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Avascular necrosis is localised death of the bone. Necrosis can occur due to traumatic injury, side effects of drugs or disease. The dead areas of the bone do not function normally, they weaken and they can collapse. Avascular necrosis eventually leads to the joints attached to the dead bone deteriorating. Avascular necrosis can occur in the knees, shoulder, waist and ankles, but the hip joint is the most commonly affected.

Causes of Avascular Necrosis

1. Traumatic injury to the affected bone, like fractures and dislocation, is a common cause
2. Use of steroid medication
3. Excessive alcohol consumption and smoking
4. Radiation and chemotherapy treatments can lead to avascular necrosis
5. Patients with underlying diseases such as systemic lupus erythematosus, diabetes mellitus, vasculitis, and inflammatory bowel disease are at risk
6. Patients with blood and bone marrow diseases such as sickle cell disease, leukaemia, Gaucher's disease or thalassemia are also at risk

Symptoms of Avascular Necrosis

1. Necrosis can begin with no pain in the abnormal bone
2. But with time and use, the pain develops
3. When the hip is affected, pain in the groin is common, especially when walking
4. The ball of the hip collapses as necrosis progress which leads to pain whenever the hip is rotated or is to bear weight while walking

Many people know that smoking causes several problems including cancer, heart disease, and respiratory disease. However, there are other diseases occur because of smoking and chewing tobacco. Buerger's Disease is one such disease in which the blood vessels in legs and arms get blocked. This blockage will interfere in blood flow and results in forming blood clots. These clots will affect both legs and
hands.
Buerger's Disease is also known as Thromboangitis Obliterans. It is a type of vasculitis which causes inflammation in the blood vessels including thickening, narrowing, weakening, or scarring.
Buerger's Disease cannot be cured easily. However, by quitting the use of tobacco and smoking, one can limit the symptoms from getting worse. If a person is not able to quit smoking, he/she might end up
suffering from severe tissue damage. One can also even lose toes, fingers, or other parts of the limbs. This is why quitting all type of tobacco or smoking is the only way to treat Buerger's Disease.

What Causes Buerger's Disease?
As discussed earlier, smoking cigarettes or cigars and chewing any form of tobacco is one of the main causes of Buerger's Disease. Still, the exact cause of this disease is unknown, but in most cases of Buerger's Disease, the sufferer has consumed tobacco products. It is an assumption that chemicals present in tobacco, cigarettes, and cigars may affect the lining of blood vessels, causing them to swell. According to experts, the genes in the body may also cause this disease. It is suspected that this disease is caused by an autoimmune response in which the immune system of the body attacks healthy tissues mistakenly. According to this theory, some people are prone to this disease.

Symptoms of Buerger's Disease-
Some of the most common symptoms of Buerger's Disease are:
Pain in the hands and feet while exercising
Stiffness due to reduced blood flow
Pain at Rest
Skin ulcerations
Gangrene of the fingers and toes in severe cases
Numbness, coldness, or tingling of the feet and hand
Pale, reddish, or blue-tinted hands or feet.

Diagnosis of Buerger s Disease-
There is a set of tests that can diagnose Buerger s disease. Doctors first ask a person about his/her lifestyle, use of tobacco, and symptoms. After seeing a few symptoms, doctors may perform a test to check the blood flow. He may also look for other diseases that cause similar symptoms. Some of the common test to diagnose Buerger s Disease are:


Allen Test: The Allen test is a blood flow test. In this type of test, patients squeeze their hand into a firm fist, which pushes out blood from hand. The doctor presses the arteries to slow down the
blood flow of the hand. At this stage, the normal color of the skin gets pale. After that, patients open his/her hand and doctors release the pressure from both sides of the wrist one by one. If it takes a longer time to go back to the normal skin color, it may be an indication of Buerger s disease

Angiogram: It is a type of X-ray that will help to check the blockage of the blood vessels in the legs and arms. In this test, doctor place catheter (thin tube) into an artery to pump the dye. After
that, he takes X-ray images. Doctors may also perform tomography (CT) or MRI scan for clear results.

Blood Tests: The blood tests will help the doctor to check if there is any other disease that causes the same symptoms as most of the vascular diseases mimics the symptoms of Buerger s
Disease. The doctor may also perform tests to check for diseases like lupus, diabetes, and those that cause blood clots.

Treatment of Buerger' Disease-
Quitting smoking and use of tobacco will help a person to lower the symptoms of this disease. Doctors may also prescribe for pain killers or antibiotics to get rid of the pain in affected areas. If a person finds it difficult to quit smoking, doctors help him/her with the right program and rehabilitation techniques.

Take Away-
Buerger's Disease is one of the rare illness caused by intake of tobacco products, this is why quitting smoking is most important to treat this disease. It is also advisable to consult a doctor as soon as a person identify any of the above symptoms.

Systemic Lupus Erythematosus
This is an autoimmune disease and it affects the body in many ways. It is chronic in nature and you can manage the symptoms with proper treatment. It is one of the most common types of lupus and it usually causes anaemia and general weakness in the body coupled with joint pain and headaches. It is generally known to affect women than men as the estrogen hormone triggers this condition in many cases. As the symptoms of this condition are not specific to lupus, it is not an easy task to diagnose this condition. Once it is clear, doctors will begin proper treatment and you need to be watchful about the symptoms for a long time as this condition is chronic and there is no cure to this condition. You can, however, manage the symptoms by taking suitable medication. In rare cases, it can cause severe complications and this usually happens when you are suffering from this condition for a very long duration.

Symptoms of Systemic Lupus Erythematosus
- Some of the common symptoms of this condition include severe fatigue along with pain in the joints. It can also cause swelling of the joints and this will be very painful. You need to consider these symptoms seriously and get suitable treatment at the right time to avoid further complications.

- It can also cause a headache as the immune system works harder than required to counter the allergic reaction in the body. This can affect the normal breathing and the supply of oxygen to the brain will be reduced leading to severe headaches.

- It is also common for people suffering from this condition to experience rashes on the nose and cheeks. This condition is also generally termed as butterfly rashes and it is easily visible on the face.

- It can also cause significant hair loss due to the overworking of the immune system and this can also become permanent hair loss when suitable treatment is not provided in a timely manner.

- Some people also experience issues with clotting of blood due to this condition. It can also cause anaemia and you will feel general weakness.

- Apart from that, there can be many other symptoms depending on which organ is affected by this condition. When it affects the heart region, symptoms like chest pain and other things are very common.

- When it starts affecting the skin, it can create rashes or another sort of inflammation as an allergic reaction. In the same manner, when the digestive tract gets affected due to this condition, it can cause diarrhoea and other related symptoms in the body.

Causes of Systemic Lupus Erythematosus
- The exact cause of this condition is not yet established and some factors are considered to trigger this condition in many individuals.

- Even though it is not a genetic disorder, it is likely to affect people having a family history of autoimmune disorders. If anyone in your family is suffering from this condition, you need to be careful about the symptoms and get suitable treatment.

- You will be surprised to know that exposure to UV light can also trigger such a condition in many people and some sensitive people develop this even after exposure for a few minutes. You should avoid getting outside during the peak sunlight period and stay away from trouble when you are allergic to such conditions.

- Similarly, taking certain medication can trigger this condition when it causes any side effects. If you notice such symptoms, you can talk to your doctor to get an alternate prescription to treat your problem.

- Exposure to certain viruses can also cause this condition and you have to treat such issues at the earliest to avoid further complications in future.

- When you are physically stressed too much, the immune system will work hard to bring it back to normal condition and this can sometimes cause this condition. In the same way, even emotional stress can mess up with the hormonal activity in the body and affect the immune system leading to this condition.

- Even trauma can induce such conditions in many individuals even though this will usually be a temporary reaction in most cases.

- Women are more likely to get affected with this condition and the estrogen hormone is known to trigger this condition. If you notice such symptoms during the monthly cycle, you need to take suitable medication to treat the issue. This condition is also common during pregnancy and the symptoms will usually last for a short duration in this case.

Diagnosis of Systemic Lupus Erythematosus
- The first step in diagnosis begins with a physical examination of the symptoms and this will give the doctors some idea about the overall nature of the problem. In this situation, the symptoms like sun rashes along with ulcers will give a clear indication of the problem. Some people may also experience hair loss and even show signs of hair loss and improper heartbeat.

- After this is done, further blood tests will be suggested as this will provide some clarity about the working of the antibodies in the body. When the immune system overreacts to certain situations, it can create more antibodies and this will be clearly understood after getting the results of blood tests.

- The kidneys will not be able to remove all the unnecessary proteins from the body in this case and you can get to know such abnormalities in the Urine test. This will also show the clear overworking of the immune system and doctors will begin suitable treatment based on the results of this test.

- Along with that, an X-ray of the chest region will also help to notice any inflammation in this area. This will also give a clear indication of any improper functioning of the lungs and heart and doctors can prescribe suitable medication to treat the condition.

- It can also be due to various autoimmune diseases and you need to discuss your medical history in a detailed manner with the doctors to aid them in the diagnostic process. Remember that a series of tests may be required before they identify the exact problem in this situation.

Prevention of Systemic Lupus Erythematosus
- You can take suitable precautionary measures to avoid this condition in the future. Remember that you need to be watchful about the symptoms and analyze what is causing them in your body. If it happens after you eat some food or after you are exposed to some environment, make sure to avoid them in the future.

- Remember that exposure to UV light can also trigger this condition in many individuals and you should note the changes in your body after you are exposed to sunlight. If you notice any rashes or other inflammation on the skin surface, you need to be careful next time and use suitable protection to avoid UV rays. You can use some creams and lotions that will protect your exposed skin from UV radiation.

- In the same manner, you can also avoid stress to a large extent and this will help you to prevent this condition in future. It is also important to engage in a limited physical activity as overloading your body can also trigger the immune system and it can overreact in some situations.

- Also, make sure that you eat a healthy and nutritious diet as this will keep your immune system functioning in proper order. You should also note that having certain vitamin and mineral deficiencies in the body can lead to problems with bones and joints and this can get inflammation easily at a later stage. On the other hand, when you exercise and eat a healthy diet, you will be able to avoid such complications.

Treatment for Systemic Lupus Erythematosus
- There is no specific way to treat this condition and only the symptoms have to be managed by choosing some medication. In this situation, it is important to know about the affected region in the body so that proper treatment can be given to providing some relief.

- When it comes to treating joint pain and other related issues due to this condition, some anti-inflammatory medication may be used as this will reduce the inflammation in the body.

- In the same manner, inflammation on the skin surface can also produce rashes and use steroids as medication or cream will provide suitable relief in this situation.

- It is also possible to slow down the immune system on a temporary basis by using some medication. However, this cannot be continued for a long duration and you need to choose this treatment only as a temporary solution.

- It is also noticed that using drugs that are used to treat malaria can give effective results in this situation.

- Apart from that, you should also make suitable changes to your diet and lifestyle as this can have a significant impact on your overall health condition. It is necessary to reduce stress and eat a healthy diet to keep your immune system in proper order.

Complications of Systemic Lupus Erythematosus
- The complications of this condition are many as this can affect various organs of the body in no time and cause severe damage when proper treatment is not provided at the right time.

- When it normally causes blood clots along with inflammation of the blood vessels in the body, it can lead to complications like vasculitis in many individuals.

- In extreme cases, it can even lead to a heart attack as it can cause inflammation of the heart region due to the autoimmune disorder.

- When this affects the brain region, it can cause a stroke in many cases. Many individuals also report seizures on a frequent basis when they are suffering from this condition.

- It is also known to impact the memory functioning of the brain and this can affect the overall ability of the person to handle various tasks in everyday life.

- It can also cause certain behavioural changes all of a sudden without any other health conditions. This should be noticed carefully as the person suffering may not be able to distinguish this as a symptom and other people in the family should identify such symptoms.

- When it affects the lining of the lungs region, it can lead to inflammation in that area and this causes shortness of breath and other complications in the long run.

- It can put a lot of pressure on the kidney as the body reacts aggressively to normal substances and produces antibodies in large quantities. In this situation, the overall functioning ability of the kidney can get reduced to a large extent and it can even lead to inflammation of this region or complete failure of the organ in extreme cases.

- You should be very careful about this condition during pregnancy as this can lead to various complications and even affect the newborn baby. In extreme stages, it can even cause miscarriage or other complications during delivery.

Myths about Systemic Lupus Erythematosus
Myth #1: This condition can be cured:

There is no cure for this condition and you should only manage the symptoms in the long run. Whenever you notice any symptoms, you need to treat them and there is no way of completely avoiding them in the future.

Myth #2: It cannot be caused by stress:

Most people do not realize the importance of leading a stress-free life and take it for granted. However, you need to understand that emotional, as well as physical stress, can trigger such conditions in the body and you will have to suffer a lot for a long duration. It is a good idea to relax once in a while to reduce the stress levels in the body.

Conclusion
You should understand that this is a chronic condition and there is no way to treat this permanently. However, the symptoms can be easily managed and you need to reduce the overactive immune system during this phase. It can be easily controlled with proper medication and you should try to avoid things that can trigger them in your body. If you notice that any medication is causing this condition, you can speak to your doctor to get some alternative medicine to treat the underlying issues.

Namaskar! Mera naam Dr. Prashant Saxena hai. Mai Max Smart Hospital, Delhi mei ek pulmonologist hun. Aaj me apse smoking ke bare me baat krunga. Smoking aisa khatarnak addiction hai joki aaj kal duniya mei badhta ja rha hai. Yuvaon ki baat alag hai. Middle age aur old age mei bhi ye shaunk bade ache se kiya ja rha hai. Smoking ke itne dushprabhav hote hain ki agar hum unki jankari len, to ek puri kitab likhi ja sakti hai. Smoking sharir ke kisi bhi organ ko affect kar sakti hai. Smoking se lag bhag 13 tarha ke cancer aaj kal dekhne ko milte hain. Jismei ki lung cancer no.1 cancer hai. Smoke mei lag bhag 7000 chemical hote hain jisme se 70 chemicals cancer sharir mei paida kar sakte hain. Smoking karne se lung cancer sabse bada cancer hai joki hamare ko ho skta hai. Iske alawa 13 or tarike ke cancer hain joki hume ho sakte hai. Lung cancer or anye cancer ke alwa, smoke se ya smoking krne se hamare ko lungs ki bimariyan ho skti hai. Jisme ki chronic bronchitis, dame ke attacks, pneumonia hona, tuberculosis jaise infections hona. Agar hum aur effects dekhen smoking ke, lungs ke alawa, to hamari eye sight pe farak pad sakta hai, hamari bones kamjoor ho skti hain. Hamare jo blood vessels hote hain uske andar ek substance deposit ho jata hai smoking karne se. Agar hamare sharir mei anthracosis ho jati hain to us insan ko heart attack padne ke ya stroke hone ke chances bahut jyada ho jate hain. Smoking agar ek mahila karti hai ya pregnant mahila karti hai to uske bahut jyada side effects hote hain. Apka bacha gir bhi skta hai. Bache ka growth retardation ho skta hai. Bache ki delivery jaldi ho skti hai. Bacha paida hone ke baad bhi agar maa smoking krti jai, to aise bachon mei dekha gya hai ki inko bahut jaldi pneumonia hote hain. Aur in logon ko dama hone ke chances bahut jyada badh jate hain. Kayi baar log hamse puchte hain ki passive smoking ya environmental tobacco smoke kya hota hai. Agar hum aam taur pe apna vatavaran ko dekhen to kayi tarha ke dust, particles, smoke, hamare environment mei hai jisme ki tobacco smoke bhi hai. Agar hum is tarike ke smoke ko inhale krte hain to usi tarha ke dush prabhav hamare sharir mei hote hain jitna ki ek smoking krne vali ciggrette se hote hain. Mtlb agar aap smoking nhi bhi kar rhen hain ya fir aap smoking environment me rhen hain ya fir koi bhi smoking kar rha hai or aap usko inhale kar rhen hai,to apko vhi bimariyan ho sakti hai jo tobacco smoking krne se paida hoti hain. Smoking krne vale ko smoke ki aadat kyu padti hai? Jab bhi hum smoke karte hain to ciggrette ke andar ek substance hota hai jiska nam nicotin hota hai. Nicotin jab body ke andar jata hai to vo body ko pleasurable effects deta hai. Mtlb usko anand aata hai, energy aati hai, usko acha lgta hai ciggrette peena. Aur jab ciggrette pina vo band krta hai to nicotin ka level body mei kam ho jata hai or uske baad usko thakan mehsus hoti hai or usko acha nhi lgta. Aur ye cycle continue hoti rehti hai. aur agar koi ciggrette chodta hai to usko withdrawl symptoms hote hain. Ye symptoms kya hote hain. Jab aap smoking chorte hain to uske kuch ghante baad as soon as half an hour, hmare andar changes aate hain, jaise ki hume anxiety hona, depression hona, ya mood change ho jana ya irritable ho jana ya pait me dard hona ya maror hona, hath pair kapna, is tarha ke lakshan shuru ho jate hain. Ye lakshan smoking chodne ke 2-3 din mei peak krte hain or 2-3 hafte tak reh sakte hain. Kuch log jo bahut jyada smoking krte hain unke andar withdrawl symptoms 2-3 mahine tak reh sakte hain. Withdrawl symptoms ke bare mei janna islia jruri hai kyuki jab bhi hum smoking chodenge to hume malum hona chaiye ki inko kaise tackle krna hai. How to quit smoking? Agar hum dekhen to smoking quit krna bahut asan kam nhi hai. Smoking quit krne k lia self-determination or bahut strong will chaiye. Aur yaad rkhiye kayi log smoking chodne ke baad bhi dubara us lat mei vapas aa jate hain. Sirf chewing gum ya tablet khane se koi smoking nhi chor skta. Agar hum dekhen to smoking chorne ke kayi sare upay hote hain. Sabse pehle hume identify krna hai ki smoking ka trigger kya hai. Kayi logon ko khelne ke baad smoking ki talab hoti hai. Kayi logon ko khana khane ke baad smoking ki talab hoti hai. Kayi logon ko alcohol peene ke sath ciggrette peene ki talab hoti hai. To hume trigger identify krna hai ki kab hume sabse jyada talab ho rhi hai or fir hume us trigger ko dheere dheere apne se durr krna hai. Agar hum pub mei jate hain, hukka bars mei jaate hain, to hume dekha hai ki hum aise places me na jayen, jahan bhi log smoke kar rhen hain. Kyuki agar hum unhe dekhenge smoke karte hue to hume dubara talab hogi ciggrette peene ki. Kuch logon ne yahan tak ye bhi kiya hai ki unhone apne doston se milna bhi chor dia hai jo ciggrette smoke krte hain kyuki agar aap aisi company mei baithenge ki vahan smoke ho rhi hai to aapka bhi mann krega ki aap smoking karein. Aur baar baar smoke ki taraf aakarshit honge. Agar hmara dimag bar bar smoking ki taraf aakarshit ho rha hai to hum koi nyi hobby ka istemaal kar skte hain jaise ki hum gym join kar skte hain, hum kuch aur creative chiz kar sakte hain, drawing, art, anything we can do. Taki hmara dimag divert rhe or smoking ki traf na jaye. Bich bich mei agar hum vegetables or fruits khate rahen or paani peete rahen to smoking ki talab kam ho jati hai. Aur agar hum doctors ki prescribe ki hui dawaiyon ka istemal karen jis se ciggrette ki talab kam ho, vo dawaiyon hame istemal krni chaiye. Ciggrette chorne ka kya tarika hota hai. Sabse pehle hume decide krna hai ki hume kis din ciggrette chorni hai ya kis mahine ciggrette chorni hai. Uske ba ciggrette chorne k 3 sabse important tarike hain. Sabse pehla tarika hota hai aaj humne decide kia ki ab hum ciggrette nhi peeyenge par ye bhi dekha gya hai ki upaye bahut jyada successful nhi hota. Dusra upaye ye hai ki hum ciggrette ki matra kam krte hain. Jaise hum 20 ciggrette peete hain to 1 hafte baad 15 peete hain. Uske 1-2 hafte baad 10 peena shuru kar den. Or jaise jaise ciggrette kam ho jaye, hum grade decide kar ke ciggrette peena chor den. Teesra tarika hai ki ciggrette hum aadhi pee ke fekna shuru kar dein. Mtlb humne 2-4 puffs liya uske bad ciggrette chor dia. Aise hamara ciggrette ka amount kam ho jayega or hume ciggrette ki latt chut jayegi. Is dauran hame side-effectss ho skte hain. Withdrawl effects ho skte hain. Hum apne physician ko consult kar sakte hain. Jo hume nicotin replacement therapy or kuch dawaiyan hain jo non-nicotin replacement therapy hoti hai, usmei hume enroll kr k, hume dawaiyan de skte hain jis se hume withdrawl symptoms se fight krne mei aasani rhegi. Yaad rakhein ki sirf planning se kaam nhi chalega. Behavior therapy, counselling + medicines and your strong will, all are most important things in quitting smoking.

Most people believe kidneys to be organs solely responsible for the filtration of blood and production of urine. But the truth is that the kidneys perform a host of vital functions in the body which include regulation of blood pressure, blood volume, and blood Ph. Around half of the individuals affected by lupus suffer from kidney problems, and the most affected part is the glomerulus whose function is filtering substances from the blood.

Effects of lupus nephritis on the kidneys
Lupus itself doesn t lead to kidney infection or inflammation. But lupus nephritis, which is the Systemic lupus erythematosus (SLE) that affects the kidneys and the medications used for treating the condition tend to suppress the immune system. It makes the person affected with lupus vulnerable to the infections of various types. It is one of the most severe conditions of that could be encountered by a person wherein the immune system starts attacking various parts of the body as they would tackle a disease.

Lupus nephritis makes the kidney unable to remove the waste materials effectively from the blood. This leads to loss of control over the amounts of fluids regulating in the body. As a result, an abnormal amount of waste can build up in the blood resulting in edema or swelling.

When left untreated, these conditions can cause scarring along with permanent damage to the kidneys and end-stage renal disease. When a person has end stage renal disease, he or she needs regular filtering of the waste products of the body with the help of a machine. In severe cases, a kidney transplant may be required to ensure that at least one kidney is working properly.

Individuals who are susceptible to developing lupus nephritis:
A person with lupus may see the symptoms of lupus nephritis within 5 years and the people aged between 20 and 40 years are most vulnerable to it. In some common instances, it is seen that lupus nephritis is leading to unexplained weight gain along with swelling and puffiness in different parts of the body such as ankles, hands, eyelids, legs, and feet. During the first stages, these symptoms are often ignored which causes worsening of the condition. The urine may also become frothy or foamy with a reddish tinge in it. It is estimated that about 40 percent of children having lupus would develop kidney complications. Lupus nephritis may also cause increased urination, blood in the urine and elevated blood pressure.

If you have lupus, it is imperative to consult with a nephrologist. Testing a sample of the urine can help in showing the problems in the functioning of the kidneys. Your doctor will advise you about the diagnostic tests that can help in determining whether the disease has progressed to severe levels and start with the treatment process accordingly.