Archive for May, 2009

Management of peptic ulcer

The aim of treatment:

The main aim of treatment of peptic ulcer is to provide symptomatic relief to the patient in the short term, induce ulcer healing and to prevent relapse in the long run. If H. pylori are found, attempt should be made to eradicate with appropriate antibiotic therapy

General measures:

 General measures for management of peptic ulcer are avoidance of smoking as it has a causative role in peptic ulcer and also smoking cause delay in ulcer healing. So smoking should be strongly discouraged. Aspirin and other NSAIDs (non-steroidal anti inflammatory drugs) should be avoided as far as possible because of the injurious effect they have on gastric and duodenal mucosa. If NSAIDs are required for pain relief of some other pain like toothache, a selective COX2-inhibitor NSAID (e.g. valdecoxib, celecoxib etc.) should be given or they can be given with proton pump inhibitor drugs (e.g. omeprazole, pantoprazole etc.) or with prostaglandin analogues like misoprostol. Alcohol should be avoided (although alcohol in moderation does no harm) as well as excess tea and coffee.

Medical Management:

Short term management of peptic ulcer is done with H2-receptor antagonist (e.g. ranitidine, famotidine etc.), proton pump inhibitor drugs (e.g. omeprazole, pantoprazole, rabeprazole, etc.), sucralfate, and prostaglandin analogues (e.g. misoprostol) or with antacids. All the above mentioned medications are equally effective in treatment of peptic ulcer.

Maintenance therapy is done with proton pump inhibitor drugs (e.g. omeprazole) or with H2-receptor antagonist like ranitidine (either of the group of drugs is safe and effective in long term maintenance).

Eradication of H. pylori is important if found in biopsy. For eradication of H. pylori 14 day treatment is given with omeprazole 20 mg, metronidazole (or tinidazole) 400 mg and clarithromycine 250 mg (available as kit which contains all 3 medicines). One kit is to be taken 2 times a day for 14 days. Other combination kits are also available where clarithromycine is replaced with amoxicillin 750 mg.

Surgical treatment:

If none of the above mentioned treatment regimens including eradication of H. pylori fails, surgical treatment should be considered. Indication of surgical intervention is strengthened by the younger age of the patient, complications like hemorrhage or perforation of intestine, strong family history of peptic ulcer, frequent relapses, if ulcer is causing obstruction to gastric outflow or produced an hour glass stomach due to fibrosis. There are also patients who do not comply with prolonged medical management, can be treated with elective surgical intervention. But in case of elderly patients surgical operation should be avoided.

Finally every ulcer should be viewed with seriousness, especially long standing gastric ulcer as it can turn malignant although rarely. As peptic ulcer is a common problem in the modern life, it should be appropriately treated and doctor’s advice followed strictly.   

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Posted by - May 21, 2009 at 12:59 am

Categories: Disease Treatment   Tags: ,

Drug Addiction Treatment

Drug addiction being an international problem which does not spare any nation should be adequately addressed and treated. For a successful drug addiction treatment the best approach is a holistic approach, which covers not only the medical and psychological aspects of the drug addict, but also covers the emotional and spiritual needs of the addict. For successful drug treatment or drug addiction treatment the role of psychiatrist is the most important as well as psychological counseling.  

The drug treatment of the addicts is not an easy task, as the addicts are usually not interested in getting good treatment and lead a drug free life. Many addicts can not even imagine a drug free life and to treat these drug addicts it is a gigantic task, which need coordinated approach of professional doctors, other technical staffs, supporting staffs, family members (of the addict) and friends of the drug addicts. The govt. help in addressing the social evil of drug addiction is very important. The help of former drug addicts is also very important to motivate the addicts and should be sought. Drug addiction is basically a social problem but the first step of management of the problem of drug addiction, is a medical management.

The drug addiction treatment is not complete without the drug rehabilitation. For drug rehabilitation, after successful drug treatment the govt., social workers play the most important role. Without good drug rehabilitation the rate of relapse of drug addiction (after successful treatment of drug addiction) may be very high. To reduce the relapse rate of drug addiction social activists and the govt. should play a major role with cooperation from the drug treatment centers.

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Posted by - May 18, 2009 at 11:41 am

Categories: Disease Treatment   Tags: ,

Treatment of Frostbite

Frostbite occurs (usually to the extremities especially fingers and toes, but can occur in hands, feet and legs) when exposed to subzero temperature and tissue temperature drops below 0°C. Ice crystals are formed which subsequently distorts and destroys the cellular architecture. If not treated very promptly there may be loss of the affected part due to death of cells and the tissues.

The most effective treatment of frostbite is rapid and complete thawing of affected frozen tissues by immersion in circulating water at 37°–40°C. A common error is the premature termination of thawing, because the reestablishment of perfusion is intensely painful and parenteral narcotics will be necessary with deep frostbite. The sign of good prognosis is formation of early, large clear distal blebs and bad prognostic indication is formation of smaller proximal dark hemorrhagic blebs.

The principle of treatment of frostbite can be summarized into three stages before thawing, during thawing and after thawing.

To do Before thawing:

First of all remove the patient from environment (usually cold and dump). After removing from environment, refreezing and partial thawing should be prevented. Stabilize core temperature and treat hypothermia which usually accompanies frostbite. Frozen parts should be properly protected and no friction or massage allowed.

To do During thawing:

Give parentaral analgesics and ketorolac, and also give ibuprofen 400 mg orally. Immerse the frozen part in 37°–40°C (temperature should be monitored with thermometer) circulating water containing an antiseptic soap until there is distal flush (which usually takes 10–45 min). Ask the patient to gently move affected part and if there is refractory pain reduce water temperature to 35°–37°C.

To do After thawing:

Gently dry the affected part, protect it and elevate it. Put cushion in between toes or fingers. If clear vesicles are intact, aspirate sterilely and if broken, debride and dress with antibiotic or sterile aloe vera ointment. Keep giving ibuprofen 400 mg orally (12 mg/kg per day) 2-3 times a day. If there are hemorrhagic vesicles leave them intact to prevent desiccation and infection. Give prophylaxis for streptococcal prophylaxis. Continue giving hydrotherapy at 37°C.

Any decision regarding debridement or amputation should be deferred until there is clear evidence of demarcation, mummification, and sloughing in the affected parts unless there is infection when amputation may have to be done early. Magnetic resonance angiography can demonstrate the line of demarcation earlier than clinical demarcation.

Delayed affects of frostbite include nail deformities, cutaneous carcinomas, and epiphyseal damage (damage to the bone ends due to incomplete growth of bones in children) in children.

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Posted by - May 13, 2009 at 12:32 am

Categories: Health Information   Tags:

Re-warming Strategies in Hypothermia

All patients with hypothermia have to be re-warmed, but how to re-warm is very important part of treatment of hypothermia. The decision to re-warm actively or passively is very important in the outcome of the treatment. Active re-warming can be active external re-warming and active core re-warming.

Passive re-warming of hypothermia patient is done in a warm environment by covering (with blanket) and insulating the patient. The head of the patient also should be covered leaving only the face open. Body temperature increase of 0.5° C to 2.0°C per hour is satisfactory and aimed for. For passive re-warming to be successful the patient should have adequate store of glycogen to produce enough heat (calorie) and for this reason passive re-warming is successful in previously health patients, who get hypothermia accidentally.

In many cases of hypothermia passive re-warming may not be successful in treating severe hypothermia and may require active re-warming. The situation where active re-warming is required are cardiovascular instability, hormone insufficiency, very young or very old patient, any accompanying CNS problem, if core temperature is below 32°C called poikilothermia, or if hypothermia is due to some disease. Active re-warming is done by air heating blankets (best method), hot packs, radiant heat etc.

In severe cases of hypothermia the patient may have to be given active core re-warming like re-warming by heating and delivering fluid or blood with a countercurrent in-line heat exchanger (the best and fast method), heated humidified oxygen (40°–45°C) via mask (it eliminates respiratory heat loss and adds 1°–2°C to the overall re-warming), normal saline or ringer lactate should be heated to 40°–42°C (but the quantity of heat provided is significant only during massive volume resuscitation) and infused, heated irrigation of the gastrointestinal tract or bladder (minimal effect due to small surface area), peritoneal dialysis at 40°–45°C and standard hemodialysis (very good and successful). All the above mentioned techniques are reserved in patients with cardiac arrest and used in combination with all available active re-warming techniques. In general these techniques are not required.      

Warnings:  Application of direct heat to the extremities should be avoided in chronic hypothermia, because it may cause dilatation of blood vessels in the periphery and precipitate core temperature called “afterdrop” which is a response characterized by a continual decline in the core temperature after removal of the patient from the cold. To avoid afterdrop heat should be applied to the trunk of the body. Electric blankets also should be avoided because vasoconstricted skin burns easily. Monitoring a hypothermia patient in a heated tub is extremely difficult and should be avoided.

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Posted by - May 2, 2009 at 11:18 am

Categories: Health Information   Tags:

Drug Rehab in Drug Rehab Centers

Addiction is a serious social problem, especially drug addiction and alcohol addiction. Drug and alcohol addiction is a global problem and all the countries are affected by these social evil, though they affect may vary country to country. Drug addition and alcohol addiction, to a large extent are dependent on the availability of drug and alcohol locally.

There are many drug rehab centers in almost all the countries which are affected by the social evil of drug addiction, especially in the United States. But many of these drug rehab centers may be lacking some important aspect of drug de-addiction like a personalized drug de-addiction program designed for the individual drug addict by highly experienced professionals with a proven track record of helping people beat their addictions. A drug rehab center should ideally have personalized drug rehab program to successfully treat the drug addicts. Drug rehab centers with personalized drug de-addiction program are better for drug de-addiction and they have better track record of successful de-addiction.

There are many advantages of personalized drug rehab program, e.g. provision of individual attention (which makes a big difference in treatment of drug addiction), maintaining of privacy for the drug addict and individual follow up after successful treatment to name a few. A good drug rehab center also provides many more facilities like location of the drug rehab center is generally in a picturesque area (overlook mountain or ocean etc.), qualified general support staff, professional technical staff, follow up facility, also facilities of massage, acupuncture etc.

Before selecting a drug rehab center you enquire about the facilities they provide and also the above mentioned services are available or not.       

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Posted by - May 1, 2009 at 2:02 am

Categories: General   Tags: