, and for those between 40 and 75 who have other risk factors for heart disease.

Dr. Spyros Mezitis, an endocrinologist at Lenox Hill Hospital in New York City, said, “We have to be aggressive with statins in diabetics.”

People with diabetes who are not taking a statin should ask their doctor if they should be taking one, he said.

Mezitis added that people with diabetes should know their cholestrol, blood pressure, average blood sugar level and weight.

The new recommendations also call for a less strict diastolic blood pressure goal of 90 mm Hg, up from 80 mm Hg for most people. The diastolic number is the bottom number in a blood pressure reading.

In addition, the standards recommend that everyone exercise regularly. They also advise that no more than 90 minutes at a time should be spent inactive.

The committee also recommends people with diabetes do resistance training at least twice a week, unless they can’t for other medical reasons.

The guidelines for people with diabetes also include:

  • A new blood sugar standard for children and adolescents — a hemoglobin A1C of 7.5 or less. This test gives an average of blood sugar levels for the past two to three months, according to the ADA.
  • A statement that e-cigarettes are not an alternative to smoking or a way to help smokers quit.
  • A recommendation that people 65 or older get the pneumonia vaccine in two separate shots — PCV13 (Prevnar), followed 12 months later by PPSV23 (Pneumovax).
  • Lowering the body mass index (BMI) threshold to 23 for screening Asian-Americans for diabetes. A BMI of 25 is what’s usually considered overweight, according to the U.S. Centers for Disease Control and Prevention. But Asians have an increased risk for diabetes at a lower BMI, according to the ADA.


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Continue reading “Give Statins to All People With Diabetes”

Top 10 Fruits for Diabetics

fruits for diabetesAccording to the American Diabetes Association, 25.8 million Americans have diabetes and by 2020 half of all Americans will suffer from this disease.

Diabetes causes high blood sugar (glucose) levels due to lack of insulin production or function. It is mainly classified as either Type 1, in which the body fails to produce insulin, or Type 2, in which the body is not able to properly use the insulin it produces.

It is essential to control diabetes because it can lead to a host of health complications including kidney failure, nerve damage, blindness, heart attacks, strokes, poor blood circulation, hearing loss and many more.

A healthy lifestyle that includes a proper diet, exercise, proper sleep, less stress and so on plays a major role in controlling blood glucose levels. A diabetes diet plan should include foods that are high in nutrients, low in fat, moderate in calories and few sugary foods.

As fruits are generally sweet, people often think that a diabetic person should avoid eating them. But there are several fruits that are particularly effective at managing blood sugar. Packed with vitamins, minerals, antioxidants and phytonutrients, fruits are a healthy addition to any diet.

Some fruits are better than others for diabetics. Moreover, diabetics also need to consider factors like glycemic index and glycemic load as they offer information on how different foods affect blood sugar and insulin levels.

Low glycemic index foods are believed to have a beneficial effect on blood glucose control as they do not significantly impact blood sugar levels. Usually, foods with a glycemic index score of 55 and below are classified as low glycemic index foods. Those with a glycemic index score of 70 and above are considered high glycemic index foods.

Here are the top 10 fruits for diabetics.

1. Apples

The crunchy, juicy and sweet apples may offer protection against diabetes. Apples are high in soluble fiber, vitamin C and antioxidants. They also contain pectin that helps detoxify the body and remove harmful waste products as well as lowers the insulin requirements of diabetics by up to 35%.

Plus, apples help prevent heart attacks, reduce the risk of cancer and ward off eye diseases among diabetic people.

Glycemic index: ranges from 30 to 50

Suggested serving size:
One small to medium-sized apple daily is recommended. Continue reading “Top 10 Fruits for Diabetics”

Being Thin Doesn’t Spare Asian-Americans From Diabetes Risk

diabetes and weightWe know that you can be fat while still fit, but how about skinny and unhealthy? This may be the case for many Asian-Americans who look slim, but actually face a higher risk of diabetes than people belonging to other ethnic groups.

As a result, Asian-Americans should consider getting tested for diabetes at a lower body mass index than previously recommended, according to new guidelines published Tuesday by the American Diabetes Association.

The old guidelines didn’t take race and ethnicity into account, suggesting all adults with a body mass index, or BMI, of 25 (considered overweight) be tested for diabetes. The new guidelines lower the bar for Asian-Americans, saying testing should begin at 23.

“We’ve never differentiated based on ethnicity because frankly, in the past, we haven’t done a good job evaluating different ethnicities,” says Dr jane Chiang, senior vice president of medical and community affairs at the ADA and one of the authors of the statement. “We used to think that one size fits all, but now we know that that’s not true.”

Asian-Americans, the fastest-growing racial or ethnic group in the U.S., are 18 percent more likely to have Type 2 Diabetes than their non-Hispanic white counterparts. Even Asian-Americans who aren’t considered overweight by standard measures (a BMI of 25 to 30) are still at risk for diabetes.

“Asian-Americans with a BMI of 23 … might have a similar risk as someone who is not Asian-American with a BMI around 27,” says Dr George King chief scientific officer at the Joslin Diabetes Center, who was not a part of the study.

This is partially because BMI isn’t a perfect predictor of diabetes risk. The index compares height and weight, but distribution of body fat can be more relevant. Asian-Americans typically gain their fat around the waist, rather than the thighs or other parts of the body. And abdominal fat is a known risk factor for diabetes.

The ADA’s recommendations come from a review of five meta-analyses that looked at 156 studies. The studies looked at Asian-American populations to consider the effects of an American lifestyle and environment.

The ADA’s Chiang says the new guidelines will help increase early detection of diabetes in Asian-Americans and enable more preventive measures. But doctors must beware the trap of treating all Asian-Americans, or people of any race or ethnicity the same. “Asian-Americans are still a very heterogeneous population, so each individual needs to be evaluated separately,” she says.

A BMI calculator (like this one from the National Institutes of Health) is a good place to start figuring diabetes risk. Chiang recommends all Asian-Americans calculate their BMI. Chiang says Asian-Americans with a BMI around 23 or 24, particularly those with a family history of diabetes, should ask their doctor about getting tested. Continue reading “Being Thin Doesn’t Spare Asian-Americans From Diabetes Risk”

Treatment Of Diabetes Mellitus Type 2

Diabetes_Medicines-A Brief Introduction: 

Diabetes Mellitus type 2 is condition in which the there is insufficient production of hormone insulin from the pancreas or the body becomes resistant to normal or even high levels of insulin. This leads to high blood sugar (glucose) levels and if not manged properly may cause a number of complications in long term.

Managing Diabetes mellitus: 

The goal of the treatment is not only to manage the symptoms but to keep the blood sugar levels in control and prevent related complications.

1. Identifying The Underlying Disease: 

Early in the course most patients may have no symptoms at all the the disease may go undiagnosed for years. It is important for any family physician to ask patients while taking a general history the risk factors and family history of diabetes and if suspected carry out appropriate test to identify the disease and control it at a early stage before the complications begin to develop.

2. Dietary And Exercise Modifications: 

Patient should be properly education and encouraged to change their life style and diet modification. Strict adherence to diet and regular exercise should be encouraged by the primary care physician at each visit. Although there is a common perception that there is a specific diabetic diet in reality it is not so. Patients just need to avoid animal fats, refined carbohydrates and sweets, and center on high fiber low fat food like vegetables and whole grains.

Some patients may have good control of their blood sugar only by managing their diet and will not need medicines. Sometimes a nutritionist may help patients educate about the diet that is healthy and protective for them.

Regular physical activity is important for every one and more so for patients with diabetes. Exercise helps to :

  • Lower blood sugar levels without the need for medications
  • Burns extra calories and fats and helps manage an ideal body weight.
  • Improves blood flow and maintains a normal blood pressure
  • Increases energy levels
  • Improves the body’s ability to handle stress

3. Regular Monitoring of Blood glucose:

The goal of treatment in type 2 Diabetes mellitus is to keep the blood glucose levels at normal or near normal levels. This can be achieved by regular monitoring and adjusting the diet and medicine if needed.

  • Home blood sugar testing is easy and may be recommended for patients who are on insulin or oral diabetes medicines. A normal fasting blood glucose is usually less than 100 mg/dl.
  • Measuring HbA1c helps in determining the average blood sugar during the past two to three months. The goal for most patients is Less than 7%.

Continue reading “Treatment Of Diabetes Mellitus Type 2”

Renal complications Secondary To Diabetes Mellitus

Diabetes and kidneysKidneys are a major organs of the human body that remove waste products from the blood. Diabetic kidney disease is a complication that may occur in some patients with diabetes mellitus.


The basic functional unit of the kidney is a nephron. A nephron consists of tiny blood capillaries that act as filters when blood flows through them. The waste products are excreted into the urine while the useful substance are returned back to the blood. In diabetes when there is high blood sugar levels it causes  kidneys to filter too much blood and this work load slowly damages the filter system. Due to this damage the useful substances like proteins begin to leak and excreted into the urine. Gradually the the normal tissues are damaged and replaced by scar tissue leading to worsening of the normal kidney function finally leading to end stage renal disease when the kidneys cannot function to clean the blood of the waste products.

Microscopic Changes:

When a kidney damaged by complications secondary to diabetes is examined under microscope it shows following gradual changes:

  • Basement membrane thickening.- Earliest detectable change
  • Expansion of mesangium and nodular sclerosis..
  • Glomerular destruction and progressive nodular glomerulosclerosis.
  • Deposits of glycogen in tubular epithelial cells.

Clinical Signs and Symptoms: 

Early in the course of the disease there are almost no symptoms. The signs and symptoms usually begin to appear when most of the kidney function is already damaged. The symptoms of kidney disease are initially non-specific. When the disease becomes more severe patient may show symptoms like:

  • Poor appetite
  • Generalized body weakness
  • Weight loss
  • Fluid retention that causes swollen feet and ankles
  • Puffiness of the face and around the eyes
  • Pallor secondary to anemia
  • Nausea and vomiting
  • Increased frequency of urination
  • Foamy or frothy appearance of urine.

Continue reading “Renal complications Secondary To Diabetes Mellitus”

Introduction To Diabetic Neuropathy

diabetic-neuropathyDiabetic neuropathy is a complication of diabetes in which the nerves are damaged most commonly in the legs and feet which leads to impaired sensations. It is a common but a serious complication of diabetes mellitus and depending upon the nerves damaged the symptoms may range from pain and numbness in the extremities to problems with digestive system, blood vessels and heart and may even sometimes be fatal.

Clinical features:

There are basically four types of diabetic neuropathies with different presenting symptoms. A patient may have symptoms of only type or may have overlapping symptoms.

1. Peripheral Neuropathy: In this type the patient usually have the legs and feet affected first followed by the hands and the arms. The nerve damage in the feet can lead to decreased sensation and increased chances of foot injury. Symptoms include:

  • Numbness
  • Reduced ability to feel pain or changes in temperature mainly in the feet and the toes.
  • Tingling sensation
  • Burning sensation
  • Pain when walking
  • Extreme sensitivity to light touch
  • Repeated ulcers, infections in the foot.

Peripheral neuropathy most commonly occurs in patients who have poor;y controlled blood sugar levels and can be prevented by keeping good control on blood sugar, as well as taking good care for the feet and legs to prevent foot injury.

2. Autonomic Neuropathy: In this type the nerves of the autonomic nervous systen that controls the heart, digestive system, bladder, sex organs and eye are damaged secondary to diabetes. Symptoms include:

  • Constipation
  • Bloating
  • Diarrhea
  • Lack of awareness when blood sugar levles falls
  • Frequent urinary tract infections
  • Urinary incontinence
  • Heartburn
  • Nausea and vomiting
  • Loss of appetite
  • Feeling of fullness of stomach due to delayed emptying.
  • Sexual difficulties
  • Sudden abnormal sweating
  • Palpitations
  • Problems in blood pressure regulation

The symptoms may be managed by strict diabetic control, eating small frequent meals, not to stand up quickly and with medications. Continue reading “Introduction To Diabetic Neuropathy”

Causes Of Pleural Effusion

pleural effusionPleural effusion is a condition in which there is abnormal fluid accumulation in the layers of tissues that line the lung and the chest cavity. There are a number of causes that may lead to pleural effusion. Some of them are briefly described as follows:

1. Congestive Heart failure: It is one of the most common causes in which because of deficient pumping by the heart the body cannot handle fluids properly leading to collection in the pleural spaces.

2. Pneumonia: In which later the fluid may get infected leading to empyma or abscess.

3. Liver disease Or Cirrhosis

5. Nephrotic Syndrome: due to low blood protein counts

6. End stage renal disease

7.  Cancer

8. Pulmonary embolism

9. Blockage in the blood vessels or the lympahtic flow.

10. Hypoalbuminemia

11. Tuberculosis .

12. Trauma         etc

When ever Pleural effusion is suspected it is important to find out the etiology so that treatment can be given accordingly.

Trasudative pleural Effusion: The cause of transudative pleural effusion is increased fuid leaking into the pleural space secondary to increased pressure in the blood vessels or low protein count. Conditions leading to this type of effusion are congestive heart failure and nephrotic syndrome.

Exudative Pleural Effusion: The cause of exudative pleural effusion is a local process like infection or inflammation that leads to increased capillary permeability and exudation of  fluid, protein, inflammatory cells and other serum constituents. Conditions causing this type of effusion are tuberculosis, pneumonia etc.


Introduction To Sciatica


The term Sciatica is used for a condition with symptoms of leg pain and may be tingling and numbness along the path of the sciatic nerve. It originates in the lower back, travels through the hip and buttock down to the back of the leg. It typically affects only one side of the body. This term sciatica describes a symptom rather than a specific disease.

Characteristic symptoms of Sciatica:

Sciatica is characterized by one or more of the following symptoms:

  • Pain in the leg which is worse when sitting.
  • Pain most often occurs only on one side.
  • Burning or tingling sensation down the leg.
  • Sometimes the pain may be felt like a jolt or an electric shock.
  • Weakness, numbness or difficulty moving the leg or the foot.
  • A sharp pain that may sometimes make it difficult to walk or move.
  • The symptoms may vary widely depending on the underlying cause leading to sciatica


Sciatica is caused by irritation of the nerve roots in the lower lumbar and the lumbosacral spine. The conditions that can cause sciatica includes:

  • Herniation of the lumbar disc that compresses on one of the lumbar or sacral nerve roots
  • Spinal stenosis
  • Pelvic injury or fracture
  • Pregnancy when the weight of the fetus compresses the sciatic nerve
  • Tumors that may impinge on the spinal cord or the nerve roots
  • Piriform syndrome- a condition in which the piriform muscle in the buttock region becomes tight and causes irritation of the sciatic nerve.
  • Trauma to the spine irritating the nerve roots.
  • Bone spurs on the spine


A complete history and a physical examination helps in the diagnosis and determining the underlying cause of sciatica.  Continue reading “Introduction To Sciatica”

Phenytoin – Anticonvulsant Drug.

phenytoinIntroduction: Phenytoin is a drug that is used to control,treat and prevent certain type of seizures. It is an anti-epileptic drug also known as the anticonvulsant drug.

Mechanism of Action: Phenytoin acts by blocking voltage dependent sodium channels and thus prevents seizures to occur. Its anticonvulsant activity is through blocking sustained high frequency repetitive firing of the action potentials. Its primary site of action appears to be in the motor cortex where it prevents the spread of the seizure activity.

Clinical Uses: Phenytoin is widely used in medicine for conditions like:

  • Complex-partial seizures
  • Generalized tonic clonic seizures
  • Status epilepticus
  • As an antiarrythmic drug to control an abnormal heart beat.
  • Arrythmias caused by digoxin toxicity.
  • Second choice for trigeminal neuralgia.

Precaution while Using Phenytoin:

  • Phenytoin has a narrow therapeutic index and needs monitoring of plasma concentration.
  • Phenytoin may interact with other drugs and it is important to inform the doctor and the pharmacist of any other medicines the patient may be taking before using phenytoin.
  • Do not use this drug if the patient is pregnant as it may cause severe fetal damage.
  • If given by intramuscular injection can lead to skin necrosis and local tissue destruction.
  • Before starting this drug it is important to get basal liver function tests and a history of any liver disease, diabetes, history of depression or suicidal thoughts, as well as any other underlying diseases like porphyria.
  • It is not considered to be safe to consume large amounts of alcohol while taking phenytoin.

Side Effects: Patients taking Phenytoin may have following side effects:

  • Difficult falling asleep or staying asleep.
  • Nausea and vomiting
  • Severe hypotension and cardiac arrthymias
  • Uncontrollable eye movements
  • Uncoordinated body movements.
  • Coarsening of facial features.
  • Overgrowth of gums and enlargement of lips.
  • Unwanted hair growth
  • Serious effects like jaundice and unusual bleeding etc.