NEED'S.. STRICT GLYCEMIC CONTROL WITH ANTIDIABETIC MANAGEMENT .. INJECTION .. NEUROKIND PLUS X .. WKLY .. SYMPTOMATIC T/T .. NEUROLOGISTS OPINION ..
Physiotherapy helps a lot in recovery. Correct her diabetes. Treat underlying cause of Bell's palsy
Strict control of diabetes Ad nerve conduction velocity Ref patient to neurologists
Control diabetes C
CT/MRI brain metastasis
Agree@Bhanudas Jadhav , @Dr. Suryam Goduguchinta (Pt)
DM control is must.may be immunity is compromised. Thorough neurological assessment is required. Brain stem mets can cause Bell's palsy.NCV may help to know whether nerve is regenerating. Degeneration is completed in 20 days.its 4 months now better to find out nerve status. Can continue physiotherapy.
first u should check any cardiac ,Neurological Histories..., if no then should go M.S...,FACIAL MUSCLES RELAXATION EX'S...like chewing. balloon blowing,Ex's could do behind Mirror,trying of Facial expressions practice............ AND FACIAL MASSAGE(SOFT Tissue MANIPULATIONS)....ALL THE BEST PHYSIO......!
Ultrasound therapy and TENS may be helpful. If eyes are involved blinking and ice therapy also can apply.
Application of interrupted galvanic current intially joined with it application and facial exercises may be helpful. Once the acute condition is over if application may be joined with faradic application and other things of treatment shall remain the same. One more component of treatment may be added as dont's i.e. diet advice- .like avoiding too cold and too hot items in eating .etc..
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P3L3 of 56yrs,known case of diabetes mellitus came with small mass in upper outer quadrant.No evidence of any secretions/ discharge from nipple.No evidence of puckering of skin.PET scan report attached. What is the mode of treatment in this pt.Dr. Gopala Vanaja0 Like13 Answers
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84 year old with a lump in the right breast since 1 week. No history of trauma. O/e - 3*3 cm well defined firm lump in upper outer quadrant of right breast. Not fixed to skin or underlying muscle. No enlarged axillary LN. Share your views regarding the mammogramDr. Rohan Khandelwal11 Likes28 Answers
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B M I n O B E S I T Y BMI is commonly used to diagnose overweight and obesity, often in conjunction with measurement of waist circumference. Leading guidelines, such as those produced by the American Association for Clinical Endocrinology (AACE),the UK National Institute for Health and Care Excellence (NICE), and the European Association for the Study of Obesity (EASO),consider a BMI of 30 kg/m2 to be the threshold for obesity, and describe 3 classes of obesity, rising in severity from low-risk/class 1 (between 30.0 and 34.9 kg/m2), through moderate-risk/class 2 (between 35.0 and 39.9 kg/m2), to high-risk/class 3 (≥40.0 kg/m2). Lower BMI thresholds may be recommended for black African, African-Caribbean, and Asian (particularly South Asian) populations in order to trigger action to reduce the risk for comorbid conditions. For example, in the NICE guidelines, a BMI of 23.0 kg/m2 in these groups indicates increased risk for type 2 diabetes mellitus (T2DM), and 27.5 kg/m2 indicates a high risk. Obesity is a global epidemic and its prevalence more than doubled between 1980 and 2014. In 2014, more than 1.9 billion adults (≥18 years), which is 39% of all adults, had overweight. More than 600 million had obesity, representing 13% of all adults. The fundamental cause of obesity and overweight is an imbalance between calories consumed and expended. Changes in dietary and physical-activity patterns worldwide have led to the increase in obesity and overweight.Obesity is a serious chronic condition that is associated with multiple comorbidities and decreased life expectancy.An increase in BMI increases a person's risk for cardiovascular disease (CVD), and obesity is an independent risk factor for CVD.It also increases the risk for T2DM; fatty liver disease; musculoskeletal disorders, in particular osteoarthritis; and some cancers, including breast, colon, kidney, and pancreatic cancer.Higher BMIs are also associated with cognitive/mood disorders, obstructive sleep apnea, gallstones, and gastroesophageal reflux. Classes 2 and 3 obesity are associated with significantly higher all-cause mortality than class 1 obesity and normal weight.Other factors, such as waist circumference, also contribute to the increased risk for obesity-related disease. As well as fat accumulation, fat distribution is related to obesity-related mortality and morbidity. Central obesity, also known as the apple shape, confers a higher risk than general obesity for several chronic diseases.In recent years, there has been a broadening of focus from BMI alone, so that the management of obesity-related comorbidities is also a priority Physical-activity counseling is an integral part of obesity management, but would not be effective on its own. EASO guidelines recommend that pharmacological therapy is considered in patients who are overweight or who have class 1 obesity if they also have comorbidities. Treatment guidelines recommend that the first stage in managing patients with obesity is to assess their views of their weight and the diagnosis, as well as the possible reasons for weight gain. Failure to engage patients and to convince them of the benefits of lifestyle interventions aimed at weight loss is likely to result in the lifestyle interventions being less effective. Therefore, this is an important first step. Eating patterns and physical-activity levels should be explored, as well any beliefs about diet, exercise, and weight gain that may be unhelpful to the patient. The physician should find out if the patient has already tried to lose weight and how successful these efforts were. They should assess the patient's confidence and willingness to engage in a weight-loss program. The health and other risks of obesity should be explained, as well as the benefits of weight loss and increasing physical-activity levels. The physician should be aware that a patient's feelings about obesity and other health problems, such as surprise or denial, may reduce their willingness or ability to change. For this reason, it may help to stress that obesity is a clinical condition with specific implications for health, rather than something that focuses on how a patient looks. It has reported a divergence in the perception of obesity between people with obesity and the clinicians treating them. For example, 65% of people with obesity consider obesity to be primarily a lifestyle disease and 44% think it is possible to have obesity and be healthy, compared with 88% and 4%, respectively, for clinicians. Barriers can be motivational, such as lack of willpower, emotional/personal, such as eating habits, or practical/systemic, such as medication costs or lack of support services. A comprehensive lifestyle intervention is a fundamental part of the management of obesity. This consists of lifestyle/behavioral training, a dietary calorie-reduction plan, and increased physical activity.When developing a weight-loss plan for a patient, the main requirement is that total energy intake is less than total energy expenditure.This will help address the imbalance of energy regulation that characterizes obesity. Obesity develops when the body's weight and energy regulatory mechanisms do not work properly, leading to an elevated body fat "set point," ie, the amount of fat the body wants to retain. The energy intake behavior of an individual is determined by whether he or she is at, above, or below the set point. Diets with a daily deficit of 600 kcal, leading to a 5% to 10% reduction in current body weight over 6 months, are considered to be realistic and have proven health benefits.Lower-calorie diets with an intake of 800 to 1600 kcal/day can be considered, but they are less nutritionally complete. Very low-calorie diets (<800 kcal/day) should not be routinely used to manage obesity. Evidence from systematic reviews suggests that, although initial weight loss is more rapid with very low-calorie diets, weight change after 1 year is not very different from comprehensive approaches. Physical activity is part of a comprehensive lifestyle intervention. Although it may have only modest effects on weight loss, it will bring other benefits, such as a reduction in the risk for T2DM and CVD.Physical activity also helps to preserve fat-free mass during weight loss and promote weight maintenance. People who have had obesity but have lost weight may need to do 60 to 90 minutes of activity per day to avoid regaining weight. Weight loss is difficult to achieve for most patients with obesity because a desire to restrict caloric intake is counteracted by biological responses to weight loss. The reduction in energy expenditure and increase in appetite that occur after weight loss are associated with changes in several hormones. Some of the hormonal changes result in altered physiology that leads to weight gain, whereas other changes lead to improvements in hormonal systems as the patient gets closer to a healthy weight. Weight-loss medications aim to reinforce the patient's efforts to change eating behaviors and produce an energy deficit.Most promote weight loss through their effects on appetite -- increasing satiety and decreasing hunger. It is possible that satiety signaling and inhibitory control are weaker in people who are prone to obesity. Many treatment guidelines recommend that weight-loss medication is considered for patients with a BMI ≥30 kg/m2 or a BMI ≥27 kg/m2 if they also have 1 or more comorbidities and a history of failure to lose weight.The inclusion of comorbidities in the criteria reinforces the benefits of weight loss for people with obesity-related disease. ORLISTAT Unlike most weight-loss medications, orlistat is a reversible gastric and pancreatic lipase inhibitor that blocks absorption of 30% of ingested fat from a 30% fat diet when taken at the recommended dosage (120 mg 3 times per day). It is approved for use in adults and adolescents, is considered one of the safest drugs in its category, and is available in most countries around the world. However, it has well-documented GI adverse events, such as fecal leakage, which limit its popularity. NALTREXONE/BUPROPION This is a sustained-release combination of an opioid receptor antagonist (naltrexone) and a noradrenaline reuptake inhibitor (bupropion). Naltrexone has a minimal weight-loss effect on its own,but it acts synergistically with bupropion to stimulate central melanocortin pathways and antagonize inhibitory feedback loops that limit weight reduction. This leads to improved energy expenditure and a reduction in appetite.The maximum total daily dose is 32 mg naltrexone/360 mg bupropion.Naltrexone/bupropion is associated with increased BP, so it should be avoided in patients whose hypertension is not controlled, and BP should be monitored in the initial phase of therapy. The most common adverse events are nausea, headache, vomiting, anxiety, and insomnia. The risk for GI events can be minimized by gradual titration. Other anti obesity drug is Liraglutide but this and Naltrexone are not available n approved in India by FDA .Only Bupropion is available but at present is used in smoking cessation n in depression.Dr. Girish Dahake12 Likes21 Answers
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*The most common cause of non malignant type of this skin lession? **the most common cause of malignant type? ***treatment?Dr. Zaka Yusto M4 Likes17 Answers
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Ten health benefits of Black Pepper. Black pepper (scientific name: Piper nigrum) is a hot, pungent spice with a host of health benefits. In fact, it is used extensively in Ayurvedic medicine. It has an active component called piperine that gives black pepper its characteristic taste. Plus, it contains iron, potassium, calcium, magnesium, manganese, zinc, chromium, vitamins A and C, and other nutrients. Black pepper usually is added to savory dishes when they are done cooking, otherwise its volatile oils tend to evaporate and diminish its flavor. Freshly ground black pepper has the most flavor. Peppercorns work well in soups, stews, marinades, and other sauces that are cooked slowly. 1. Increases Nutrient Absorption The piperine in black pepper enhances the bioavailability of various nutrients such as vitamins A and C, selenium, beta-carotene, and others, thereby improving your overall health. Bioavailability refers to the amount of a nutrient or supplement that is absorbed by the body. For example, researchers have found that it can increase the bioavailability of the compound curcumin (found in turmeric) twentyfold. Curcumin helps fight cancer, infection, and inflammation. Moreover, piperine stimulates amino acid transporters in the intestinal lining and inhibits enzymes that help metabolize nutritional compounds. It also prevents the removal of substances from cells and reduces intestinal activity, so more substances enter the body in active form and remain available for use. 2. Improves Digestion Black pepper stimulates the taste buds and increases the secretion of hydrochloric acid in the stomach, which in turn aids proper digestion. Interestingly, most digestive problems are caused by a lack of hydrochloric acid rather than excess amounts of it. By improving digestion, black pepper relieves issues like colic, bloating, indigestion, flatulence, and constipation. It also has antibacterial qualities that help treat intestinal diseases caused by bacteria. 3. Stimulates Appetite Besides adding flavor to your food and promoting digestion, black pepper works as an appetite stimulant. Research has shown that black pepper helps improve the appetite through olfactory stimulation. This makes it an excellent, simple remedy for those with a poor appetite. An Ayurvedic remedy specifically for this purpose calls for consuming a mixture of one-half teaspoon of black pepper and one tablespoon of jaggery powder (gur). Take this remedy on a regular basis till you see improvement. 4. Facilitates Weight Loss Although it stimulates the appetite, black pepper also can help you lose weight. The outer layer of peppercorns contains phytonutrients that encourage the breakdown of fat cells. A 2010 study of the effects of piperine on the metabolism of mice revealed that it suppresses fat accumulation in the body. Also, by improving your metabolism this fat-free food can help you burn calories. In addition, being a diuretic and diaphoretic herb, it promotes urination and perspiration, which in turn help flush toxins and excess water from the body. 5. Relieves Gas Being a carminative, black pepper relieves stomach gas and also helps prevent gas formation. If you are prone to stomach gas, try spicing up your food with black pepper instead of chili powder or peppers.To cure indigestion and heaviness in your stomach, you can have a glass of buttermilk mixed with one-quarter teaspoon each of black pepper and cumin powder.You can also massage your belly with black pepper oil mixed with carrier oil (a base oil) to relieve gas pain. 6. Helps Clear Congestion Black pepper can be used to clear up a stuffy nose and congestion as it helps loosen phlegm. It also has antimicrobial properties, which is why black pepper is included in various cough and cold remedies. Simply drink a glass of lukewarm water mixed with one-half tablespoon of black pepper powder, two or three times a day to clear the respiratory system.Alternatively, you can try steam inhalation from a pot of hot water mixed with some black pepper and eucalyptus oil.Another simple remedy is to sniff a mixture of black pepper and a few drops of sesame oil. It will induce sneezing but clear your sinuses. 7. Combats Arthritis The piperine present in black pepper is highly beneficial for treating arthritis due to its anti-inflammatory and anti-arthritic properties. In addition, this wonderful spice improves circulation, thereby preventing or reducing joint pain caused by poor circulation. Researchers have also found that black pepper helps reduce the perception of pain and arthritic symptoms. 8. Fights Cancer and Prevents Other Diseases Black pepper has antioxidant qualities that fight cancer, particularly colon and breast cancer. A study done at St. Louis University in Missouri found that black pepper can help inhibit colon cell proliferation due to its significant anti-proliferative activity. Furthermore, its polyphenol content protects against high blood pressure, diabetes, and cardiovascular disease. 9. Works as a Natural Antidepressant The piperine in black pepper acts as an antidepressant by increasing serotonin production. Serotonin is a neurotransmitter important for mood regulation. Low levels of serotonin are associated with depression Moreover, piperine increases beta-endorphins in the brain and promotes mental clarity. Endorphins work as natural painkillers and mood elevators. They reduce stress and promote a feeling of wellness that alleviates anxiety and melancholy. So, add black pepper in your daily meals to improve your cognitive functioning and lift your mood. 10. Treats Teeth and Gum Problems As it reduces pain and inflammation, you can use black pepper with its partner salt to reduce gum inflammation along with problems like bad breath and bleeding gums. Just mix equal amounts of both salt and pepper in a few drops of water, and massage your gums with the mixture.To alleviate a toothache, mix a pinch of black pepper powder in clove oil and apply it on the affected area.Dr. Sanjay Kumar Mallick12 Likes19 Answers