Kathuria Hospital

The sudden spread of the Influenza-A (H1N1) virus has left the Karnataka government a bit worried as the death toll this year has reached 6 with two fresh casualties in Bengaluru.

The government has alerted all the districts and has ordered to take the preventive measures to combat the prevalent disease. A total of 4,902 H1N1 cases have been tested positive this year across the country, out which 456 have been registered in Karnataka only.

What is H1N1 flu?

It is also known as swine flu because of its past. Initially, people go got infected with it used to be in direct contact with pigs. It is a respiratory disease which is caused by influenza viruses that infect the respiratory tract of pigs leading to barking cough, decreased appetite, nasal secretions, etc. The molecules released by the infected pigs quickly get transmitted to humans turning the flu into a pandemic.

How does H1N1 flu prevail?

It spreads just like seasonal flu. It is transmitted from one person to another through sneeze or cough. The small molecules released while sneezing or coughing stay alive in the air and whenever another person comes in contact with these drops, he/she also gets infected by the virus. It also gets transmitted when someone touches the things used by an infected person.

H1N1 Flu Symptoms:

Swine Flu has similar symptoms to the seasonal flu. They include:

• Cough
• Fever
• Sore throat
• Body aches
• Headache
• Running nose
• Fatigue
• Chills
• Breath shortness
• Frequent vomiting
• Dizziness
• Pain in the belly region

H1N1 flu, however, can lead to more serious ailments like pneumonia, lung infection and breathing problems. It worsens the situation in case the patient is already a diabetic or asthma patient.

Ways to diagnose H1N1 infection:

Due to various similarities in the symptoms of seasonal flu and swine flu, the doctor has to run a swab up inside the nose around the back of the throat of the patient. The doctors, however, use this method only on those having life threatening issues due to swine flu.

H1N1 Treatment:

The doctors prescribe same anti-viral drugs for swine flu that are given to treat seasonal flu. Oseltamivir (Tamiflu), peramivir (Rapivab) and zanamivir (Relenza) are some drugs that fetch best results.

Consuming antibiotics will solve no purpose in H1N1 flu as it is caused by virus, not bacteria.

H1N1 flu prevention:

The vaccinations are a good option to keep swine flu at bay but here are some more preventive tips that can be of help:

• Keep your hands clean
• Use alcohol-based hand-sanitizer
• Do not touch your eyes, mouth or nose
• Try to maintain a safe distance from infected people

Preventive tips for family members and colleagues of a swine flu patient:

• They should ensure they cover their mouth while sneezing or coughing
• They should wear a mask while sharing the same room or cabin with the infected person
• They should wash their hands with soap and water multiple times a day
• They should avoid using or touching the clothes or other products used by the infected person

H1N1 flu is a deadly pandemic that is causing serious issues for the people as well as the government in Karnataka. Everyone should be aware of the preventive measures to keep themselves as well as their families safe in such a situation. If you also have any of the symptoms of swine flu, you should immediately visit a doctor to diagnose the problem.

PCOS, or polycystic ovarian syndrome, is a disorder that affects about 10 to 15% of women during their reproductive years. Though the exact reason or cause for the syndrome is not identified yet, it is believed to be genetic and runs in families. Obesity is believed to be another risk factor. There are multiple fluid-filled cysts in the ovaries, giving it the name.

PCOS is being identified as one of the main causes of infertility and therefore more women are becoming aware of this condition. There is a huge hormonal impact, and so there are physical as well as emotional symptoms which makes it difficult for both the woman and the people associated with her.

Symptoms:

• Gynecological symptoms mainly include bleeding disorders ranging from excessive bleeding to scanty bleeding to no bleeding at all during menstruation. There could also be irregular bleeding with some women bleeding for weeks together during a period, to some having no period for a few months. There could be multiple abortions, and this could probably lead to the diagnosis of PCOS
• Physical symptoms include excessive hair on the body (known as hirsutism), excessive acne, hair thinning, skin tags, insulin resistance, increased cholesterol and high blood pressure, the onset of diabetes, and pelvic pain.
• Emotional symptoms include increased stress levels, anxiety and depression, severe mood swings, and reduced self-esteem.

While allopathy offers a regular dose of birth control pills as the mainstay treatment for PCOS, it does not help much. This is where homeopathy comes into the picture, as it offers safe products that address the root of the issue with no complications. 

Of note, homeopathy medicines should not be taken without consultation with a doctor. Symptoms should be discussed in detail before the doctor prescribes a compound.

Stammering or stuttering is a type of speech impairment where sounds or syllables are repeated involuntarily or there are unintended gaps in between words when the person is unable to make the desired sound. People develop stutters due to genetic flaws, motor functioning defects, coordination problems or due to psychological stressors. The condition can result in anxiety, depression and withdrawal from verbal communication.

How does homeopathy help?

A stutter can be practiced away or corrected by speech therapy but there is no specific medicine that can be used to cure stammering. Homeopathic medicines can provide relief from the symptoms by fixing flawed nervous functions, improve motor coordination and modify the vocal apparatus. Different homeopathic treatments can be used depending on the nature of the condition.

The following is a list of homeopathic remedies and lifestyle changes that can be used to address the problem:

1. Foods rich in vitamin B6 like nuts, fish, bananas and chicken should be consumed regularly by children who have a stutter to help with motor functions.

2. Adults should avoid caffeine, tobacco and other recreational drugs as they cause hyper-stimulation of the nervous system.

3. Stramonium(jimsonweed) can be used when the stammering is violent and the person distorts his facial muscles heavily in order to be able to speak.

4. Lychopodium (clubmoss) can be useful for stammering as well as depression, memory weakness and sleep problems. This is especially helpful if the patient struggles with the last few words of a sentence.

5. Spigelia is beneficial for a mild stutter at the beginning of a sentence, often followed by undisturbed speech.

6. Causticum is prescribed when emotional excitability causes stammering, twitching of the facial muscles or problems in the vocal chords.

7. Staphysagria can aid in reducing social anxiety which often causes stammering i.e. the stammer only appears while interacting with strangers or authority figures.

8. Nux vomica (strychnine) is the medicine to use when stammering is a result of extreme stress or over work.

9. Fright or shock often causes speechlessness or stammering. Aconite can provide immediate relief in such cases.

10. Lachesis is an effective homeopathic medicine when the patient stutters over specific letters or syllables.

11. Gelsemium is used to treat stuttering after severe viral infections when the patient complains of a heavy tongue and lack of general coordination.

Heel bone spur is a form of calcium deposit that causes a bony protrusion under the heel bone. An X-ray can reveal up to a half inch elongation under the hill. Without image report, this condition is commonly known as heel spur syndrome. Heel spurs are mostly painless but reports of pain in not uncommon. They are often related to plantar fasciitis. The latter is an inflammation of the connective tissue that stretches through the foot bottom connecting the heel bone and the football.

What causes heel spurs?
Heel spurs are a result of prolonged calcium deposit. This condition can result from the heavy strain on the muscle of the foot and ligament, stretching of fascia and wear and tear of the heel bone membrane. These injuries are frequently observed among athletes who are involved with activities such as jumping and running. 

What are the risk factors?
1. Walking abnormalities that involve putting more than normal stress on the bone, nerve and ligament in and around the heel.
2. Running on surfaces that are hard in nature
3. Shoes lacking arch support
4. More than normal body weight 
5. Spending too much time on the feet
6. Too flat or too high arches
7. A person suffering from diabetes
8. In case the protective pad of the heel is fading away due to old age or other bone disorder

Non-Surgical treatment
Unlike common belief, only rest may not be the best way to treat heel bone spurs. On the contrary, a patient might feel sharp pain immediately after sleep. This happens when he tries to walk and the plantar fascia elongates all of a sudden. The pain decreases with more walking. Some treatment methods that work for 90 percent of the sufferers includes wearing the right shoe, stretching exercises, wearing orthotic devices inside the shoes and physical therapy. Over the counter medicine such as Aleve, Tylenol and Advil can be consumed to reduce the pain and for improving the overall condition. Corticosteroid injection also tends to give relief from the inflammation.

Surgical treatment
If heel spurs persist for more than 8-9 months, surgical options should be explored by the patient. There are two angles on which a doctor works, either removing the spur or release the plantar fascia. Pre-surgical exams are necessary to ensure that a person is eligible for surgery and all non-surgical avenues are explored. Post-surgical activities are equally important for the process of healing. Usage of bandages, crutches, splints and surgical shoes is a mandate to avoid complications such as infection, numbness, and scarring. Possible side effects should be discussed with the surgeon well before the surgery. The estimated healing time from this procedure is close to 8-12 weeks.

The term sinus is usually used in reference to the cavities near the nose. If these cavities become inflamed or swollen, the condition is known as sinusitis. If this condition lasts for more than 12 weeks, it is categorized as chronic sinusitis. This leads to a buildup of mucus that can make breathing difficult. Home remedies may help relieve some of the symptoms associated with this condition but in most cases, medication is required.

Symptoms of Chronic Sinusitis
Sinusitis usually affects adults but in some cases, children may be affected as well. Symptoms of this condition can be categorized as primary symptoms and secondary symptoms. In order for it to be diagnosed with chronic sinusitis, at least 2 of the primary symptoms should be present. These include:

• Thick discharge from the nose or discharge that flows down the back of the throat. This discharge may be yellowish or greenish in colour.
• Difficulty breathing through the nose because of nasal congestion.
• Swelling, tenderness and pain around the nose, eyes, cheeks and forehead.
• Loss of smell and taste in the case of adults.
• A persistent cough in the case of children.

The secondary symptoms of this condition include:

• Pain in the ear
• Pain in the teeth and upper jaw
• A cough that is worse at night
• A sore throat
• Persistent bad breath
• Tiredness
• Nausea
• Irritability
• Frequent headaches

Cause of Chronic Sinusitis
Chronic sinusitis may be caused by a number of factors. The most common amongst these are:

1. Nasal polyps: This refers to the growth of tissue in the nasal passages that block the air path and allow mucus to build up.
2. Deviated nasal septum: The septum is a wall that separates both nostrils. In some cases, this wall may deviate so as to block the sinus passages.
3. Respiratory tract infections: Cold is the most common infection responsible for chronic sinusitis. Such infections can thicken the sinus membranes and block the passageway for mucus to drain out. This infection may be caused by bacteria, viruses or fungi.
4. Allergies: Allergies such as hay fever can block the sinus passages and lead to chronic sinusitis. Asthma also causes chronic sinusitis. a reaction to aspirin may also cause a blockage in the sinus passages.
5. Other medical conditions: Medical conditions such as HIV, gastroesophageal reflux and cystic fibrosis can also cause chronic sinusitis. Patients suffering from diseases related to the immune system have a high risk of suffering from chronic sinusitis.

Getting intimate with your partner is an interest which is also known as libido. Its loss can affect both men and women to lose interest in sex. There are many causes for this including stress, chronic ailments, decline in the frequency of sexual activity, and even relationship problems. Let us look at ways in which one can deal with the loss of sexual interest in men.

Symptoms: To begin with, let us understand the tell-tale signs that point to the loss of sexual interest in men. Usually, this condition is characterised by the lack of connection or emotion with the sexual partner or the act, not being able to look forward to enjoying a session with your loved one, having sex only once or twice in a month, not being an initiator any longer, and almost never having fantasies or sexual thoughts.

Causes: There are many causes behind this condition ranging from erectile dysfunction to performance anxiety, to stress and medical conditions like diabetes and cardiovascular diseases that can lead to a decline of sexual interest in men. Depression is also one of the causes.

Medical Intervention: To begin with, the very first thing that one must do if the lack of sexual interest persists is to visit a doctor so as to have the problem checked thoroughly. Also, one can visit a psychiatrist or a sexologist in order to address any stress related reasons for the lack of interest. Couples counselling and sex therapy can help in understanding the root cause and realigning the brain with the help of discussions and various exercises that can heal and activate. Also, medication for the condition may be prescribed in case the underlying cause has to do with a medical ailment like premature ejaculation or erectile dysfunction.

Imagination: One of the greatest tools that can help in activating sexual interest is imagination. When you imagine you and your partner entwined in various sexual scenarios, you may be more open to the idea of trying those scenes out.

Focus on the Body: Any good sex therapist will tell you that focussing on the whole body rather than the intimate body parts will help in a slow yet steady build-up of stimulation that can culminate into a satisfactory intercourse and orgasm, thereafter.

Planning: Building anticipation is the key to bringing back some excitement in an area that you had considered dormant, with certain shared experiences and activities so that it can graduate to attraction, excitement and then sexual peak.
The use of various toys, medicines like anti-depressants and therapy can go a long way in bringing back your lost libido.

Complications in the heart valve occur when the functioning of the heart valve is impaired. Valves of the heart allow the blood to flow in one direction and prevent the blood from flowing back into the ventricles of the heart.

Heart valve diseases can be classified as follows:

1. Valvular stenosis: This condition occurs when the valves of the heart does not open completely due to stiffness. As the opening is narrow, the heart has to work hard to pump blood. This condition may lead to heart failure.
2. Valvular insufficiency: This is a condition where the valve does not close tightly. This causes some of the blood to flow back to the valve. As this condition deteriorates, the heart has to work harder to pump blood. 

Types and Causes of valve diseases:

1. Acquired valve disease: The structure of the valve changes due to various infections or rheumatic fever. Rheumatic fever is caused by bacterial infectionthat had not been treated. It tends to occur in children and cause inflammation of the valve.
2. Congenital valve disease: This condition usually affects the pulmonary valve where the size of the valve is abnormal.
3. Bicuspid aortic valve disease: It is a type of valve disease that impairs the aortic valve. Instead of the regular three cusps, the bicuspid valve only has two. This may cause the valve to be stiff or cause it to leak.
4. Mitral valve prolapse: This condition causes the valve to flop back when the heart contracts. This condition also causes the leaflets of the valve to turn irregularly and cause it to stretch. This condition causes the valve to leak.

Symptoms: The symptoms of valve diseases are as follows:

1. Weakness: This condition may cause weakness and cause severe discomfort while performing daily activities.
2. Palpitations: Symptoms such as irregular heartbeats, skipped beats and rapid heart rhythm occurs in this condition.
3. Inability to gain weight: Patients tend to lose weight and are always unable to put on some weight in mitral valve disease. Weight gain only happens late in disease process when their tricuspid valve is involved and they start accumulation of fluid ie water in their body.
4. It may cause swelling in your ankles, abdomen and feet.
5. This condition causes shortness of breath. 

Urinary Incontinence is the sudden urine loss that occurs involuntarily in women. Some of the factors which cause urinary incontinence are pregnancy, menopause and childbirth. It should be noted that urinary incontinence by itself is not a disease, but is a symptom of other underlying disorders such as diabetes, infections and other conditions.

Causes of temporary cases of urinary incontinence include:

1. Constipation
2. Urinary tract infections
3. Excess consumption of alcohol and caffeine
4. Consuming carbonated drinks
5. Use of artificial sweeteners
6. High doses of vitamin B and vitamin C
7. Being on sedatives, muscle relaxants, blood pressure and heart medications
8. Eatables which are too spicy, acidic or sugary

However, persistence of incontinence might be due to a more serious condition. Some of the causes are stated below:

1. Age: The bladder muscles tend to weaken with age. This affects the bladder’s urine holding capacity.
2. Pregnancy: Hormonal changes and increase in weight during pregnancy can cause incontinence.
3. Menopause: Oestrogen is responsible for the healthy maintenance of the lining of the urethra and bladder. The onset of menopause causes the oestrogen hormone levels to drop. The gradual damage of the bladder tissues causes incontinence.
4. Childbirth: The bladder control muscles are weakened during normal vaginal delivery, thus leading to incontinence.
5. Obstruction: Occurrence of tumours in the urinary tract can block the normal flow of urine which can cause incontinence.
6. Hysterectomy: The same ligaments and muscles support both the bladder as well as the urethra. With removal of the uterus by hysterectomy, the pelvic floor muscles are deteriorated. This leads to urinary incontinence.
7. Neurological disorders: Conditions such as multiple sclerosis (autoimmune disorder in which the immune system destroys the protective sheath of the nerves), Parkinson’s disease (disorder affecting motor functioning of the body), brain tumours, spinal injury or strokes are capable of causing incontinence.

Different forms of urinary incontinence are classified on the basis of their symptoms:

1. Urge incontinence: Urge or urgency incontinence occurs when there is a leak before the person reaches the toilet.
2. Stress incontinence: Small amounts of urine leak out during normal physical movements such as sneezing, coughing and exercising. This happens because of the minimum stress exerted on the body, and hence, the name.
3. Functional incontinence: Sudden leakage of urine occurs due to external deterrents or physical disabilities such as not being able to find a toilet.
4. Overactive Bladder: This is characterized by frequent and urgent urination.
5. Overflow incontinence: A full bladder, at times, leads to unexpected leakage.
6. Transient incontinence: If urine leakage occurs due to temporary situations such as infections, or new medications.

Anemia refers to a condition wherein the body possesses fewer red blood cells than what it contains under normal circumstances. Oxygen gets carried by the red blood cells to tissues and organs all over the body, thereby enabling them to use the necessary energy from food. A person suffering from anemia, will have his red blood cells carrying less amount of oxygen to organs like heart and brain, thus interrupt smooth functioning of the organs. Kidney disease leads to the problem of anemia. In fact, it is a very common side effect of kidney disease, wherein the body fails to produce the required amount of red blood cells.

What results in anemia?
A person can suffer from the problem of Anemia, when sufficient amount of red blood cells are not there in the body. Oxygen is carried through a person’s bloodstream by the Red blood cells, providing him energy and also ensure that the bones, muscles and organs function properly. Anemia can make a person feel weak and very tired as he or she is unable to receive the required amount of energy.

How can chronic kidney disease lead to anemia?
Anemia is common among people, who suffer from chronic kidney disease, though the problem can occur to anyone. People suffering from chronic kidney disease may have anemia during the early stages of their kidney disease and as the kidney problem gets worse, so does anemia. Improper functioning of kidneys generally link towards the problem of anemia. People, who suffer from complete loss of kidney function, tend to develop the problem of anemia. Kidney failure leads to a person, requiring dialysis or kidney transplant, for ensuring longevity.

Anemia becomes even more common in chronic kidney disease, if a person:

• Has high diabetes.
• Is suffering from heart problems.
• Has a high level of blood pressure. 

Some of the other causes of anemia in people, suffering from kidney disease include loss of blood from hemodialysis and lower levels of some of the nutrients like iron, folic acid and vitamin B12, found in food.
These three nutrients are essential for the red blood cells to make haemoglobin, which is the main carrier of protein through oxygen in red blood cells.

Signs and symptoms of anemia with chronic kidney disease
The signs and symptoms of anemia in someone, suffering from chronic kidney disease are:

• He might have terrible weakness.
• A person might suffer from headaches on a frequent basis.
• There would be problems with regard to concentration.
• The color of the skin would become pale.

Treatment
A doctor would try and increase the levels of iron in a person’s body, as the first step of treatment. Iron pills would help in improving the levels of iron and haemoglobin. Red Blood Cell transfusion is another way to treat this problem. Transfusion would be done inside the patient’s vein by raising the level of the patient’s blood consisting of red blood cells, thereby also increasing the amount of oxygen. Vitamin B12 and Folic Acid supplements are also suggested by healthcare providers, to help treat anemia.

HIV testing in pregnancy should be done early so as standard care can be taken for the pregnant women. The HIV testing must be repeated in the third trimester, usually before 36 weeks of gestation. This should be done in women with HIV seronegative and also in pregnant women who are at a high risk of developing HIV infection.

Expedited HIV tests should be performed at the time of delivery and labor and this is a must in women who have not been documented for HIV. The results of the test should be available within an hour of the test and the testing should be available 24 hours. In case the results are positive then, infant postnatal antiretroviral and intrapartum drug prophylaxis should be started immediately.

Women who have not been able to get tested for HIV at the time of labor and delivery are suggested expedited screening for HIV. Their screening can be done immediately postpartum or their babies should undergo screening. In case the infant and mother, both are positive, then infant antiretroviral drug prophylaxis should be started immediately. These mothers should avoid breastfeeding their babies, until the supplemental HIV tests are negative. In infants with positive HIV, prophylaxis should be discontinued and antiretroviral drug therapy should be started. 

In case of acute HIV infection during pregnancy, that is in the intrapartum period, or during breastfeeding, initial testing can be performed with an antigen/antibody combination immunoassay. If the supplemental test is negative, then an additional test which is the virologic test (DNA, RNA) are necessary for the diagnosis of the HIV infection. If the mother is HIV positive, then this information must be documented in the infant's medical record and also communicated to the infant's care provider.

The knowledge of an antenatal maternal HIV infection allows the:

1. Women with HIV infection to get the correct antiretroviral therapy along with prophylaxis for the infections, which might occur due to the immunocompromised state of the body. This also prevents and decreases the risk of transmission to their partners.
2. When there is provision for antiretroviral therapy for the mother during pregnancy and labor along with antiretroviral drug prophylaxis for the baby there is less risk of perinatal transmission of the HIV.
3. The HIV-infected women should be counseled for a cesarean delivery. The option of an elective cesarean reduces the perinatal transmission of the HIV.
4. The HIV women should be counseled about the risk of breastfeeding. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.