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JANUDICE IN CHILDREN (EXCLUDING NEONATES

JANUDICE IN CHILDREN (EXCLUDING NEONATES

           Jaundice is not a disease by itself. It is a symptom of many diseases related to liver and blood.            Commonest cause of jaundice is viral infection of liver. There are many viruses which can affect liver. Common infections are those caused by Hepatitis A and Hepatitis E viruses. These are transmitted by feco-oral route through contaminated food and water. Hepatitis B, C & D. Viruses are transmitted by contaminated blood, needles, sexual route and from mother to fetus in utero. A & E are mild infections but B,C,D are serious infections.            Whenever your child develops yellowish discoloration of eyes, please consult your doctor. Your doctor will assess signs and symptoms of liver disease and do some investigations. After thorough work up, if there are no danger signs, it is likely to be mild infection. If the jaundice is due to blood disorders, management is different and your doctor will advice you. Symptoms of A & E infection :             Fever, vomiting, pain over right upper part of stomach. Once fever subsides, patient will develop jaundice and passes yellow urine continuously. There is severe loss of appettite. Gradually jaundice will increase. Treatment : There is no specific treatment for Hepatitis A and Hepatitis E. These are self limiting infections. Child should take rest for 7-10 days and your doctor will give you some medications for vomiting and other supportive medications. Diet : Appetite will be very less and improve gradually. Diet is very important part of management. Avoid non vegetarian and fatty food for 15-20 days completely. Give less pulses. All forms of cereals, fruits and vegetables can be given liberally. Protection of other family members :           As Hepatitis A and E are transmitted by feco-oral route through contaminated food and water, take all hygienic measures like washing hands with soap, hygienic preparation and storage of food and drinking water. Prevention :  There are effective and safe vaccines to prevent Hepatitis A and Hepatitis B. Please ensure that all family members are protected against these two viruses by taking vaccination. Hepatitis B can be taken by anybody from birth and hepatitis A from 1 year of age. There is no upper age limit.
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COMMON CANCERS IN FEMALE :

COMMON CANCERS IN FEMALE :

COMMON CANCERS IN FEMALE :   Uterine cancer : (endometrial cancer) :   It is the cancer of the uterus. Most often happens in over 55 years and in women following menopause.   The uterus is a muscular organ where a fetus grows. Uterine cancer can start in different parts of the uterus.   Most uterine cancer starts in the endometrium.   Risk factors :   Obesity Hypertension History of polycystic ovaries Patient on estrogen alone Radiation therapy to the pelvis On tamoxifen for breast cancer Family history of colon/ovarian/ endometrial cancer   Signs/symptoms :   1-5% asymptomatic 90% of Unusual vaginal bleeding 10% of women present with purulent vaginal discharge, sometimes blood tinged. Pelvic discomfort, uterine enlargement. On examination- abdominal mass Ascities Metastases Uterus may be small/enlarged irregular, fixed. There is no standard or routine screening test for endometrial cancer. Tests that may detect are - PAP test Ultrasound TVS Endometrial sampling   Management :   Surgery remains the cornerstone in the management of uterine cancer. Further treatment depends on the histo pathological report, staging, grading, of the hysterectomy specimen.   Cervical Cancer :           The cervix is the lower part of the uterus that opens into the vagina.                Cervical cancer is the cancer that starts in the cervix due to abnormal growth of cells that have the ability to invade or spread to other parts of the body.            It is the second most common cancer, next to breast cancer.            Although women between the ages of 55 to 59 are most vulnerable to this condition, it can occur at any age, can occurs between 15 and 44 years of age.   Risk factors :   Smoking HIV/AIDS Sexually transmitted infections Obesity/over weight Birth control pills Early pregnancy/early sexual intercourse Poor hygiene Malnutrition         Good news ! cervical cancer is believed to be preventable, and in fact is one of the most preventable of all cancers. Being aware of risk factors, visit your         Gynecologist regularly and ask all relevant questions to know how to take good care of your overall health. Maintain ideal weight – physical activity and healthy diet. Increase antioxidents – fruits, vegetables, whole grains. Regular screening with pap smear. Protection – avoid unprotected sex and practice safe sex to avoid the risk of other infections. HPV vaccination – reduce the risk of cancerous changes of the cervix. Eligible for vaccine- 9 to 10 years onwards.   Signs and symptoms :  Early – no symptoms are seen. Later   -     abnormal vaginal bleeding. Pelvic pain Lower back pain Unusual vaginal discharge Pain during sex Vaginal bleeding after sex Longer or heavier menstrual periods than usual. Post menopausal bleeding Frequent urination Screening of  Cervical cancer : Done with PAP smear Should begin after the age of 21 years  Symptoms :  Consult gynecologist if above risk factors and symptoms are present. Done with PAP smear Should begin after the age of 21 years and sexually active women.   In early stages -                Local excisional procedures are available.  In later stages -                Hysterectomy In advance stages -                Radiotherapy and chemotherapy Breast cancer :             It is the cancer that develops from breast tissue. Incidence is more after the age of 40 years and highest over age of 70 years. Risk factors :  Hereditary Early menarche, multiparity, late menopause. Estrogen use Post menopausal hormone therapy Previous breast cancer Alcohol Obesity Factors that decreases the risk : First pregnancy < 20-25 years Multiple pregnancy Breast feeding Regular exercises Symptoms :       In most cases, patients with early breast cancer have no symptoms and their disease is discovered through mammography screening : Swelling/mass in the breast Swelling in the axilla Ulcer of skin of breast Retracted/inverted nipple Skin discoloration/skin dimpling Eczema thickening/paered orange Nipple discharge/blood stained secretion Diagnosis : Triple Diagnostics Clinical examination Imaging (ultrasound, mammography) Needle biopsy         Self breast examination is a must for all the women and consult doctors in case of any problems.   Treatment :         Depends on the stage of the cancer either surgery (chemotherapy, Radiotherapy).
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THYROID DISORDERS IN PREGNANCY :

THYROID DISORDERS IN PREGNANCY :

The thyroid disorders : hyperthyroidism and hypothyroidism are relatively common in pregnancy and important to treat.          The thyroid is an organ located on the front of your neck that releases hormones that regulate your metabolism, heart and nervous system, weight, body temperature and many other process.  Untreated thyroid disorders in pregnancy may lead to premature birth, pre-eclampsia, (increased BP) miscarriage, low birth weight, deficit in  development in infants.  Symptoms of hypothyroidism Tiredness Weight gain Constipation Sensitivity to cold temperature Muscle cramps Symptoms of hyperthyroidism Fatigue Increase heart rate nervousness Sensitivity to hot temperature Severe nausea or vomiting Slight tremor Weight loss  Diagnosis:            1)  Symptoms                2)  Examination              3)  Blood test-TSH, T3, T4 Treatment for hyperthyroidism : Propylthiouracil Metinmazole Treatment for hypothyroidism :  levothyroxine          Monitor thyroid function tests every 4-6 weeks during pregnancy.
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POSTNATAL CARE OF MOTHER :

POSTNATAL CARE OF MOTHER :

       Post natal period is the period beginning immediately after the birth of a child and extending for about 6 weeks.        It is the most critical and yet the most neglected phase in the lives of mothers and babies; most deaths occur during the postnatal period.        Post natal diet is the most important part of postnatal care. A healthy diet plan is a pre-requisite if you plan to breast feed your baby depending on your total calorie intake you will need about 450 to 550 extra calories in the first 3 months to meet the nutritional needs of your child and your baby.          Diet rich in fresh fruits, vegetables, pulses, legume, milk and diary products, drink plenty of water.          Avoid drinking alcohol, quit smoking.         Start with simple exercises like pelvic floor exercise as they will gradually help to have control over your bladder and get you in shape.         Care should be taken towards breast, bladder, bowel perineal and caesarian wound. Sleep should be adequate 1 week following discharge women should visit doctor.           Can be resumed to work from 6 weeks following birth. Avoid lifting heavy weight/strenuous exercises.          Exclusively breast feeding mother should begin contraception from 6 weeks onwards and women who do not breast feed should start contraception from 3 weeks onwards.          Contraception in the form of exclusive breast feeding (lactactional amenorrhea method), progesterone only pills, injectables, vaginal rings, intrauterine copper T devices, sterilization methods. Combined oral contraception pills.
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TIPS FOR BREAST FEEDING :

TIPS FOR BREAST FEEDING :

Breast feeding is not a choice it’s a responsibility  When to start ?          Ideally start soon after your baby is born or half an hour following vaginal delivery and 1 hour or when patient recovers from caesarian delivery.  How Long ?         Exclusive breast feeding should be given for 6 months and continued complementary feeding for 2 years.  Common problems in breast ?  Breast engorgement-local rise in temperature, redness over breast, pain. Mastitis Crack nipple Sore nipple Breast abscess  In order to prevent above problems, feeding should be 2nd hourly and on demand feeding, and proper positioning of the baby and nipple care.  Breast feeding latch : proper position :  Hold baby with whole body facing your body, head end upwards. Place your baby’s nose and chin against your breast. Support your baby’s head, neck back. ¾th of the areola to be covered, lower lip everted.  Benefits of breast feeding :  Breast milk contains antibodies that help baby fight against infections. Decreases risk of asthma, allergies, respiratory illness in the baby. Decrease risk of malnutrition obesity, heart disease Mother-baby bonding is increased. Economical, all time supply, sterile, immunologically safe, natural food, temperature perfect, deaths are reduced.  No supplements :            Don’t give your baby sugar water or other supplements. This may actually interfere with baby’s appetite for nursing and decreased milk supply.  “A new born baby has only three demands. They need warmth in the Arms of its mother, food from her breasts, and security in the knowledge of her presence.”  “Breast feeding satisfies all three”
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