intertrochandric fracture

जीवनं बृंहणं सात्म्यं स्नेहनं मानुषं पयः| नावनं रक्तपित्ते च तर्पणं चाक्षिशूलिनाम्|| Ch. Su. 27/224 Human breast milk is Jeevana – enlivening Brumhana – nourishing, nutrition rich. Useful in Brimhana therapy Satmya – congenial to human body Snehana – unctuous, increases body oiliness, useful in relieving dryness. Abhighata – it is useful in people suffering from injury with hemorrhage. Exclusive breastfeeding for optimal growth, development and health of infants Breastfeeding has many health benefits for both the mother and infant. Breast milk contains all the nutrients an infant needs in the first six months of life. Breastfeeding protects against diarrhoea and common childhood illnesses such as pneumonia, and may also have longer-term health benefits for the mother and child, such as reducing the risk of overweight and obesity in childhood and adolescence. Breastfeeding has also been associated with higher intelligence quotient (IQ) in children. Exclusive breastfeeding means that the infant receives only breast milk. No other liquids or solids are given – not even water – with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals or medicines. WHO recommendations Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods, while continuing to breastfeed for up to two years or beyond. Last Post on Breastfeeding Week #Social_Responsibility

Hyperthyroidism Hyperthyroidism (overactive thyroid) is a condition in which the thyroid gland produces the high level of the hormone thyroxine. In other words, it can be called as overreactive thyroid. The thyroid gland is an organ located in the front of your neck and releases hormones that control your metabolism (the way your body uses energy), breathing, heart rate, nervous system, weight, body temperature, and many other functions in the body. When the thyroid gland is overactive (hyperthyroidism) the body’s processes speed up and you may experience nervousness, anxiety, rapid heartbeat, hand tremor, excessive sweating, weight loss, and sleep problems, among other symptoms. Pathophysiology In hyperthyroidism, serum T3 usually increases more than does T4, probably because of increased secretion of T3 as well as the conversion of T4 to T3 in peripheral tissues. In some patients, only T3 is elevated (T3 toxicosis). T3 toxicosis may occur in any of the usual disorders that cause hyperthyroidism, including Graves’ disease, multinodular goitre, and the autonomously functioning solitary thyroid nodule. If T3 toxicosis is untreated, the patient usually also develops laboratory abnormalities typical of hyperthyroidism (ie, elevated T4 and 123I uptake). The various forms of thyroiditis commonly have a hyperthyroid phase followed by a hypothyroid phase. Causes A variety of conditions can cause hyperthyroidism. Graves’ disease, an autoimmune disorder, is the most common cause of hyperthyroidism. It causes antibodies to stimulate the thyroid to secrete too much hormone. Other causes of hyperthyroidism include: Excess iodine, a key ingredient in T4 and T3 Thyroiditis, or inflammation of the thyroid, which causes T4 and T3 to leak out of the gland Tumours of the ovaries or testes Benign tumours of the thyroid or pituitary gland Large amounts of tetraiodothyronine taken through dietary supplements or medication Risk factors Have a family history of thyroid disease Have other health problems, including Pernicious anaemia, a condition caused by a vitamin B12 deficiency Type 1 diabetes Primary adrenal insufficiency, a hormonal disorder Eating large amounts of food containing iodine, such as kelp, or use medicines that contain iodine, such as amiodarone, a heart medicine Older than age 60, especially if you are a woman Pregnant within the past 6 months Clinical manifestations The symptoms of hyperthyroidism include the following: An enlarged thyroid gland (goitre), which may appear as a swelling at the base of your neck Fatigue or muscle weakness Light periods or skipping periods. Weight loss Hand tremors Mood swings Rapid heartbeat Nervousness or anxiety Trouble sleeping Protruded eyeballs Skin dryness fine, brittle hair Heart palpitations or irregular heartbeat Increased frequency of bowel movements Breast development in men Complications Heart problems include atrial fibrillation and congestive heart failure An irregular heartbeat that can lead to blood clots, stroke, Brittle bones like osteoporosis Graves’s ophthalmology may exhibit eye problems including bulging, red or swollen eyes, sensitivity to light, and blurring or double vision. Red, swollen skin. Thyrotoxic crisis. Diagnosis and Test Thyroid function blood test Thyroid function test is performed using a sample of blood obtained from the patient with hyperthyroidism. It is used to check the levels of: Thyroid-stimulating hormone (TSH) – a hormone produced by the pituitary gland (a gland at the base of the brain) that controls the production of thyroid hormones Triiodothyronine (T3) – one of the main thyroid hormones Thyroxine (T4) – another of the main thyroid hormones Your levels will be compared to what’s normal for a healthy person. A low level of TSH and high levels of T3 and/or T4 usually means you have an overactive thyroid. Radioactive Iodine Uptake Test To detect the way thyroid gland takes in and absorbs the orally given iodine dose and uses it to produce thyroid hormones. Conclusions are drawn based on the results obtained in this test. Thyroid scan A dye-injection or oral iodine dose test that enables visualization of the thyroid gland, which is seen on a computer. It helps to detect whether a region of the thyroid gland or the entire gland is affected. Ultrasound Scan – To detect the enlargement of the thyroid gland and surrounding structures. CT or MRI Scan – Scanning specified region if a tumour is suspected. Treatment and Medications No single treatment is best for all patients with hyperthyroidism. The appropriate choice of treatment will be influenced by your age, the type of hyperthyroidism that you have, the severity of your hyperthyroidism, other medical conditions that may be affecting your health, and your own preference. Antithyroid Drugs: Drugs known as antithyroid agents-methimazole (Tapazole®) or in rare instances propylthiouracil (PTU)-may be prescribed to treat the hyperthyroidism by blocking the thyroid glands to secrete thyroid hormones. Methimazole is preferred due to less severe side-effects. These drugs work well to control the overactive thyroid, and do not cause permanent damage to the thyroid gland. Radioactive Iodine: Another way to treat hyperthyroidism is to damage or destroy the thyroid cells that make thyroid hormone. Because these cells need iodine to make thyroid hormone, they will take up any form of iodine in your bloodstream, whether it is radioactive or not. The radioactive iodine used in this treatment is administered by mouth, usually in a small capsule that is taken just once. Once swallowed, the radioactive iodine gets into the bloodstream and rapidly it is taken up by the overactive thyroid cells. The radioactive iodine that is not taken up by the thyroid cells disappears from the body within days over a period of several weeks to several months (during which time drug treatment may be used to control hyperthyroid symptoms), radioactive iodine destroys the cells that have taken it up. The result is that the thyroid or thyroid nodules shrink in size, and the level of thyroid hormone in the blood returns to normal. Thyroid surgery: Hyperthyroidism can be permanently cured by surgical removal of all or most of the thyroid gland. This procedure is best performed by a surgeon who has experience in thyroid surgery. An operation could be risky unless the hyperthyroidism is first controlled by an anti-thyroid drug or a beta-blocking drug, usually for few days before surgery, a surgeon may prescribe to take drops of nonradioactive iodine-either Lugol’s iodine or supersaturated potassium iodide (SSKI). This extra iodine reduces the blood supply to the thyroid gland and thus makes the surgery easier and safer. Beta-Blockers: Beta blockers do not stop thyroid hormone production but can reduce symptoms until other treatments take effect. Beta blockers act quickly to relieve many of the symptoms of hyperthyroidism, such as tremors, rapid heartbeat, and nervousness. Most people feel better within hours of taking beta blockers. Propranolol (Inderal®) was the first of these drugs to be developed. Some physicians now prefer related, but longer-acting beta-blocking drugs such as atenolol (Tenormin®), metoprolol (Lopressor®), nadolol (Corgard®), and Inderal-LA® because of their more convenient once- or twice-a-day dosage. Prevention and Cure Patients being treated for hyperthyroidism need to follow-up with the physician for regular monitoring. For weight loss, fatigue and other complaints a proper nutritional plan is essential. To prevent further weakness, bone thinning and to maintain good health, it is necessary to follow a proper diet plan and healthy routine as advised by the physician. Taking calcium and vitamin D supplements may be considered with medical advice. Regular exercise can help to improve bone and heart health. For those suffering from eye disturbances or Grave’s ophthalmology, special care of the eyes can help. Some measures include wearing sunglasses, applying cool eye compresses, using lubricating eye drops and raising the head while sleeping to relieve pressure on the eyes.

A 75-year-old woman presents with back pain. This developed suddenly a week previously after carrying a heavy suitcaset. The pain is persistent and in her lower back. She has had increasing problems with back pain over the past 10 years, and her family have commented on how stooped her posture has become. H/o- known case of severe chronic asthma. She takes courses of oral corticosteroids, and use steroid inhalers on a regular basis. Examination She has a thoracic kyphosis. She is tender over the L4 vertebra. She has a moon-face, abdominal striae and a number of bruises on her arms and thighs. She is not anaemic, and examination is otherwise unremarkable.

A obese patient age 40 yrs,weight 113kg has a following report. plz suggest a remedy for the patient for losing his weight and get rid from the obesity

The Clinical Importance Of Vitamin D ( Cholecalciferol ) Last Sunday, I gave a lecture on this topic to a group of doctors and I would like to share some of that information on this forum ! This topic will be useful for those who are not aware of the important role of Vitamin D in our each body system, for those of you, who are aware, please consider this as a revision. We are familiar with the important role of Vitamin D in Calcium absorption and bone metabolism. Now let's go beyond these effects. The widening range of therapeutic applications available for Cholecalciferol have come from the recent research data , as both a Vitamin and a pro-hormone. Recent data highlights the physiological requirement for Vitamin D in adults may be as high as 5000IU/day, which is less than half of the >10000IU that can be produced endogenously with full body sun exposure. Vitamin D receptors are not only seen in the gut and bone, but also in brain, breast, prostrate and lymphocytes and recent research suggests that higher Vitamin D levels provide protection from DM, Osteoporosis, Osteoarthritis, Hypertension, CVD, Metabolic syndrome, Depression, cancers of the breast, prostrate and colon and several autoimmune diseases. We should be assessing the Vitamin D status and treating with oral Vitamin D supplements , as a routine component of clinical and preventive medicine Periodic assessment of Serum 25OH-vitamin D and serum Calcium helps to ensure Vitamin D levels are sufficient and safe for good health and disease prevention. We shall concentrate our attention, more on on the use of Vitamin D in the management of T2DM, osteoporosis, Osteoarthritis, Hypertension, CVD, metabolic syndrome, Multiple sclerosis, PCOD, Musculoskeletal pain,depression, epilepsy, and also in the prevention of cancer and T1DM. Supplementation of vitamin D is a must in all age groups, infants, children, adults and during pregnancy and lactation. CVD Deaths from CVD are more common in winter, more common at higher latitudes and more common at lower altitudes, observations that are consistent with vitamin D insufficiency. The risk of A heart attack is twice as high for those with 25(OH)D levels < 34 ng/ml than for those with vitamin D status above this level. Patients with CCF were recently found to have markedly lower levels of vitamin D than controls. HYPERTENSION It has long been known that BP is higher in winter than in the summer, increases at a greater distances from the equator and is affected by skin pigmentation - all observations consistent with a role of vitamin D in regulating BP. When patients with HT were treated with ultraviolet light three times a week for 6 weeks, their vitamin D levels increased by 162 % and their BP fell significantly. Even small amounts of oral cholecalciferol 800IU for 8 weeks lowered both BP and HR. T2DM Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction in diabetic young adults who are apparently healthy. Healthy adults with higher serum 25( OH)D levels had significantly lower 60 minutes, 90 minutes, and 120 minutes PPBS levels and significantly better insulin sensitivity than those who were vitamin D deficient.. One interesting observation was that Metformin improved insulin sensitivity by 13% and higher vitamin D status correlated with a 60% improvement in insulin sensitivity. OSTEOARTHRITIS We know that vitamin D helps in prevention and treatment of osteoporosis, but few know that the progression of osteoarthritis is lessened by adequate blood levels of vitamin D. Framingham data shows that osteoarthritis of knee progressed more rapidly in those with 25(OH)D levels < 36 ng/ml. MULTIPLE SCLEROSIS This autoimmune/ inflammatory disease is notably rare in sunny equatorial regions and becomes increasingly prevalent among people who live farther from the equator and/or who lack adequate sun exposure .Daily supplementation with approximately 1000mg calcium, 600mg magnesium and 5000 IU vitamin D ( from cod liver oil ) for upto 2 years and found a reduction in number of exacerbations and an absence of adverse effects. PREVENTION OF T1DM This is generally caused by autoimmune/inflammatory destruction of pancreatic beta cells. In a study with >1000 participants, supplementation in infants < 1yr of age and children with 2000 IU of vitamin D reduced the incidence of T1DM by approximately 80%. DEPRESSION Seasonal affective disorder ( SAD ), a subset of depression characterized by the onset or exacerbations of melanocholia during winter months, when bright light, sun exposure and serum 25(OH)D are reduced. A dose of 10000IU of vitamin D was found superior to light therapy in treatment of SAD after 1 month, also in another study supplementation with vitamin D 400 - 800 IU per day improved mood witin five days of treatment. EPILEPSY Seizures can be the presenting manifestation of vitamin D deficiency. Hypovitaminosis D decreases the threshold for and increases the incidence of seizures and several anticonvulsant drugs interfere with the fformation of calcitriol in the kidney and further reduces the calcitriol levels via induction of hepatic clearance. Therefore anticonvulsants may lead to iatrogenic seizures by causing iatrogenic Hypovitaminosis D. Conversely, supplementation with 4000-16000 IU per day of vitamin D helps to reduce seizure frequency, a study finding ! MIGRAINE HEADACHES Calcium clearly plays a role in the maintenance of vascular tone and coagulation, both of which are altered i patients with migraine. In a study, a daily supplementation with 1200 mg of calcium and 1200- 1600 IU of vitamin D in women with vitamin D deficiency showed a reduction in frequency, duration and severity of menstrual migraine headaches. PCOD Surprisingly, this disease is seen only in humans and is classically characterized by polycystic ovaries, amenorrhea, hirsuitism, IR and obesity. Studies have shown that calcium is essential for oocyte activation and maturation. Vitamin D deficiency is highly prevalent in these patients. Thus a supplementation of 1500 mg of calcium per day and 50000 IU of vitamin D on a weekly basis helps in normalization of menstruation and/or fertility. MUSCULOSKELETAL PAINS Patients with non traumatic, persistent Musculoskeletal pain show a significant high prevalence of overt vitamin D deficiency .In a study, patients with non specific low back pain , good results were obtained with supplementation with 5000- 10000 IU of vitamin D per day after 3 months. I hope, after this reading you might be convinced of importance of vitamin D . Let us add vitamin D in treatment, more often !