Sep 012012
 

Cystic fibrosis is a genetic disorder that is inherited in an autosomal recessive pattern and is characterized bya defective transport of chloride and sodium across the epithelium that causes thick, sticky mucus to build up in the lungs, digestive tract, and other areas of the body. It is one of the most common chronic lung diseases in children and young adults.

Some of the treatment options are discussed briefly here:

Physiotherapy 

Daily chest percussion and physiotherapy with postural drainage reduces respiratory exacerbations

Antibiotics

Early high dose , broad spectrum , long duration (minimum 2-3 weeks) antibiotics helps minimize lung damage in infective exacerbations. Oral or intravenous fluroquinolones combined with nebulized antibiotic is often the initial choice; resistance and chronic carriage needs intravenous combinations. Prophylactic antibiotics are also increasingly used.

Bronchodilators

These are helpful for symptomatic relief.

DNase- alpha mucolytics

These are administered as areosol spray. Mechanism of action is that it interferes with sputum neutrophil DNA, helping to liquefy sputum and encourage expectoration, thus  helps in reducing cough.

Pancreatic enzyme replacement

Since patients with cystic fibrosis have pancreatic enzyme deficiency therefore enzyme  replacement helps avoid malabsorption.

Immunization 

Routine pneumococcal and influenza vaccination  are recommended for patients with cystic fibrosis. Continue reading »

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Aug 182012
 

Von Willebrand’s disease is the most common congenital disorder of hemostasis. It is transmitted in an autosomal dominant pattern. It is characterized by deficient or defective von willebrand factor. Von willebrand factor plays a role in platelet adhesion to damaged subendothelium as well as stabilizing factor VIII in plasma.

Clinical Manifestations

It can affect both males and females.

Most bleeding is mucosal ( epistaxis, gingival bleeding, menorrhagia and GI bleeding ).

bleeding follows minor trauma or surgery.

Aspirin increases bleeding while pregnancy and estrogen use decreases bleeding.

Investigations

Bleeding time : Increased

PT : normal

APTT : raised

Factor VIII : low

vWF : low

In von willebrand’s disease bleeding time is prolonged while in Hemophilia bleeding time is normal. Continue reading »

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Feb 262012
 
The patient with attention deficit hyperactivity disorder (ADHD) has difficulty focusing his attention or engaging in quiet, passive activities, or both. Although the disorder is present at birth, diagnosis before age 4 or 5 is difficult unless the child shows severe symptoms. Some patients, though, aren’t diagnosed until adulthood. Males are three times more likely to be affected than females.
Causes
ADHD is commonly thought to be a physiologic brain disorder with a familial tendency. Some studies indicate that it may result from disturbances in neurotransmitter levels in the brain.
Signs and symptoms
Typically, the patient is characterized as someone who fidgets and daydreams. Other descriptive terms include inattentive and lazy. Although the patient may be highly intelligent, his school or work performance patterns are sporadic, and he may jump from one partly completed project, thought, or task to another. Some patients have an attention deficit without hyperactivity; they’re less likely to be diagnosed and treated.
In a younger child, signs and symptoms include an inability to wait in line, remain seated, wait his turn, or concentrate on one activity until it’s completed. An older child or an adult may be described as impulsive and easily distracted by irrelevant thoughts, sounds, or sights. He may also be characterized as emotionally labile or inattentive. His disorganization becomes apparent when he has difficulty meeting deadlines and keeping track of school or work tools and materials.
Diagnosis
Commonly, the child with ADHD is referred for evaluation by the school. Diagnosis of this disorder usually begins by obtaining data from several sources, including the parents, teachers, and the child himself. Complete psychological, medical, and neurologic evaluations rule out other problems. Then the child undergoes tests that measure impulsiveness, attention, and the ability to sustain a task. The combined findings portray a clear picture of the disorder and of the areas of support the child will need
Treatment
Education represents the first step in effective treatment Continue reading »
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