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35 year old G2 P1 L1 LCB 13 years with two months amenorrhoea. ultrasound sowed a 7 weeks live intra uterine pregnancy associated with intra mural fibroid of 6*5 cms. patient c/o bleeding pv . per speculam examination showed a fibroid polyp as shown. what is the line of management.Dr. Suvarchala Pratap2 Likes26 Answers
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Ayurveda and Mental Health BACK GROUND Psychiatric illnesses are fundamentally no different from medical illness. Historically, illnesses in which there was prominent disturbance of psychological function or behavior and no obvious pathology came to be regarded as psychiatric. However, modern world now knows that there is demonstrably altered brain function in many psychiatric disorders; also psychiatric illness is no less real or less deserving of care than are medical conditions. Ayurveda defines health as a state of equilibrium of tridosha, trimala, sapatadhatu and homoeostasis of mind as well as sense organs. Grahachikitsa is one among the eight major branches of Ayurveda that deals with prevention and management of mental problems. In spite of great advancement in the science of psychiatry, since decades the problems retained with the management of a certain mental problems like anxiety, stress, mental retardation etc. have not fully solved. In addition to this, adverse effect of anti-psychotic; anxiolytic medication is also creating considerable amount of discomfort to the patient. At this juncture, need is felt for he exposition and adaptation of such therapies that could effectively tackle these conditions without adverse events. EXPOSITION OF PSYCHE: AYURVEDIC VIEW: The mind or manas is considered three dimensional in terms of three gunas viz. sattva, rajas and tamas. The raja represents activity and dynamism while the tamas denotes inertia and darkness. Sattva is the state of pure mind with absolute balance when both the extreme qualities of mind viz. rajas and tamas cease or merge in each other. It is believed that all mental illness are because of the disorders of rajas and tamas. Sattva is never the cause of illness. This is why rajas and tamas are also called manas doshas. In consideration of the trigunas, Ayurvedic puts forward that there can be three broad categories of mental personalities or prakritis viz. sattvik prakriti, rajasik prakriti and tamasik prakritis. These three on the basis of finer consideration are further divided into 16 manas prakritis or mental traits. These 16 personality traits are characterized with unique features, which may also predispose specific mental diseases simulating 16 personality factors (16PF) of modern psychology. According to Ayurveda, Mind is a Sensory as well as a Motor organ, because the impulse of Action of a Sensory organ like the Human Eye and a Motor function like speech are due to Mind only. Mind is amalgamated to Touch Sense. Touch sense is present all over the Body (Area of Consciousness). The sense of Touch and also the corresponding faculty in Mind in which the duel cause- is yields pleasurable and painful sensations. This also links Mind with the Body Metabolism. Mind exerts a special effect on the Metabolism of the Body. Ayurveda regards three metabolic elements present in our body. These are called Vata, Pitta and Kapha. They are nothing but the Biological representatives of the five basic proto-elements, in the Body. These three are responsible for normal physiological functions or pathological Disorders. Their Balanced state results in normal Healthy Life while their physiological Imbalance is responsible for Body Metabolism. Similarly the disturbed Mental States also disturb the balance of these three Biological elements, which in turn cause Body Disorders. Hence Disorders emerges as results of visciation of both the body and the Mind. Thus interaction of Body and Mind is well thought of in Ayurveda. As stated beforehand, Mind is ultimately the Stronghold of the Body. Hence Ayurveda regards mind as the Keymaster in causing Body disorders through visciation of the three Biological Elements and vice-versa. THE MENTAL HEALTH AND ILL HEALTH: AN OVERVIEW: It can be concluded that consciousness, mind and body disorders are invariably interlinked with each other. Most of the body disorders can be well averted by achieving a higher state of consciousness and a healthy mental state. Ayurveda strongly advocates Mental Health Care for keeping sound Mental Hygiene. Human Mind is like the strongheld of the Horses Indriyani (organs) of the Chariot). Sharira (body) lead by buddhi (Intelect) for the Master Self (Soul). One become wise by properly holding his Mind under control. Mind thus controlled leads the Body in proper orderly manner. Otherwise an uncontrolled Mind goes astray and provokes temporary lasting, untruly, destructive activities. Hence Ayurveda preaches sound Mental Hygiene by adoring Truth and avoiding untruth in short. Rasayan (rejuvinisation) is the method by which old age and disorders are avoided by increasing natural body immunity. Besides intake of certain drugs, it can be achieved by following Mental Hygiene also. This is called as Achara Rasayana, According to Ayurvedic, mental health is a state of sensorial, mental, intellectual and spiritual well-being. The mental ill health is brought about essentially as a result of unwholesome interaction between the individual and his environment. This interaction operates through three fundamental factors viz. Kala (time rhythm) ie the deficient excessive or perverted aspects of seasons etc. Indriyartha (sensorial inputs) i.e. deficient, excessive or perverted use of senses. Buddhi (intellect) i.e. volitional transgression. When the intelligence, retaining and controlling powers and memory of an individual are distracted and in that state when he performs wrong actions, then it is called volitional transgression. It is the perverted use of mind and intelligence or faulty understanding (pragyaparadha). Ayurveda believes in the theory of punarjanma (reincarnation) and Karma (actions of past life). Accordingly, the principal causative factors involved in mental illness are (1) genetic factors, (2) personality make up and (3) environmental factors. The mental disease in general is characterized by altered behavior, which may present with a wide range. The clinical diagnosis is done on the basis of pattern of alteration of the behavior and certain associated symptoms and signs. An over all view of the total Ayurvedic literature available in the context of ancient psychiatry would reveal that Ayurveda describes in detail all possible clinical entities of psychiatric illness as comparable to the contemporary sciences. The common psychiatric diseases described in Ayurveda are different kinds of unmade (psychosis), apasmara (convulsive disorders), chittodvega (anxiety disorders), chittavasada (depressive illness), mada (alcoholism and drug abuse), murcchha, smanyasa(condition associated unconsciousness). PRINCIPLES OF MANAGEMENT: The treatment modalities described in Ayurvedic classics include-: Daiva Vyapashraya: Spiritual therapy that includes the use of mantra, japa, other religious activities and wearing of precious stones etc. Satvavajaya: Psycho-behavioral therapy incorporating the principles of assurance therapy (ashvasana), replacement of emotions and psycho-shock therapy. Yukti vyapashraya chikitsa: Biological therapy includes samshodhan (cleansing therapy/panchkarma), and shaman therapy (pacification) The patient is subjected to biocleansing therapy in order to cleanse the channels of the body followed by shaman therapy or palliative treatment with the help of drug, dietetics and life style. A number of single and compound medhya (promoters of intellectual faculties) formulations are used in Ayurveda for the treatment of mental diseases. These are believed to act as brain tonics and adaptogens. The medhya drugs are considered as specific molecular nutrients for the brain providing a better mental health leading in turn to alleviation of the behavioral alterations. Source : CCRASDr. Hemant Adhikari7 Likes13 Answers
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A 46-year-old female presented with menorrhagia, dysmenorrhea along with chronic pelvic pain. Sometimes she also have dyspareunia. A diffusely enlarged uterus is noted on examination.Dr. Lakshmi Narayan1 Like11 Answers
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You can find here key changes in ADA guidelines. They are published in Diabetes Care once yearly in the month of January. GENERAL CHANGES The field of diabetes care is rapidly changing as new research, technology, and treatments that can improve the health and well-being of people with diabetes continue to emerge. With annual updates since 1989, the ADA has long been a leader in producing guidelines that capture the most current state of the field. To that end, the “Standards of Medical Care in Diabetes” now includes a dedicated section on Diabetes Technology, which contains preexisting material that was previously in other sections that has been consolidated, as well as new recommendations. SECTION 1. IMPROVING CARE AND PROMOTING HEALTH IN POPULATIONS Additional information was included on the financial costs of diabetes to individuals and society. Because telemedicine is a growing field that may increase access to care for patients with diabetes, discussion was added on its use to facilitate remote delivery of health-related services and clinical information. SECTION 2. CLASSIFICATION AND DIAGNOSIS OF DIABETES Based on new data, the criteria for the diagnosis of diabetes was changed to include two abnormal test results from the same sample (i.e., fasting plasma glucose and A1C from same sample). The section was reorganized to improve flow and reduce redundancy. Additional conditions were identified that may affect A1C test accuracy including the postpartum period. SECTION 3. PREVENTION OR DELAY OF TYPE 2 DIABETES This section was moved and is now located before the Lifestyle Management section to better reflect the progression of type 2 diabetes. The nutrition section was updated to highlight the importance of weight loss for those at high risk for developing type 2 diabetes who have overweight or obesity. Because smoking may increase the risk of type 2 diabetes, a section on tobacco use and cessation was added. SECTION 4. COMPREHENSIVE MEDICAL EVALUATION AND ASSESSMENT OF COMORBIDITIES On the basis of a new consensus report on diabetes and language, new text was added to guide health care professionals’ use of language to communicate about diabetes with people with diabetes and professional audiences in an informative, empowering, and educational style. A new figure from the ADA-European Association for the Study of Diabetes (EASD) consensus report about the diabetes care decision cycle was added to emphasize the need for ongoing assessment and shared decision making to achieve the goals of health care and avoid clinical inertia. A new recommendation was added to explicitly call out the importance of the diabetes care team and to list the professionals that make up the team. A recommendation was added to include the 10-year atherosclerotic cardiovascular disease (ASCVD) risk as part of overall risk assessment. The fatty liver disease section was revised to include updated text and a new recommendation regarding when to test for liver disease. SECTION 5. LIFESTYLE MANAGEMENT Evidence continues to suggest that there is NOT an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes. Therefore, more discussion was added about the importance of macronutrient distribution based on an individualized assessment of current eating patterns, preferences, and metabolic goals. Additional considerations were added to the eating patterns, macronutrient distribution, and meal planning sections to better identify candidates for meal plans, specifically for low-carbohydrate eating patterns and people who are pregnant or lactating, who have or are at risk for disordered eating, who have renal disease, and who are taking sodium–glucose cotransporter 2 inhibitors. There is NOT a one-size-fits-all eating pattern for individuals with diabetes, and meal planning should be individualized. A recommendation was modified to encourage people with diabetes to decrease consumption of both sugar sweetened and nonnutritive-sweetened beverages and use other alternatives, with an emphasis on water intake. The sodium consumption recommendation was modified to eliminate the further restriction that was potentially indicated for those with both diabetes and hypertension. Additional discussion was added to the physical activity section to include the benefit of a variety of leisure-time physical activities and flexibility and balance exercises. The discussion about e-cigarettes was expanded to include more on public perception and how their use to aide smoking cessation was not more effective than “usual care.” SECTION 6. GLYCEMIC TARGETS This section now begins with a discussion of A1C tests to highlight the centrality of A1C testing in glycemic management. To emphasize that the risks and benefits of glycemic targets can change as diabetes progresses and patients age, a recommendation was added to reevaluate glycemic targets over time. The section was modified to align with the living Standards updates made in April 2018 regarding the consensus definition of hypoglycemia. SECTION 7. DIABETES TECHNOLOGY This new section includes new recommendations, the self-monitoring of blood glucose section formerly included in Section 6 “Glycemic Targets,” and a discussion of insulin delivery devices, blood glucose meters, continuous glucose monitors (real-time and intermittently scanned, and automated insulin delivery devices. The recommendation to use self-monitoring of blood glucose in people who are not using insulin was changed to acknowledge that routine glucose monitoring is of limited additional clinical benefit in this population. SECTION 8. OBESITY MANAGEMENT FOR THE TREATMENT OF TYPE 2 DIABETES A recommendation was modified to acknowledge the benefits of tracking weight, activity, etc., in the context of achieving and maintaining a healthy weight. A brief section was added on medical devices for weight loss, which are not currently recommended due to limited data in people with diabetes. The recommendations for metabolic surgery were modified to align with recent guidelines, citing the importance of considering comorbidities beyond diabetes when contemplating the appropriateness of metabolic surgery for a given patient. SECTION 9. PHARMACOLOGIC APPROACHES TO GLYCEMIC TREATMENT The section on the pharmacologic treatment of type 2 diabetes was significantly changed to align, as per the living Standards update in October 2018, with the ADA-EASD consensus report on this topic. This includes consideration of key patient factors: (a) important comorbidities such as ASCVD, CKD, and HF, (b) hypoglycemia risk, (c) effects on body weight, (d) side effects, (e) costs, and (f) patient preferences. To align with the ADA-EASD consensus report, the approach to injectable medication therapy was revised. A recommendation that, for most patients who need the greater efficacy of an injectable medication, a GLP-1 agonist should be the first choice, ahead of insulin. A new section was added on insulin injection technique, emphasizing the importance of technique for appropriate insulin dosing and the avoidance of complications (lipodystrophy, etc.). The section on non-insulin pharmacologic treatments for DM1 was abbreviated, as these are not generally recommended. SECTION 10. CARDIOVASCULAR DISEASE AND RISK MANAGEMENT For the first time, this section is endorsed by the American College of Cardiology. Additional text was added to acknowledge heart failure as an important type of cardiovascular disease in people with diabetes for consideration when determining optimal diabetes care. The blood pressure recommendations were modified to emphasize the importance of individualization of targets based on cardiovascular risk. A discussion of the appropriate use of the ASCVD risk calculator was included, and recommendations were modified to include assessment of 10-year ASCVD risk as part of overall risk assessment and in determining optimal treatment approaches. The recommendation and text regarding the use of aspirin in primary prevention was updated with new data. For alignment with the ADA-EASD consensus report, two recommendations were added for the use of medications that have proven cardiovascular benefit in people with ASCVD, with and without heart failure. SECTION 11. MICROVASCULAR COMPLICATIONS AND FOOT CARE To align with the ADA-EASD consensus report, a recommendation was added for people with type 2 diabetes and chronic kidney disease to consider agents with proven benefit with regard to renal outcomes. The recommendation on the use of telemedicine in retinal screening was modified to acknowledge the utility of this approach, so long as appropriate referrals are made for a comprehensive eye examination. Gabapentin was added to the list of agents to be considered for the treatment of neuropathic pain in people with diabetes based on data on efficacy and the potential for cost savings. The gastroparesis section includes a discussion of a few additional treatment modalities. The recommendation for patients with diabetes to have their feet inspected at every visit was modified to only include those at high risk for ulceration. Annual examinations remain recommended for everyone. SECTION 12. OLDER ADULTS A new section and recommendation on lifestyle management was added to address the unique nutritional and physical activity needs and considerations for older adults. Within the pharmacologic therapy discussion, de-intensification of insulin regimes was introduced to help simplify insulin regimen to match individual’s self-management abilities. SECTION 13. CHILDREN AND ADOLESCENTS Introductory language was added to the beginning of this section reminding the reader that the epidemiology, pathophysiology, developmental considerations, and response to therapy in pediatric-onset diabetes are different from adult diabetes, and that there are also differences in recommended care for children and adolescents with type 1 as opposed to type 2 diabetes. A recommendation was added to emphasize the need for disordered eating screening in youth with type 1 diabetes beginning at 10–12 years of age. Based on new evidence, a recommendation was added discouraging e-cigarette use in youth. The discussion of type 2 diabetes in children and adolescents was significantly expanded, with new recommendations in a number of areas, including screening and diagnosis, lifestyle management, pharmacologic management, and transition of care to adult providers. New sections and/or recommendations for type 2 diabetes in children and adolescents were added for glycemic targets, metabolic surgery, nephropathy, neuropathy, retinopathy, nonalcoholic fatty liver disease, obstructive sleep apnea, polycystic ovary syndrome, cardiovascular disease, dyslipidemia, cardiac function testing, and psychosocial factors. SECTION 14. MANAGEMENT OF DIABETES IN PREGNANCY Women with preexisting diabetes are now recommended to have their care managed in a multidisciplinary clinic to improve diabetes and pregnancy outcomes. Greater emphasis has been placed on the use of insulin as the preferred medication for treating hyperglycemia in gestational diabetes mellitus as it does not cross the placenta to a measurable extent and how metformin and glyburide should not be used as first-line agents as both cross the placenta to the fetus. SECTION 15. DIABETES CARE IN THE HOSPITAL Because of their ability to improve hospital readmission rates and cost of care, a new recommendation was added calling for providers to consider consulting with a specialized diabetes or glucose management team where possible when caring for hospitalized patients with diabetes. SECTION 16. DIABETES ADVOCACY The “Insulin Access and Affordability Working Group: Conclusions and Recommendations” ADA statement was added to this section. Published in 2018, this statement compiled public information and convened a series of meetings with stakeholders throughout the insulin supply chain to learn how each entity affects the cost of insulin for the consumer, an important topic for the ADA and people living with diabetes.Dr. Peerzada Ovais Ahmad6 Likes8 Answers
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Dear my friends and fellow Colleagues, Here is an update on the mortality rate of COVID19. COVID-19 mortality is highest in 16 districts of 4 Indian states 1) Gujarat Ahmedabad Surat 2) Karnataka Belagavi, Bengaluru, Kalaburagi Udupi 3) Tamilnadu Chennai, Kanchipuram, Ranipet, Theni, Thiruvalluvar, Tiruchirapalli, Tuticorin& Virudhunagar 4) Telangana Hyderabad & Medchal Malkajgiri. Report from Union Health & Family Welfare Ministry, August, 2020. Regards and thanks, Dr Sepuri Krishna MohanDr. Sepuri Krishna Mohan4 Likes7 Answers