High ESR all time suggestive of chronic inflammation of body either specific or non specific RA factor negative serological test may be done even if comes as negative it may be sero negative type. Other than rheumatiod other chronic specific infection like tuberculosis can be evaluated SLE Malignancy like lymphoma, multiple myeloma.
रोगी यकृतशोथ से पीड़ित है। चिकित्सा संबंधी योग,,,, यकृत दारी लौह 4 रत्ती ताप्तयादि लौह 4 रत्ती शहद में मिलाकर सुबह-शाम सेवन कराएं। उपर से ताजा गिलोय का काढ़ा बनाकर पीने से लाभ होगा। योग परिक्षित है। पिछले 40 वर्ष से प्रयोग कर रहा हूं।
Respected sir ESR increase means any chronic disease & inflammation may be Bone & specially KUB system & may be tubercular & if HB is low then ESR will increase. You should have to go also for any lympadenitis
Adv ecg 2decho to r/o Rheumatic heart disease 2 extrapulmonary tuberculosis like GUT or genital infection
Chronic PID ?? SERO NEGATIVE RA?? start oflox 200bd for 7 days Tab. Voveran 50mg bd Ashokarishta 2tsp bd
MRCP to evaluate biliary tree,any periampullary pathology,may need ERCP for further evaluation.
Lipid profile Nd uric acid..?
It can be only viral
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pt is hvng fvr wth jnts pain since a month anable to lift her both uppr lmbDr. Sharad Vish0 Like33 Answers
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Friends today I am discussing about High uric acid problem. Patient have pain in joints in sole of feet just take pain killer never try to rule out whether uric acid is high or any other cause. I am telling in detail. Hyperuricemia (High Uric Acid) What Is Hyperuricemia? Hyperuricemia is an excess of uric acid in the blood. Uric acid passes through the liver, and enters your bloodstream. Most of it is excreted (removed from your body) in your urine, or passes through your intestines to regulate "normal" levels. Normal Uric acid levels are 2.4-6.0 mg/dL (female) and 3.4-7.0 mg/dL (male). Normal values will vary from laboratory to laboratory. Also important to blood uric acid levels are purines. Purines are nitrogen-containing compounds, which are made inside the cells of your body (endogenous), or come from outside of your body, from foods containing purine (exogenous). Purine breaks down into uric acid. Increased levels of uric acid from excess purines may accumulate in your tissues, and form crystals. This may cause high uric acid levels in the blood. Uric acid formation may occur when the blood uric acid level rises above 7 mg/dL. Problems, such as kidney stones, and gout (collection of uric acid crystals in the joints, especially in your toes and fingers), may occur. What Causes Hyperuricemia? Causes of high uric acid levels (hyperuricemia) can be primary (increased uric acid levels due to purine), and secondary (high uric acid levels due to another disease or condition). Sometimes, the body produces more uric acid than it is able to excrete. Causes of High Uric Acide Levels: Primary hyperuricemia Increased production of uric acid from purine Your kidneys cannot get rid of the uric acid in your blood, resulting in high levels Secondary hyperuricemia Certain cancers, or chemotherapy agents may cause an increased turnover rate of cell death. This is usually due to chemotherapy, but high uric acid levels can occur before chemotherapy is administered. After chemotherapy, there is often a rapid amount of cellular destruction, and tumor lysis syndrome may occur. You may be at risk for tumor lysis syndrome if you receive chemotherapy for certain types of leukemia, lymphoma, or multiple myeloma, if there is a large amount of disease present. Kidney disease - this may cause you to not be able to clear the uric acid out of your system, thus causing hyperuricemia. Medications - can cause increased levels of uric acid in the blood Endocrine or metabolic conditions -certain forms of diabetes, or acidosis can cause hyperuricemia Elevated uric acid levels may produce kidney problems, or none at all. People may live many years with elevated uric acid levels, and they do not develop gout or gouty arthritis (arthritis means "joint inflammation"). Only about 20% of people with elevated uric acid levels ever develop gout, and some people with gout do not have significantly elevated uric acid levels in their blood. Symptoms of Hyperuricemia: You may not have any symptoms. If your blood uric acid levels are significantly elevated, and you are undergoing chemotherapy for leukemia or lymphoma, you may have symptoms kidney problems, or gouty arthritis from high uric acid levels in your blood. You may have fever, chills, fatigue if you have certain forms of cancer, and your uric acid levels are elevated (caused by tumor lysis syndrome) You may notice an inflammation of a joint (called "gout"), if the uric acid crystals deposit in one of your joints. (*Note- gout may occur with normal uric acid levels, too). You may have kidney problems (caused by formation of kidney stones), or problems with urination Things You Can Do About Hyperuricemia: Make sure you tell your doctor, as well as all healthcare providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies). Remind your doctor or healthcare provider if you have a history of diabetes, liver, kidney, or heart disease. Follow your healthcare provider's instructions regarding lowering your blood uric acid level and treating your hyperuricemia. If your blood levels are severely elevated, he or she may prescribe medications to lower the uric acid levels to a safe range. If you have an elevated blood uric acid level, and your healthcare provider thinks that you may be at risk for gout, kidney stones, try to eat a low purine diet. Foods that are high in purine include: All organ meats (such as liver), meat extracts and gravy Yeasts, and yeast extracts (such as beer, and alcoholic beverages) Asparagus, spinach, beans, peas, lentils, oatmeal, cauliflower and mushrooms Foods that are low in purine include: Refined cereals - breads, pasta, flour, tapioca, cakes Milk and milk products, eggs Lettuce, tomatoes, green vegetables Cream soups without meat stock Water, fruit juice, carbonated drinks Peanut butter, fruits and nuts Keep well hydrated, drinking 2 to 3 liters of water per day, unless you were told otherwise. Take all of your medications for hyperuricemia as directed Avoid caffeine and alcohol, as these can contribute to problems with uric acid and hyperuricemia. Avoid medications, such as thiazide diuretics (hydrochlortiazide), and loop diuretics (such as furosemide or Lasix®). Also, drugs such as niacin, and low doses of aspirin (less than 3 grams per day) can aggravate uric acid levels. Do not take these medications, or aspirin unless a healthcare provider who knows your condition told you. If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. Drugs or Treatments That May Be Prescribed by Your Doctor: Your doctor or healthcare provider may prescribe medications if you have a high blood uric acid levels. These may include: Non-steroidal anti-inflammatory (NSAID) agents and Tylenol®- such as naproxen sodium and ibuprofen may provide relief of gout-related pain. Gout may be a result of a high uric acid level. If you are to avoid NSAID drugs, because of your type of cancer or chemotherapy you are receiving, acetaminophen (Tylenol() up to 4000 mg per day (two extra-strength tablets every 6 hours) may help. It is important not to exceed the recommended daily dose of Tylenol, as it may cause liver damage. Discuss this with your healthcare provider. Uricosuric Drugs: These drugs work by blocking the reabsorption of urate, which can prevent uric acid crystals from being deposited into your tissues. Examples of uricosuric drugs include probenecid, and sulfinpyrazone. Xanthine oxidase inhibitors - Such as allopurinol, will prevent gout. However, it may cause your symptoms of gout to be worse if it is taken during an episode of painful joint inflammation. Allopurinol may also be given to you, if you have a certain form of leukemia or lymphoma, to prevent complications from chemotherapy and tumor lysis syndrome - and not necessarily to prevent gout. With high levels of uric acid in your blood, as a result of your disease, the uric acid will collect and form crystals in your kidneys. This may occur during chemotherapy, and may cause your kidneys to fail. When to Contact Your Doctor or Health Care Provider: Localized joint pain (especially in a toe or finger joint), that is red and inflamed. Shortness of breath, chest pain or discomfort; should be evaluated immediately. Feeling your heart beat rapidly (palpitations). Bleeding that does not stop after a few minutes. The top five homeopathic medicines for elevated uric acid levels include Colchicum, Benzoic Acid, Ledum Pal, Guaiacum, and Lithium Carb. Colchicum – Homeopathic Medicine for Uric Acid Colchicum Autumnale (commonly known Meadow Saffron) is a homeopathic remedy derived from the freshly dug up bulb of herb colchicum autumnale. This herb belongs to the family Liliaceae and is a native of Great Britain and Ireland. Colchicum is especially indicated in cases where high uric acid levels give rise to the onset of gout. There may be a sharp pain in the great toe. The affected parts may be swollen and very hot to touch. There could be great sensitivity to touch along with extreme pain. The pains could be more intense in the evening and at night. Colchicum may be indicated almost as a specific medicine in most cases of high uric acid levels. Slightest effort to move the legs gives rise to a sharp, shooting and unbearable pain in the toe. Walking may also be difficult. The person needing this remedy has intense swelling and pain in the big toe that is worse from motion. The toe pain also worsens from slightest touch, with the tendency of evening aggravation of the toe pain. Benzoic Acid – Homeopathic Medicine for Uric Acid When Signs Show up In Urine Benzoic Acid is homeopathic medicine for uric acid that is indicated when the signs of high uric acid show urinary symptoms. Uric acid crystals may be deposited in the kidneys or the urinary tract, giving rise to stones. On examination, the urine may exhibit very high levels of uric acid. The color of urine may also keep changing from dark brown to pale yellow. Benzoic acid may also be indicated when there are joint complaints, like a crackling sensation in the joints. The great toe may be swollen, causing difficulty in walking or even moving the limb. Cracking in the knee joint on movement may also be felt. In some cases, nodes from the deposition of urate crystals may be present on the knees. Homeopathic medicine Benzoicum Acidum also works well in cases of knee pain gets worse from drinking wine. It is also indicated as a general medicine in all cases of raised uric acid levels. Ledum Pal – Homeopathic Medicine for Uric Acid with Ankle Pain Ledum Palustre is a homeopathic medicine derived from a small flowering shrub, commonly known as Marsh tea. Marsh tea is a low growing evergreen shrub that only grows up to a height of one meter. The shrub belongs to the heath family and is a native of northern Europe. It is also widely distributed in British America and around Canadian lakes. Ledum pal is indicated when the high levels of uric acid in the blood result in the deposition of the crystals in the joint spaces. The first attack of pain could be triggered by an increased intake of meat or alcohol. Ledum Pal is a very beneficial homeopathic medicine for gout leading to ankle pain. The person needing Ledum Pal has pain and swelling in the ankle. The pain from the ankle may radiate up the leg, and movement tends to intensify the ankle pain. Guaiacum – Homeopathic Medicine for Uric Acid Homeopathic medicine Guaiacum is prepared from the resin obtained from the woods of Guaiacum officinale. Commonly known as Lignum Vite Resin, it belongs to the family Zygophyllaceae and is a native of tropical America. It is a well-indicated remedy to treat high uric acid levels and works well in chronic cases where the deformities and contractures set in. Intolerance to heat in any form, the affecting joints being extremely hot to touch, bad smell from the body are other symptoms. It is given in acute cases where the affected limb is painful, stiff and immobile. Lithium Carb – Homeopathic Medicine for Uric Acid with Stiffness Lithium Carb is a homeopathic medicine used to treat raised uric acid levels. The high levels of uric acid give rise to an unusual stiffness all over the body. Another peculiar feature is itching all over the skin of the joints. The pains are relieved by pouring hot water. Uric acid may get deposited in the joint spaces to give rise to nodosities which can be felt externally. The nodes may also be felt in the finger joints. In severe cases, they may be felt in the ear pinnaDr. Rajesh Gupta9 Likes23 Answers
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58 female right pleural effusion mild. Protein 6.2 g/dL, sugar 78, ADA 48, pale yellow clear fluid. No history available . Cytology field stainDr. Yashpal Jalpota1 Like16 Answers
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45F with intermittent fever and wt loss. T4 mildly elevated. FNAC showing chronic non specific reactive lymphadenitis. kindly suggest DD & RxDr. Ravikanth Moka5 Likes33 Answers
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Here is one lady pt. complaints of modrat fever with enlarged lympnodes Report is attached No hypertension Non diabetic he is also unable to hold urin he pass urine every 10 minutes what further investigation is required and how to manag Dx ? Rx ?Dr. Kapil Sahu1 Like21 Answers