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Diagnosis of tuberculosis is based on a combination of clinical features, smear examination of sputum where available, tuberculin skin testing or Mantoux test, chest X-ray and Histopathologic / cytologic examination as appropriate. Common clinical features are weight loss, persistent fever and /or cough of more than 2 weeks duration and history of close contact with another Tuberculosis patient.
Mantoux test also known as Tuberculin skin test is used for the detection of infection by Mycobacterium Tuberculosis bacteria. The test consists of slowly injecting a liquid intradermally (superficially within the layers of the skin) on the forearm, leading to formation of a raised vesicle which should be easily visible to the naked eye. This liquid, used in India, is Tuberculin PPD RT 23 strain. Tuberculin is a glycerol extract of the Tuberculosis bacteria. This is one of the two WHO accepted standard tuberculins, apart from PPD-S. In India, where the prevalence of tuberculosis is high, the recommended dose of this liquid is 0.1 ml of 1 TU (TU stands for tuberculin units) .1 TU is the strength of the liquid mentioned on the vial. This liquid is usually administered by a very tiny syringe, usually of 26 gauge. (Needle diameter).
Please click on the link to watch a video demonstrating how this procedure is performed.
Test principle : The individual who has been infected with Tubercle bacilli responds with a hypersensitivity reaction at the test site in the form of induration. Induration is the palpable raised hardening of the skin, while erythema refers to redness of skin. Only induration is clinically significant and measured after 48 to 72hours following injection. Diameter of the Induration is measured by a scale in millimetres perpendicular to the long axis of the forearm.
Interpretation of the tuberculin test
- Size of induration 15 mm and above : - signifies infection with tubercle bacilli
- Size of induration 10-14 mm : - could be due to infection with tubercle bacilli, BCG induced sensitivity, or due to cross reaction with other environmental mycobacteria.
It is more likely to be attributable to infection with tubercle bacilli in case of history of contact with smear positive case of pulmonary TB, clinically confirmed TB OR X-ray consistent with active TB.
- Size of induration 5 -9 mm: usually non tuberculous in nature generally
- Size of induration <5 mm : indicates absence of any type of mycobacterial infection.
Precautions during this procedure :
- If a raised vesicle does not appear it means that the liquid has been injected too deeply, and the test should be repeated on the other arm. If the same arm is used the injection site should be should be separated at least 5 cm from the first injection site.
- Occasional patients may experience severe allergic reaction to the tuberculin PPD
- Larger the size of the induration, higher the probability of presence of infection with tubercle bacilli.
- Almost all reactions with induration more than 15 mm maybe considered attributable to infection with tubercle bacilli.
- Formation of necrosis (ulcer) at the test site, indicates high degree of tuberculin sensitivity and suggests presence of infection with tubercle bacteria.
- Tuberculin reaction may be suppressed (falsely low) in presence of immunosuppressive states. Like HIV, malnutrition, patient on steroid therapy etc.
- Mantoux test is generally not recommended for infants less than 12 weeks old. If the test turns out to be positive, then it is significant, but if the test is negative, then the test needs to be repeated again.
- The tuberculin test detects only the presence or absence of tuberculosis infection. The presence of infection is not synonymous with disease. It simply means, that even if you have tuberculosis infection in your body, as detected by positive Mantoux test, it does not mean you have active Tuberculosis in your body and require anti tuberculosis drugs in all cases. The clinician will correlate your mantoux test result with other tests ( as mentioned at the top of the blog) to give you a final picture.
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एक समय था जब झुर्रियों को बुढ़ापे की निशानी माना जाता था। लेकिन, आजकल, यह आश्चर्यजनक नहीं होगा कि आप केवल 25 वर्ष के हों, तो भी यह दिखना शुरू कर दें। व्यस्त जीवनशैली, तनाव, नींद की कमी और अनुचित आहार अक्सर त्वचा का नुकसान होने के कारण होता है।
झुर्रियां पतली, सगनी त्वचा के कारण होती हैं। वे विशेष रूप से चेहरे, गर्दन, हाथों की पीछे, और अग्र-भुजाओं के शीर्ष पर दिखाई देते हैं। झुर्रियां तब होती हैं जब त्वचा के संयोजी ऊतक में कोलेजन और इलास्टिन कमजोर हो जाते हैं और टूट जाते हैं। समय से पहले या अधिक झुर्रियां अन्य कारकों जैसे सूरज की रोशनी या कठोर वातावरण, धूम्रपान, कुछ दवाओं के उपयोग, अत्यधिक तनाव, अचानक वजन घटाने, विटामिन ई की हानि, गतिहीन जीवन शैली और आनुवंशिक पूर्ववृत्ति के कारण भी हो सकती हैं।
झुर्रियों से बचाव के घरेलू उपाय
यदि आपने हाल ही में अपने चेहरे पर महीन रेखाओं पर गौर किया है या लंबे समय से उन्हें छुटकारा पाने के लिए संघर्ष कर रहे हैं, तो यहां कुछ अद्भुत घरेलू उपाय हैं जो झुर्रियों को बहुत प्रभावी ढंग से हटा सकते हैं।
1. जैतून का तेल:
जैतून का तेल आपकी त्वचा के लिए एक अद्भुत मालिश तेल है। यह एंटीऑक्सिडेंट जैसे विटामिन ए और ई, का एक अच्छा स्रोत है, जो त्वचा के लिए हानिकारक मुक्त कणों से लड़ते हैं। नियमित रूप से प्रभावित त्वचा क्षेत्र पर जैतून का तेल मालिश करना त्वचा की कोशिकाओं को मॉइस्चराइज, मरम्मत और पुनर्जीवित करेगा।
आप 1 बड़े चमच जैतून के तेल में 1/2 चम्मच कालनजी तेल को भी जोड़ सकते हैं, इसे अधिक शक्तिशाली बनाने के लिए।
मेथी के पत्ते विटामिन और खनिजों में बहुत समृद्ध हैं जो आसानी से शरीर द्वारा अवशोषित होते हैं और झुर्रियाँ और अन्य त्वचा की समस्याओं का इलाज करते हैं। ताजी मेथी के पत्तों को पीस लें, एक पेस्ट बनाने के लिए। अपने चेहरे पर पेस्ट को लागू करें और इसे रात भर छोड़ दें। सुबह इसे गुनगुने पानी से धो लें।
आप मेथी के बीज के साथ उबला हुए पानी से भी अपना चेहरा धो सकते हैं या अपनी झुर्रियों और महीन रेखाओं पर मेथी तेल लगा सकते हैं।
यह इलास्टिन के टूटने को रोकने में मदद करता है, झुर्रियां और महीन रेखाओं के मुख्य कारणों में से एक है। अदरक एंटीऑक्सिडेंट्स में समृद्ध है, इस प्रकार भी झुर्रियों को रोकने में मदद करता है। शहद की एक चम्मच के साथ कसा हुआ अदरक मिलाएं और हर सुबह इस मिश्रण को खाएं। आप अदरक और शहद वाली चाय भी पी सकते हैं।
एलोवेरा विटामिन ई का एक समृद्ध स्रोत है, जो त्वचा के लिए एक बूस्टर है। एलोवेरा एंटीऑक्सिडेंट और शोथ रोधक यौगिकों के साथ सुस्त त्वचा को भी स्वस्थ कर देता है। 1 बड़ा चमचा एलोवेरा जेल और 1 अंडे के सफेद हिस्से का उपयोग करके पेस्ट बनाएँ और इससे अपने चेहरे पर मालिश करें। इसे आधे घंटे के लिए छोड़ दें और फिर धो लें।
केले विटामिन, खनिज और एंटीऑक्सिडेंट्स में समृद्ध हैं जो झुर्रियों और महीन रेखाओं के कारणों से मुकाबला करते हैं। एक गाढ़ा पेस्ट बनाने के लिए दो केलों को कुचल दें। झुर्रीदार क्षेत्रों पर पेस्ट को लागू करें। इसे कम से कम आधे घंटे के लिए छोड़ दें और फिर इसे गुनगुने पानी से धो लें।
बादाम में विटामिन ई होता है जो त्वचा की प्राकृतिक लोच को लौटाता है। बादाम फाइबर, लोहा, जस्ता, कैल्शियम, फोलिक एसिड, और ओलिक एसिड का भी एक उत्कृष्ट स्रोत है, जो संयुक्त रूप से बुढ़ापे की प्रक्रिया में देरी कर सकते हैं और झुर्रियों का इलाज कर सकते हैं।
रात भर के लिये कच्चे दूध में कुछ बादाम सोखें। सुबह, उन्हें छील लें और पीसकर गाढ़ा पेस्ट बनायें। इसे चेहरे पर लागू करें, 15 मिनट तक सूखा दें और फिर पानी से धो लें।
अनानास में एंजाइम होते हैं जो त्वचा लोच को बढ़ावा देते हैं, त्वचा को मॉइस्चराइज करते हैं और साथ ही मृत त्वचा कोशिकाओं को खत्म करने में मदद करते हैं। यह एंटीऑक्सिडेंट, फाइबर और विटामिन में भी समृद्ध है जो त्वचा के स्वास्थ्य को बढ़ावा देते हैं।
प्रभावित त्वचा क्षेत्र पर अनानस मांस रगड़ें। आपकी त्वचा पर अनानस का पल्प लागू करें। इसे लगभग 20 मिनट तक सूखने के लिए छोड़ दें और फिर इसे धो लें।
Hi Doctor, I'm Abinash! One of my friend told me that if I apply Beer (alcohol) on my face then it will glow and it really helps in removal of dead cells from the face. How far is it true?
In India, especially the urban centers, obesity or even being overweight is becoming a new epidemic. The increases in consumption of fast foods, sedentary lifestyles and stress have increased the incidence of this problem. This has in turn, led to an exponential increase in the cases of diabetes, heart diseases and blood pressure among a host of other problems.
The Ayurvedic approach
Ayurveda is a discipline, which has been practiced over many millennia and contains the collective wisdom to effectively treat problems of obesity or being overweight without side effects. According to Ayurveda, the body is made up of 7 elements or Dhatus:
- Rasa (Lymph)
- Rakta (Blood)
- Maans (Muscle)
- Meda (Fat)
- Asthi (Bones)
- Majja (Nervous system)
- Shukra (Reproductive System)
However, if you are overweight then it means that due to an imbalance of the ‘Kapha’ dosha, you are accumulating more ‘meda’ or fat. Ayurveda has some very effective actions to prescribe through which you can lose weight very effectively. Some of these tips are mentioned below.
- Drink a mixture of lemon, honey and water first thing in the morning: Drinking a mix of lemon, honey and water helps to jump start your metabolism and boost your digestive system. Drinking this regularly over a period of a few months and would help reduce your weight very quickly.
- Meditate for at least 10 minutes a day: This is a very important step as meditation helps relax your mind, muscles and nerves and reduces stress. This enables you to take better decisions throughout the day. It also controls your appetite thus stopping you form binge eating. Meditation and relaxation have also been shown to contribute to weight loss by keeping the metabolism regulated.
- Do at least 30 minutes of exercise: It is important that you do at least 30 minutes of exercise daily as it would regulate your metabolism and help you to keep burning fat throughout the day. Incorporating light yoga along with a brisk walk is possibly the best way to safely and easily lose weight. Some of the easiest poses to lose weight would be
- Dhanurasana or Bow pose
- Setubandhasana or Bridge pose
- Bhujangasana or Cobra pose
- Vakrasana or Half spinal Twist pose among many others
- Consider your diet according to season: According to Ayurveda, you should be careful about what you eat during the various seasons as this will ensure maximum nutrient absorption without the deposition of fat.
- Eat three meals a day, not more: According to Ayurveda, you should have three meals a day without any snacks in between. Have a heavy breakfast as that tends to set the tone for the day, followed by a comparatively light lunch and an even lighter dinner. This is because your digestive system functions most effectively in the morning, fairly fast at noon, but it is the most sluggish at night.
- Go to bed early and rise early: This is often propagated as disturbances in the Circadian rhythm or the natural sleep and waking cycles are a big contributor to weight gain. Once this is properly regulated, it could result in weight loss because of your body metabolism being properly regulated.
Mai 38 years old hu. Par 4 mahinose muze eka hi din blooding Hoti hai. Badame bus spot dikhate hai. Aur mere chehare me bahot sare pimals AA Gaye hai. Skin bhi dry ho gai hai. Aur pigmentation ho Gaya hai.
My Mother 40 have a black small patches on her hand in other words black circle mark on her hand please suggested her some home remedy or treatment and tell us how it come please it's your most kindness. thanks.
I have tried every single suggestions from my family members and I moved to gym but now it seems to be impossible for me to gain my weight.
I am 88 kg 21 year old women. Hypothyroidism patient. I need to loose weight but unable to. Any suggestion.
I am 21 year old women height 5'3. Weight is 41 kg. I am unable to increase my weight and I am skinny. What diet or habit should I take to gain weight as I feel really low energy.
Hello Doctor. I am 31 years old female. My height is 5'4" but weight is only 41 kg. How can I gain my weight?
From few months I was in a depression of my health but now I was cleared everything and because of that depression my skin became dull (I have no bad habits) now what should I do to get chubby and fair skin as I am moving to my Post graduation.
My height is 173 cm and my weight is 97 kg. My belly size is 44 inch I want reduce it please suggest me diet and exercise?
Due to constant study for board exams my belly fat came out, now I have started some exercise and running but its not going. Please tell me about eatables to eat for vanishing it.
Is there is any harm in drinking honey and lemon along wid little bit warm water. I usually drink it to reduce my belly fat. I am drinking this solution now a days. But some of my friends are saying that its good as it affect lever. Please tell me how to reduce the belly fat and best morning drink.
Has your skin become dry or itchy? Has it darkened or reddened after contact with a foreign material or substance? These symptoms may indicate allergic contact dermatitis (ACD), a skin condition which is caused by an allergic reaction of the skin after coming in contact with an external material. The condition usually arises after some time of the skin coming in contact with the material.
ACD is commonly caused due to skin contact with nickel or gold jewellery, latex gloves, several chemicals present in cosmetics, perfumes and poison oak. After being exposed to a foreign substance, the body releases inflammatory chemicals, which lead to irritation and itching on the skin. The skin may become scaly, flaky, appear leathery and dry blisters may develop.
There are several ways to treat ACD. They are as follows:
- Avoiding the cause: Identification and avoidance of the allergens and irritants which cause ACD is the first step of treatment. By avoiding these allergens or reducing your exposure to them, the symptoms can be reduced.
- Emollients: Emollients offer a form of moisturizing treatment and are directly applied to the skin for reduction of water loss. A protective film covers the skin. They are efficient in treating conditions such as dry and scaly skin. There are different types of emollients.It is recommended that you apply a mix of emollients, which include an ointment for dry skin and a cream or lotion for dry skin. You should use emollients in place of soaps and should add them to your bath water as well. Make sure you use different emollients on your face, hands and body.
- Topical corticosteroids: In case your skin is severely red, inflamed or sore, a topical corticosteroid can be applied to your skin directly. This helps in reducing the inflammation quickly. Corticosteroids are different from anabolic steroids and are quite safe for the treatment of ACD. There are topical corticosteroids of different strengths and the dosage to be used depends upon the severity and location of ACD.
You may be instructed to use a strong topical corticosteroid in case of intense ACD. When the condition is mild, a weaker dosage of corticosteroid should be used. For treating contact dermatitis on the face, genitals or in the crease of the joints, a weaker dosage is used, whereas for treating it on the soles of your feet and the palms, a stronger dosage is required. Major cases of ACD go away on their own. However, when the condition is severe and the rashes are developed near the eyes or mouth, you should consult a doctor right away for proper and timely treatment.
Homeopathy has a number of uses. It is a popular form of medication since it has negligible side effects. Homeopathy can even be used to help reduce weight and maintain a healthy BMI or body mass index. However, do not expect a miracle. Homeopathic medicines act slowly and it can be quite a while before you notice physical changes.
As with any homeopathic medicine, no one cure fits all. When prescribing homeopathic medication for weight loss, a doctor will need to understand your detailed medical history, lifestyle and overall constitution. Homeopathic medication to lose weight works by stimulating metabolism. Thus, in order for the medication to be effective, it needs to be accompanied by regular exercise and a controlled diet.
- Calcarea carbonica: This is prescribed in cases where weight gain is due to thyroid problems and when fatty tissue is accumulated in the abdomen. They also have a slow metabolism and often suffer from constipation. It can also be prescribed to women suffering from Polycystic Ovarian Disease to trigger weight loss.
- Natrum mur: Patients who have been prescribed natrum mur for weight loss have usually put on weight due to chronic stress and depression. Their weight is often concentrated on the thighs and buttocks. They also often suffer from anemia.Natrum Mur can also be prescribed in combination with Ignatia when weight gain is triggered by depression.
- Lycopodium; This is used mainly in cases where excess fat deposits are concentrated on the thighs and buttocks. These people often suffer from indigestion with common complaints of flatulence and constipation. They are also very irritable and prone to overeating.Lycopodium and calcarea carb are often prescribed together to trigger weight loss in patients suffering from hypothyroidism.
- Nux vomica; A sedentary lifestyle is one of the most common causes for obesity and excessive weight. In such cases, nux vomica is an effective form of treatment. People who can be benefitted by nux vomica often also suffer from constipation and intolerance to cold drafts.Nux Vomica can also be prescribed in combination with Alumina.
- Antimonium crudum: This is usually prescribed to obese children who have a tendency to overeat. These children also often suffer from indigestion alternating between diarrhea and constipation.
- Graphites and Sepia: This is usually prescribed to women who may have put on excess weight due to menopause. They can be used on their own or in combination depending on the personality of the woman and the symptoms showcased. If you wish to discuss about any specific problem, you can consult a homeopath.