The patient has fever, vomiting, headache of different durations for past 7 days. Occipital headache with frontal headache, maybe bilateral. Any neck pain? Fundus examination? With the presentation , I would prefer to rule out 1. meningoencephalitis 2. Cvt CT brain may be normal in both. Sinusitis may be a source of nasal spread for meningitis especially in view of uncontrolled diabetes. I would suggest a venogram and a lumbar puncture examination with opening pressure as well. As per guidelines, first dose of antibiotic and steroid (10 mg dexamethasone prior to or with antibiotic followed by 4 mg q8h- q6h) can be given before the tests. In view of age of 50 years and above , third generation cephalosporin and vancomycin can be initiated followed by specific antibiotic as per report. Do take a consult with the neurologist available there.
For dm 2, tell me the fbs, ppbs, hba1c status, medication status. For htn, what's the BP..? Is he on any sort of medications..? Add a ace inhibitor or ARB if not taking it. For headache, ethmoidal Sinusitis - tab amoxyclav 625 bd, tab pacimol active 1 tab sos, tab levocetrizine 10 od before food. For constipation, softovac sf - 2tsp in half glass water hs, Add a ppi to it.
@Dr. Umesh Patnaik @Dr. Siba Dalai diagnosed as varicella Zoster meningitis prognosis? treatment?
I agree with Dr S Dalai
@Narayan Pal diagnosis?
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A 62 years old man c /o difficulty in urination at night. Forked stream. Unsatisfactory urination. Sneezing alternating with itching in the eyes, nose, ear, throat. Erysipelas inflammation of extremities < cold air. Difficulty in breathing. Coryza. Constipation. Vertigo < rising from a seat. USG abdomen and blood report attached. Respected doctors suggest your viewsDr. K.suresh Kuzhikandathil4 Likes21 Answers
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Todays Herb ALOE VERA (Kumari) Ras -Tikta kashay virya- Shit vipak- Katu Doshghnata- Kapha pittaDr. Deepak Dobade17 Likes20 Answers
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Friends today I am discussion about a savere disease. Shingles/Herpes Zoster Shingles or herpes zoster is an infection which is characterized by a painful blistering skin rash. The rash usually affects one side of the body, i.e. the torso and/or one side of the face. It appears in a band formation and therefore the name ‘shingles’, which is Latin for ‘belt’. Shingles is caused by the same virus that causes chickenpox, called the varicella-zoster virus. The initial warning symptoms appear one to five days before the rash appears. You will feel the warning signs on the location where the rash will appear. These initial symptoms include itching, pain, burning, pricking and stabbing sensation, followed by high fever, chills and muscle pain. The tell-tale rash appears soon after. When a person (usually children) gets infected by the varicella-zoster virus, he/she develops chickenpox. After the chickenpox heals, the virus remains in a dormant state in the nerve roots or the dorsal root ganglia, which contains the cell bodies of sensory neurons. Years later, this virus may wake up to cause an outbreak of shingles or herpes zoster. Although the reason for its waking up is not certain, experts believe a variety of conditions can lead to its activation such as normal ageing weakening of the immune system stress and anxiety Healthy people and young children too are not exempt from the risk. In fact, anyone who has had chickenpox is at a high risk of developing herpes zoster or shingles. Appearance of the Blistering Rash The distinctive feature of this illness is the rash that appears on one side of the body. The rash is accompanied by a pricking and sometimes stabbing pain. It erupts into clusters of small red patches that develop into blisters. Within 7 - 10 days the blisters break open and a fluid comes out. During this period, if anyone who never had chickenpox before, accidentally touches the oozing blisters of the patient, he/she will develop chickenpox. Once the fluid comes out, the rash slowly begins to dry and crust. The rash disappears completely after two to four weeks. When the blisters scab and dry, the virus cannot spread anymore. Because herpes zoster affects the nerve cells in the body, it is very common for the rash to appear in the formation of a band on one side of the body along the path of a nerve. In some people, the rash may spread to the eyes, and occur inside the eyelids. This can be extremely painful, with the person experiencing stabbing pains in the eye, constant eye watering, sensitivity to light, and blurry vision. The symptoms in the eyes usually vanish within three to five weeks. A person with shingles cannot transmit shingles to another person. Though, he can transmit chickenpox to a person, who has never had chickenpox before. Post-Herpetic Neuralgia (PHN) Around 20% of the people who suffer from shingles may develop a condition known as post-herpetic neuralgia. This occurs when the proper functioning of a nerve is disrupted due to the damage caused to it by shingles. It is commonly believed that shingles causes scar tissue to develop around the nerve, which when inadvertently pressed, causes pain signals to go to the brain. The person suffering from PHN will experience a sudden throbbing, burning, shooting, or even a stabbing pain along the damaged nerve for months, or even years, after the rash has healed. In some cases, the pain may be continuous for a few months after the rash has healed, however, if the condition runs into years, the person will experience paroxysms of pain along the nerve. Who is prone to shingles/herpes zoster? a weak immune system are experiencing any stress or trauma are suffering from any illnesses such as diabetes, HIV, cancer are taking any medications that affect the immune system such as steroids are taking treatments for certain ailments such as cancer are recuperating from any illness, be it even a cold, or flu have erratic sleeping patterns are suffering from malnutrition a dull constant pain which can be mild or severe, or an intermittently shooting pain in the affected area soreness, burning sensation, itching, or numbness in the affected area exhaustion fatigue sensitivity to light fever headache the appearance of a painful, itchy and red rash on one side of the body and sometimes in and around the eyes a sensation of pins and needles piercing through in the areas of the rash throbbing pain in the eye with burning sensation and irritation soreness and redness in and around the eye extreme sensitivity to light constant eye watering blurred vision What are the complications of shingles/herpes zoster? Shingles is a self-limiting condition which disappears within three weeks. However, in people with very low immunity, it may take a serious turn. Delaying, or not undertaking medical treatment can cause serious complications which include: Postherpetic Neuralgia - which is nerve pain caused by the damage to nerves by the varicella-zoster virus. The stabbing pain can remain for months and even for years in patients. Eye Complications - which can occur if the rash spreads to the eyes. Swelling of the cornea may occur which can leave permanent scars. Shingles in the eye can also cause the retina to swell, or increase pressure in the eye which can lead to glaucoma and eventually loss of vision. Skin Infections - may occur if the area affected by the rash is not kept clean, which can lead to scarring. Neurological Complications - can ensue if the shingles affects the nerves in the brain. The neurological complications include Guillain-Barre Syndrome, Ramsay Hunt Syndrome, Bell’s palsy, encephalitis, meningitis, and even stroke anytime in the year following the illness. Disseminated Herpes Zoster- is when the virus spreads to other organs. People with compromised immune systems ( those suffering from cancer, HIV/AIDS), are at a risk of Disseminated Herpes Zoster. This can be life-threatening especially if it affects the lungs. What is the treatment for shingles/herpes zoster? Though there is no known cure or for that matter treatment for shingles, your general physician may prescribe antiviral medicines, which will reduce the pain and duration of shingles. He may also prescribe some topical antibiotics to apply on the rashes which will reduce the stinging and prevent infection. Homoeopathic medicines for Herpes Primary Remedies Arsenicum album. If a person feels chilly, anxious, restless, and exhausted during fever-and the burning pain of the eruptions is relieved by heat-this remedy may be indicated. ... Apis mellifica. ... Iris versicolor. ... Mezereum. ... Ranunculus bulbosus. ... Rhus toxicodendron. ... Clematix.Dr. Rajesh Gupta18 Likes29 Answers
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Panchakarma- Five Teatments -1 Pancha Karma is the cornerstone to Ayurvedic management of disease. Pancha Karma is the process which gets to the root cause of the problem and corrects the essential balance of 'Tridosha' in body. Pancha Karma is not only good for alleviating disease but is also a useful tool in maintaining excellent health. Ayurveda advises undergoing Pancha Karma at the seasonal changes to clean the body, improve the digestion and to improve the metabolic processes. Panchakarma is a Sanskrit word that means "five actions" or "five treatments ". This age-old science of purifying the body is an ancient branch of Ayurveda, The Treatment in Ayurveda consists of two main types. One is Shaman Chikitsa, used to subdue the vitiated Doshas, due to which any ailments may be produced. It is administered by using various medicinal herbo-mineral preparations. However, if the Doshas are vitiated beyond a particular level, they give rise to various endotoxins, which have a tendency to be accumulated in the minute channels. These are beyond the level of pacification and hence need to be eliminated or removed from the body. In such cases, the second type of treatment, which is Shodhan Chikitsa or cleansing therapy, is indicated. Since it consists of the five types of main therapies, it is known as the Panchakarma Chikitsa. Panchakarma has been given a special place in all the ancient Ayurvedic texts. Aacharya Charak, the author of the most important ancient text on internal medicine, has described a wide use of Panchakarma therapy for almost all the major diseases. Two separate sections, Kalpa Sthanam, and Siddhi Sthanam in Charak Samhita describe the details of special decoctions and other preparations used for Panchakarma therapy. Panchakarma includes three parts namely: Poorva Karma (Preparatory Methods)which includes : Paachan (Digestion) Snehan (Internal and external oleation) Swedan (Fomentation) Pradhan Karma (Main methods)which includes : Vaman (Induced vomiting) Virechan (Induced purgation) Basti (Medicated enema) Nasya (Nasal medicine) Rakta Mokshan (Artificial bloodletting) Pashchat Karma (Post-Therapeutic Measures)which includes: Sansarjan Krama (Specific dietetics), DhumaPana (smoking of medicinal cigars) and some rules to follow specific activities. Purvakarma : Pre-purification Measures Before the actual operation of purification begins, there is a need to prepare the body in prescribed methods to encourage the body to let go of the toxins. The two procedures are 'snehan' and 'swedan'. Snehan is the oil massage. Oil is applied to the entire body with a particular type of massage which helps the toxins to move towards the gastro-intestinal tract. Oil massage also makes the superficial and deep tissues soft and supple. Snehan is given daily for three to seven days, as indicated. Swedan is sudation or sweating and is given every day immediately following the snehan. An herbal concoction may be added to the steam to further loosen the toxins from the individual. Swedan liquefies the toxins and increases the movement of toxins into the gastro-intestinal tract. After three to seven days of snehan and swedan, the doshas become well "ripened". A particular panchakarma method is then given according to the individual's constitution and disorder, prakruti and vikruti, respectively. Panchakarma - Five Basic Shodhans: Cleansing Methods 1) Vaman : therapeutic vomiting or emesis 2) Virechan : purgation 3) Basti : enema 4) Nasya : elimination of toxins through the nose 5) Rakta moksha : detoxification of the blood Vaman: Emesis Therapy When there is congestion in the lungs causing repeated attacks of bronchitis, colds, cough or asthma, the Ayurvedic treatment is therapeutic vomiting, vaman, to eliminate the kapha causing the excess mucus. First, after the snehan and swedan, three to four glasses of licorice or salt water is administered, then vomiting is stimulated by rubbing the tongue which triggers the vomiting center through the gag reflex. One may alternatively take two to three glasses of salt water which will also aggravate kapha and then rub the tongue to induce vomiting. Once the mucus is released the patient will feel instantly relieved. It is likely that congestion, wheezing and breathlessness will disappear and that the sinuses will become clear. Therapeutic vomiting is also indicated in chronic asthma, diabetes, chronic cold, lymphatic congestion, chronic indigestion and edema. Emetic Substances: madan-emetic nut, madhuka-yastimadhu-licorice, neem-bitter leaf, bimbi, kutaj-kurchi- conessi bark, murva-clematis, triloba-devdaru-deodar, Cedrus deodara, Salt, NaCl, ela-cardamom, nux vomica. Indications for Vaman : used for all kapha type disorders good for pitta headache, dizziness, and nausea will help to release blocked emotions respiratory congestion bronchitis chronic cold sinus congestion kaphagenic asthma Contra-Indications for Vaman : below the age of 12 or over age 65 menstruation pre-menstrual period (one week prior) pregnancy emaciation delicate or sensitive person with too much fear, grief or anxiety hypoglycemia vata prakruti vata diseases heart diseases during vata season acute fever diarrhea obesity Virechan : Purgation Therapy When excess bile, pitta, is secreted and accumulated in the gall bladder, liver and small intestine, it tends to result in rashes, skin inflammation, acne, chronic attacks of fever, biliary vomiting, nausea and jaundice. Ayurvedic literature suggests in these conditions the administration of therapeutic purgation or a therapeutic laxative. Virechan is facilitated with senna leaves, flax seeds, psyllium husks or triphala in a combination that is appropriate for the individual person. Virechan Substances: Senna, prune, bran, flaxseed husk, dandelion root, psyllium seed, cow's milk, salt, castor oil, raisins, mango juice, triphala. Indications for Virechan: allergic rash skin inflammation acne, dermatitis, eczema chronic fever ascites biliary vomiting jaundice urinary disorder enlargement of the spleen internal worms burning sensation in the eyes inflammation of the eyes conjunctivitis gout Contra-Indications for Virechan: low agni acute fever diarrhea severe constipation bleeding from rectum or lung cavities foreign body in the stomach after enema emaciation or weakness prolapsed rectum alcoholism dehydration childhood old age ulcerative colitisAyurveda-Panchakarma Basti & Nasya -2 Basti: Enema Therapy Vata's predominant site is the colon. Ayurvedic basti involves the introduction into the rectum of herbal concoctions of sesame oil, and certain herbal preparations in a liquid medium. Basti, is the most effective treatment of vata disorders, although many enemas over a prescribed period of time are usually required. It relieves constipation, distention, chronic fever, cold, sexual disorders, kidney stones, heart pain, backache, sciatica and other pains in the joints. Many other vata disorders such as arthritis, rheumatism, gout, muscle spasms and headaches may also be treated with basti. Vata is a very active principle in pathogenesis. If we can control vata through the use of basti, we have gone a long way in going to the root cause of the vast majority of diseases. Vata is the main etiological factor in the manifestation of diseases. It is the motive force behind the elimination and retention of feces, urine, bile and other excreta. There are eight main types of basti, according to traditional texts, each with their own indications and contra-indications as listed below. 1. Anuvasana (oil enema) is used in pure vata disorders and when a person is having excess hunger or dryness related to vata imbalances. 2. Niruha-Asthapana (decoction enema) is used, among other conditions, for evacuation of vata, nervous diseases, gastro-intestinal vata conditions, gout, certain fever conditions, unconsciousness, certain urinary conditions, appetite, pain, hyperacidity and heart diseases. 3. Uttara Basti (through the urethra with men or vagina with women) is used for selected semen and ovulation disorders and for some problems involving painful urination or bladder infections. This is not to be used for someone with diabetes. 4. Matra Basti (daily oil enema) is used by someone emaciated by overwork or too much exercise, too much heavy lifting, walking too long of a distance, too much sexual activity or someone with chronic vata disorders. It does not need to be accompanied by any strict dietary restriction or daily routine and can be administered, in the appropriate cases, in all seasons. It gives strength, promotes weight and helps elimination of waste products. 5. Karma Basti (schedule of 30 bastis), 6. Kala Basti (schedule of 15 bastis; 10 oil + 5 decoction) 7. Yoga Basti (schedule of 8 bastis; 5 oil + 3 decoction). 8. Bruhana Basti (nutritional enema) is used for providing deep nutrition in select conditions. Traditionally, highly nutritive substances have been used, such as warm milk, meat broth, bone marrow soup and herbs like shatavari or ashwagandha. General Indications for Basti: constipation low back ache gout rheumatism sciatica arthritis nervous disorders vata headache emaciation muscular atrophy General Contra-Indications for Basti (include but are not limited to the following): Enema therapy should not be used if the patient is suffering from diarrhea, bleeding of the rectum, chronic indigestion, breathlessness, diabetes, fever, emaciation, severe anemia, pulmonary tuberculosis, old age or for children below the age of seven years. for oil enemas: diabetes, obesity, indigestion, low agni, enlarged liver or spleen, unconsciousness, tuberculosis and cough. for decoction enemas: debility, hiccough, hemorrhoids, inflammation of anus, piles, diarrhea, pregnancy, ascites, diabetes and some conditions involving painful or difficult breathing. for nutritional enemas: diabetes, obesity, lymphatic obstruction, ascites. for urethra or vaginal enemas: diabetes Nasya: Nasal Administration The nose is the doorway to the brain and it is also the doorway to consciousness. The nasal administration of medication is called nasya. An excess of bodily humors accumulated in the sinus, throat, nose or head areas is eliminated by means of the nearest possible opening, the nose. Prana, life force as nerve energy, enters the body through the breath taken in through the nose. Prana is in the brain and maintains sensory and motor functions. Prana also governs mental activities, memory, concentration and intellectual activities. Deranged prana creates defective functioning of all these activities and produces headaches, convulsions, loss of memory and reduced sensory perception. Thus nasal administration, nasya is indicated for prana disorders, sinus congestion, migraine headaches, convulsions and certain eye and ear problems. There are six main types of nasya, as listed below. 1. Pradhamana (virechan) Nasya (cleansing nasya) uses dry powders (rather than oils) that are blown into the nose with a tube. Pradhamana nasya is mainly used for kapha types of diseases involving headaches, heaviness in the head, cold, nasal congestion, sticky eyes, hoarseness of voice due to sticky kapha, sinusitis, cervical lymph adenitis, tumors, worms, some skin diseases, epilepsy, drowsiness, Parkinsonism, inflammation of the nasal mucosa, attachment, greed and lust. Traditionally, powders such as brahmi are used. 2. Bruhana Nasya (nutrition nasya) uses ghee, oils, salt, shatavari ghee, ashwagandha ghee and medicated milk and is used mainly for vata disorders. It is said to benefit conditions resulting from vata imbalances such as vata-type headaches, migraine headache, dryness of voice, dry nose, nervousness, anxiety, fear, dizziness, emptiness, negativity, heaviness of eyelids, bursitis, stiffness in the neck, dry sinuses and loss of sense of smell. 3. Shaman Nasya (sedative nasya) is used according to which dosha is aggravated but mainly for pitta-type disorders such as thinning of hair, conjunctivitis and ringing in the ears. Generally certain herbal medicated decoctions, teas and medicated oils are used. 4. Navana Nasya (decoction nasya) is used in vata-pitta or kapha-pitta disorders and is made from decoctions and oils together. 5. Marshya Nasya (ghee or oil nasya) 6. Prati Marshya (daily oil nasya) This helps to open deep tissues and can be done every day and at any time to release stress. Substances Used in Nasya: brahmi, ginger, ghee oils, decoctions, onion, garlic, Piper longum, black pepper, curry pepper, rose, jasmine, mogra flowers and henna. Indications for Nasya: stress emotional imbalances stiffness in the neck & shoulders dryness of the nose sinus congestion hoarseness migraine headache convulsions Contra-Indications for Nasya: sinus infections pregnancy menstruation after sex, bathing, eating or drinking of alcohol should not be used below 7 years or over 80 years of age Click here to read more about 'Nasyakarma' Raktamoksha : Traditional Ayurvedic Method for Purification and Cleansing of the Blood Toxins present in the gastro-intestinal tract are absorbed into the blood and circulated throughout the body. This condition is called toxemia, which is the basic cause of repeated infections, hypertension and certain other circulatory conditions. This includes repeated attacks of skin disorders such as urticaria, rashes, herpes, eczema, acne, leukoderma, chronic itching or hives. In such conditions, along with internal medication, elimination of the toxins and purification of the blood is necessary. Raktamoksha is also indicated for cases of enlarged liver, spleen and gout. Extracting a small amount of blood from a vein relieves the tension created by the pittagenic toxins in the blood. Bloodletting also stimulates the spleen to produce antitoxic substances which helps to stimulate the immune system. Toxins are neutralized enabling radical cures in many blood born disorders. Bloodletting is contraindicated in cases of anemia, edema, extreme weakness, diabetes and in children and elderly persons. Indications for Raktamoksha: urticaria rash acne eczema scabies leukoderma chronic itching hives enlarged liver or spleen gout Contra-Indications for Raktamoksha: anemia edema weakness young children old age during pregnancy during menstruation Read more about Various Diseases and Indicated Panchakarma procedures for them > @Dr. Tapan Kumar Sau15 Likes22 Answers
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30yrs,Male Engineer. C/o feeling thirsty, dry mouth after teeth brush. (to avoid dryness he drinks water frequently) Bad smell of mouth mainly 1-2hours after food since last 7-8yrs. (Brushing 2times a day-changed many toothpaste,consulted dentist many time-oral hygine good,no any dental problem) Feeling of incomplete defecation in morning (use to go for toilet 2 times in morning) Consulted GI specialist -Taken empirical rx for H.Pylori.(tab.PyloKit for 10days) No c/o loose motion,constipation,fever,cough,cold,breathlessness. No any addiction. Habitual to self check mouth odor every time before talking to people. Habitual to observe people during talking with him as they sense his bad breath or not. He noted many time his friends,colleagues use to rub his/her nose while talking with him. O/E General and Systemic examinations:Normal. Did All routine investigation 2-3times -All investigations are normal. CBC,Sugar,LFT,TFT,RFT,SE. What will be the cause of halitosis? Any treatment availble in other pathies?Dr. Aditya Salgarkar3 Likes13 Answers