Poliomyositis-dermatomyositis

Poliomyositis and dermatomyositis are conditions in which the skeletal muscle is damaged by an inflammatory process dominated by lymphocytic infiltration. It comes under the disease of the connective tissues, bones and joints. The term poliomyositis is applied when the condition spares the skin and the term dermatomyositis when poliomyositis is associated with a characteristic skin rash. This disease is divided into five different groups. Clinical manifestations of this disease are Weakness of the proximal muscles of the lower limbs results in difficulty in arising from the kneeling position and in climbing or descending stairs. Pain and tenderness of the involved, muscles of buttocks, thighs and calves may be present. Weakness of the trunk muscles and flexor muscles of the neck may be present. The distal muscles are spared in most of the patients. Skin may precede or follow the muscle syndrome and include a localized or diffuse erythema, maculopapular eruption or scaling eczematoid dermatitis. Simple diagnosis are 1.Erythrocyte sedimentation rate is usually raised, 2.Elevated serum levels of the muscle enzymes, such as creatine kinase, adolase, lactic dehydrogenase and serum gultamic pyruvate transminase. The best treatment of choice is predisolone at a dose of 1 mg/kg daily till patients shows significant improvement.

Angina pectoris

Angina pectoris is a clinical syndrome of discomfort due to transient myocardial ischemia. It is worsened by factors which increase myocardial oxygen requirement or reduce supply. Transient myocardial ischemia is due to one or both of obstruction of coronary flow by atheroma. Clinical features are follows 1.Pian is usually in location and brought on by exertion. It is relieved by rest and sublingual nitrates, Pain seldom lasts more than 20 minutes, 2.Angina decubitus is pain while lying flat, 3.Nocturnal angina is an unusual form of angina occurring on aortic regurgitation, 3.Prinzmetal’s angina or variant angina is pain which comes capriciously due to coronary arterial spasm and is accompanied by transient ST segment elevation on ECG. Physical examinations are usually negative, but may find tendon xanthomas, thickening of Achilles tendons, aortic valve disease, diabetes, peripheral vascular disease and obesity. Some physical examinations are rise in blood pressure and heart rate, fourth heart sound and relief of pain by carotid sinus massage. Investigations are 1.Electrocardiography –ECG is normal in most patients at rest and in between attacks. Patients may require exercise testing, 2.Myocardial perfusion scanning using small radioactive thallium; 3.Echocardigraphy and radionuclide blood pool scanning provide information about ventricular function

Methanol poisoning

Methanol poisoning occurs when industrial sprit is consumed or when the supply of liquor is adulterated with methyl alcohol .Methanol is a mild CNS depressant. Methanol as such is not a toxic agent. However its metabolites formaldehyde and formic acid are responsible for its toxicity. The enzyme responsible for conversion of methanol to formaldehyde is alcohol dehydrogenase while aldehyde dehydrogenase, formaldehyde dehydrogenase and other enzymes convert formaldehyde to formic acid. Oxidation of methanol is much slower than that of ethanol. In presence of both ethanol and methanol, the former is preferentially metabolized by alcohol dehydrogenase resulting in a reduced toxicity of methanol. Most preferred clinical features are early manifestations are caused by methanol and late manifestations are due to the methanol metabolic formic acid, methanol produces nausea , vomiting ,abdominal pain , headache, vertigo, confusion, obtundation, convulsions and coma, but other manifestations are rapid breathing due to metabolic acidosis, myocardial depression ,bradcardia , shock and anuria. Diagnosis is confirmed by measurement of serum methanol level which is usually more than 20mg/dL. Methanol derived formic acidosis can be confirmed by a large anion gap, low serum bicarbonate, and elevated serum formate levels. The osmolol gap is elevated due to methanol.

Keratoconjunctivitis sicca

Keratoconjunctivitis sicca is an immunologic disorder characterized by progressive destruction of exocrine glands leading to mucosal and conjunctival dryness. It is one type of disease of the connective tissues, bones and joints. A diagnosis of this syndrome is made when there is a triad of Keratoconjunctivitis sicca, xerostomia and mononuclear cell infiltration of salivary gland. It is differentiated into four different type’s namely primary, secondary and glandular type. In primary type disease occurs by itself, in the absence of any connective tissue disorder .But in case of secondary type the disease is accompanied by a variety of autoimmune disorders. In glandular type only clinical manifestations are within the exocrine system. Some clinical features are 1. Keratoconjunctivitis sicca is a dryness of eyes resulting from lack of lacrimal secretion which results in grittiness, burning or itching; 2.Xerostomia is dryness of mouth resulting from lack of salivary secretion, 3.Common laboratory abnormalities are leucopenia, thrombocytosis, elevated levels of circulating immune complexes and auto antibodies. Following treatment should be taken to overcome this disease they are Hydroxychloroquine is very helpful for arthralgias, Corticosteroids are useful particularly in the management of glomerulonephritis and pneumonitis, Immunosuppressive therapy is indicated for patients with systematic vasculitis.

Irritable bowel syndrome

Irritable bowel syndrome is a benign, chronic symptom complex of altered bowel habits and abdominal pain. It is one type of disease of the gastrointestinal system. The aetiology are no organic cause can be found, altered motility occurs in the form of exaggerated gastrolic reflex , altered gastric emptying , increased small bowel contractions and increased small intestinal transit, certain food may precipitate the attack, psychological disturbances like anxiety, tension and excessive worry are all aetiologically significant. The clinical features are 1.It is more common in women in the age group 20-40 years, 2. Abdominal pain is the most common symptom. But pain is referred to left or right iliac fossa or hypogastrium, 3.Pain often provoked by food and relieved by defecation,4.mucus may or may not be present .Primary investigations are to exclude organic bowel diseases, exclude lactase deficiency , hyperthyroidism and alcohol abuse. Other investigations are sigmoidoscopy, barium enema etc. To overcome this disease following treatment should be followed such as reassurance of the patient and explanation for the syndrome, patients should prefer loperamide 2-4mg up to 4 times a day, cholestyramine a bile acid sequestrating agent, is a second line agent and addition of a fiber supplementation.

Helicobacter pylori

Helicobacter pylori play a role in the development of gastritis, lymphoma and gastric adenocarcinoma. It is one type of diseases of the gastrointestinal system. Helicobacter pylori are a gram negative bacillus which produces mucosal damage. In a developing country more over 80% of the people are colonized with it by the age of 20 years. This disease gets transmitted through oral-oral or faceo-oral –route. These bacteria secrete following key factors such as urease, catalase, lipase, adhesions, activating factors etc. Clinical features of Helicobacter pylori are follows such as 1. Peptic ulcer is a chronic condition with a natural history of spontaneous relapses and remissions lasting for decades or even life, 2.Pain is localized that the patient will localize the site with one finger; 3.pain occurs on empty stomach and is relived by food or antacids, 4. In some patients with gastric ulcer, food may precipitate the pain, 5. Patients are more symptomatic during winter and spring; 6.It is more common in smokers than non-smokers. To prevent we need to take two type of treatment namely long term and short term. In case of general measures patient should avoid smoking, avoid aspirin and non-steroidal anti-inflammatory drugs and alcohol should be avoided.

Haemoptysis

Haemoptysis is defined as expectoration of blood or bloody sputum. Potentially lethal or massive haemoptysis is defined as greater than 600 to 800mL blood in 24 hours. Most common causes of this disease is pulmonary tuberculosis, bronchial carcinoma, chronic bronchitis, bronchiectasis, lung abscess, pneumonia, bronchial adenoma, left ventricular failure and hemorrhagic diathesis and mitral stenosis. Some investigations for haemoptysis are blood should be examined for hemoglobin level, total and differential leucocytes counts, erythrocyte sedimentation rate and blood group. Urine should be examined by microscopy for red cells and red cell casts is suspected hemorrhagic diathesis and good pastures syndrome. Sputum should be examined in all cases by microscopy and culture. Chest radiographs, both poster anterior and lateral views can provide important diagnostic clues and presence of cystic lesions, ring shadows, tram tracks, grape cluster. Apart from this computed tomography, electrocardiogram, bronchoscopy and isotope lung scans should be suggested to overcome this disease. Treatment of haemoptysis are substantial haemoptysis should be treated by keeping the patient calm, intubation and suction equipment should be ready at the bedside, position the patient so that the side of the chest from which bleeding is arising is lowermost and it prevents asphyxiation due to aspiration of blood into the normal lung, strong sedatives should be avoided but mild sedatives may be given to relieve anxiety, distressing cough may be suppressed with linctus codeine 15mL daily, consider endotracheal intubation if the patient has poor gas exchange has rapid ongoing haempotysis is unstable or has severe shortness of death.

Eczema

Eczema is not a specific disease entity but a characteristic response of the skin to both exogenous and endogenous agents. This is one type of skin disease. It is of two types namely exogenous and endogenous. Irritant contact eczema and allergic contact eczema are the two types of exogenous eczema. Irritant contact eczema is due to the detergents, alkalis, acids, solvents and abrasive dust but strong irritants often cause eczema, whereas weak irritants often cause chronic eczema. In case of endogenous eczema there are several types they are atopic eczema, seborrhoeic eczema, discoid eczema, gravitational eczema. While coming to atopic eczema it is due to predisposition of form excessive antibodies to inhaled, injected or ingested antigens. They have tendency to develop other allergic diseases like asthma, hay fever, urticaria, food and other allergies. The cardinal features are itch and scratching. Seborrhoeic eczema often runs in families and is associated with a tendency to dandruff. Discoid eczema is commonly found in limbs of elderly males. Asteatotic eczema is commonly seen moat often on the lower legs and is often elderly patients. General management for eczema is explanation, reassurance and encouragement. Avoidance of contact with irritants. Topical steroids should be used judiciously.