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WHAT IS EPIDURAL ANAESTHESIA ?

It’s an injection given at the back of the body that numbs some nerves and stop you from feeling pain in a particular region of the body.

WHAT DOES THE PROCEDURE ENTAIL ?

An injection that deadens nerves temporarily (local anaesthetic) is injected into a space inside the back bone (epidural space). This blocks pain in a targeted region of the body.

The amount and type of the anaesthetic drug, as well as the level of the back bone at which the drug is injected, determines the extent of the analgesia [loss of pain]

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WHAT IS APPENDICITIS ?

Appendicitis means an inflammation of the appendix.

What is the appendix ?

The appendix is a closed-ended, narrow tube up to several inches in length that attaches to the caecum (the first part of the large intestine) like a worm.

 

The open central core of the appendix drains into the caecum. The inner lining of the appendix produces a small amount of mucus that flows through the open central core of the appendix into the caecum.

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A neonate is an infant less than four weeks old. Jaundice is a yellowish staining of the skin, the white of the eyes and the lining of other body openings (mucous membranes) by high level of a body substance called bilirubin.

Neonatal jaundice is therefore a yellowing of the skin and other tissues of a newborn infant. Neonatal Jaundice is the most common condition that requires medical attention in newborns affecting about 50% of term and 80% of preterm babies in the first week of life. The more preterm a baby is, the more the likelihood of developing jaundice.

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WHAT IS CAESAREAN SECTION?

It is a surgical operation performed by making a cut on the abdomen and the womb of a pregnant woman to facilitate the delivery of a baby.

Historical hint

It was originally thought that the ancient roman ruler and general – Julius Caesar – was born through this means.

Types of caesarean section

Elective or planned – there is foreknowledge of the surgery, and a particular day is chosen for it to be performed.

Emergency – needs to be performed urgently because of unexpected problem.

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WHAT IS BRONCHIOLITIS?

Bronchiolitis means inflammation of the small airways of the lungs( bronchioles). It is usually caused by a virus called respiratory syncytial virus (RSV). It may also be caused by other viruses.

Who Is At Risk Of Having Bronchiolitis ?

It is a common condition of babies. Most especially babies that are;

  • Premature.
  • With pre-existing heart and/or lung conditions.
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WHAT IS BRONCHOPNEUMONIA?

Bronchopneumonia- Is a type of pneumonia. Pneumonia is inflammation of the lungs, caused by infection from micro-organisms such as bacteria, viruses and fungi. The infection causes inflammation in the alveoli (also known as the air sacs) in the lungs, making it to be filled with pus or fluid. Bronchopneumonia affects both lungs and the bronchi. Bronchopneumonia can be mild or severe, with viral bronchopneumonia usually being less severe.

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WHAT IS MYOMECTOMY?

This is the surgical removal of fibroids from the womb.

Options For Myomectomy ?

  • Hysteroscopic – surgical removal of fibroids with special instrument inserted through the vagina and cervix into the womb. This can be performed only if fibroids are within or bulging into the uterine cavity (submucosal).
  • Laparoscopic – surgical removal of fibroids with specialized instrument inserted through a key-hole opening made on the abdomen.
  • Laparatomic -surgical removal of fibroids through a wide incision made on the abdomen.
  • Hysterectomy – surgical removal of the entire womb. This could be through the vaginal route, a key-hole incision on the abdomen or a wide incision on the abdomen.
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Ischemic heart disease (IHD) also known as Coronary artery disease (CAD), is a group of diseases that includes:

  1. Stable Angina
  2. Unstable angina
  3. Myocardial infarction
  4. Sudden coronary death

Acute coronary syndrome (ACS) is an umbrella term that includes unstable angina and myocardial infarction. It is an emergency. It refers to a group of conditions due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies.

The coronary arteries supply oxygen-rich blood to the heart muscle. If these arteries are narrowed or blocked, the heart does not get enough oxygen. This can cause angina (central chest pain from reduced blood supply to the heart) or a myocardial infarction (death of part of the heart muscle due to sudden cessation of blood supply). The most common symptom of ischemic heart disease is chest pain.

Ischemic heart disease is the most common type of cardiovascular diseases and occurs more in men than women of a given age.

Signs and Symptoms:

The common symptom is chest pain or discomfort which may travel into the back, neck, or jaw. The chest pain is pressure-like in character, and associated with nausea and sweating.

Occasionally the pain may feel like heartburn. Usually symptoms occur with exercise emotional stress, last less than a few minutes, and get better with rest. Shortness of breath may also occur and sometimes no symptoms are present.

Chest pain that occurs regularly with activity, after eating, or at other predictable times termed stable angina and is associated with Angina that changes in intensity, character or frequency is termed unstable angina.

In myocardial infarction (heart attack), the chest pain is usually sudden and is not relived by rest.

Risk Factors for ischemic heart disease

  1. Family History of cardiovascular
  2. High blood pressure
  3. Cigarette Smoking
  4. Diabetes
  5. Lack of exercise
  6. Obesity
  7. High blood cholesterol (bad cholesterol)
  8. Poor diet
  9. Excessive alcohol
  10. Stress (Job stress appears to play a minor role accounting for about 3% of cases.)
  11. Depression

Causes Of Ischemic Heart Disease

Atherosclerosis

The main underlying mechanism responsible for Ischemic Heart Disease is the arteries of the heart.

What is Atherosclerosis?

Atherosclerosis simply means hardening and narrowing of the Arteries are blood vessels that carry blood from the heart throughout the body. They are lined by a thin layer of cells called the endothelium. The endothelium works to keep the inside of arteries toned and smooth, which keeps blood flowing freely.

Atherosclerosis begins with damage to the endothelium caused by high pressure, smoking, or high cholesterol. The damage leads to the formation of plaque.

Plaque is a jumble of cholesterol, cells, and debris that creates a bump on the artery wall. As atherosclerosis progresses, that bump gets bigger. And when it gets big enough, it can create a blockage to the flow of blood inside the artery.

Risk factors for atherosclerosis include the following:
  1. Ageing
  2. Family history coronary heart disease
  3. Smoking or other tobacco use
  4. Diabetes mellitus
  5. Hypertension
  6. High cholesterol
  7. Obesity
  8. Lack of exercise
  9. Psychosocial stress
  10. Poor oral hygiene

Non-Atherosclerosis Causes of Ischemic heart disease

These include –

  1. Coronary occlusion secondary to vasculitis (arterial occlusion resulting from inflammation within the arterial wall).
  2. Ventricular hypertrophy (thickening of the heart muscles thereby demanding more blood supply)
  3. Coronary artery emboli (blood clot or other substances coming from other part of the body to block the coronary arteries)
  4. Congenital coronary anomalies (in-born defects of the coronary arteries)
  5. Coronary trauma
  6. Drug use e.g., cocaine and amphetamines
  7. Coronary anomalies, including aneurysms (weakening of the wall) of coronary arteries
  8. Factors that increase oxygen requirement, such as heavy exertion, fever, orhyperthyroidism

Diagnostic Tests for ischemic heart disease

Diagnostic testing in any patient with the suspicion of coronary artery disease include:

  1. Electrocardiography
  2. Exercise ECG – Cardiac Stress
  3. Exercise radioisotope test (nuclear stress test, myocardial)
  4. Echocardiography (including stress)
  5. Coronary computed tomography angiography
  6. Coronary angiogram
  7. Intravascular ultrasound
  8. Magnetic resonance imaging

The first investigation is an electrocardiogram (ECG), both for “stable” angina and acute coronary syndrome.
An X-ray of the chest and blood tests may be performed.

Treatment of ischemic heart disease

  1. Anti-platelets
  2. Beta blockers
  3. Nitroglycerin
  4. Procedures such as percutaneous coronary intervention or coronary may be used in severe disease

Prevention of ischemic heart disease

  1. Eating a healthy diet (rich in fruits and vegetable and low in cholesterol)
  2. Regular exercise
  3. Maintaining a healthy weight
  4. Not smoking
  5. Adequate medication for diabetes, high cholesterol, or high blood pressure
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BLOOD TRANSFUSION

Definition

A transfusion is putting blood or some part of it in a vein through an intravenous (IV) line or access.
Transfusions of blood and blood products temporarily replace parts of the blood when a person has been bleeding, or when their body cannot make enough blood. The blood usually comes from another person, called a donor.
People usually donate whole blood – blood taken right out of a vein through a needle. This whole blood may be called a unit or pint of blood, and equals about 450 millilitres or 16.7 ounces. But whole blood is rarely given as a transfusion. Blood has many parts, such as red blood cells, white blood cells, platelets, plasma, clotting factors, and small proteins.

Types of Transfusion

Red Blood Cell Transfusion: This is done when the haemoglobin level is low. Normal haemoglobin level is 12-18g/dl. When haemoglobin level is less than 8g/dl, red blood cell transfusion may be considered. Following surgery, there may be a need for red blood cell transfusion depending on patient’s haemoglobin level before or after the surgery.Red Blood Cell Transfusion: This is done when the haemoglobin level is low. Normal haemoglobin level is 12-18g/dl. When haemoglobin level is less than 8g/dl, red blood cell transfusion may be considered. Following surgery, there may be a need for red blood cell transfusion depending on patient’s haemoglobin level before or after the surgery.

Plasma Transfusion: Plasma is the liquid portion of the blood in which red and white cells including platelets are suspended. It is rich in clotting factors and commonly given to patients who are bleeding because their blood is not clotting the way it should.

Platelet Transfusion: Platelet are fragments of cells in blood involved in preventing bleeding. Normal platelet cell count is 150,000 to 400,000/mm3. If level is less than 20,000/mm3 as in some cancer patients, then it is necessary to do platelet transfusion once surgery is required.

Cryoprecipitate Transfusion: Cryoprecipitate is the name given to a small fraction of plasma that separates out (precipitates), when plasma is frozen and then thawed in the refrigerator. Cryoprecipitate can be given to replace several blood clotting factors such as:
    a) Factor viii (missing in hemophiliac A patient)  
    b) Vonwillebrand Factor (needed to help platelet work)
    c) Fibrinogen (a substance that can solidify into a clot)

White Blood Cell Transfusion: Chemotherapy (cancer treatment) can damage cells in the bone marrow, and patients getting such treatment often have low white blood cell counts. White blood cells, especially the type called neutrophils, are very important in fighting infections. Patients with very low neutrophils can therefore benefit from white blood cell transfusion.However, Instead of transfusing white blood cells, doctors now commonly use drugs to help the body make its own neutrophils.

Complications of blood transfusion

Transfusion of blood sometimes causes transfusion reaction. There are several types of reaction and some are worse than others. Also, some are immediate while others could be delayed reactions. Complication of blood transfusion includes-
    a) Allergic Reaction: most common reactions seen is itching. This can be treated with antihistamines medications.
    b) Febrile Reaction: This is the occurrence of fever within 24hrs of transfusion. There could be headache, nausea, chills or general feeling of discomfort accompanying this fever.
    c) Transfusion Related Acute Lung Injury (TRALI): The main symptom is trouble with breathing which can be life threatening. If suspected during blood transfusion, the transfusion is usually stopped. Its treatment could require oxygen, fluid and sometimes support with a breathing machine (Ventilator).
    d) Acute Immune Haemolytic Reaction: It is the most serious type of transfusion reaction, but it is very rare. It happens when donor and patient blood do not match. Such patient can have chills, fever, chest and lower back pain, kidney damage resulting in dialysis.
    e) Delayed haemolytic reaction: This type of reaction occurs when the body slowly attacks an antigens (other than ABO antigens) which it receives from the transfusion. It usually occurs between one to four weeks after transfusion. It can manifest with a drop in haemoglobin level, fever and jaundice.
    f) Infection: Blood transfusion can transmit infections caused by bacteria, viruses and parasites. Examples include malaria, hepatitis B&C viral infections, HIV, and syphilis. However, in standard healthcare practice, blood and blood products are routinely screened and certified free from such infections before transfusion.

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BREAST LUMPS AND BREAST CANCER

Breast lumps can be caused by infections, injuries, non-cancerous growths and cancer. There are many causes of breast lump, some are harmless/benign, while others are dangerous. Every breast lump should be evaluated by a doctor to exclude or establish a diagnosis of cancer.

Common types of benign breast lumps

1. Fibroadenoma – solid, usually painless growth most commonly seen in women 30-35 years old. May occur as a result of excessive growth of glands and connective tissue within the breast tissue.
2. Breast cyst – fluid-filled sac within the breast tissue. May vary in size during the menstrual period and may be tender.
3. Mastitis – usually seen in lactating mother, following bacterial infection of cracked nipples, resulting in inflammation of the breast tissue.
4. Breast abscess – following inflammation of the breast tissue (mastitis), a deep pocket of pus may form and present like a lump.
5. Fibrocystic changes – a group of benign conditions that affects the breast, presenting with breast pain, breast lump (usually cystic), increase in breast size and lumpiness of the breast. It is usually more pronounced during the menstrual period and symptoms usually disappear after menstruation.
6. Lipoma – this is a fatty growth that develops within the fat tissue of the breast. It usually doesn’t require any treatment.
7. Fat necrosis – trauma to the breast can damage the fat cell in the breast tissue and form a lump. Fat necrosis can also occur at the site of a previous biopsy.

BREAST CANCER

Breast cancer is a malignant tumour (cancerous growth) that starts in the cells of the breast and has the ability to invade surrounding cells and spread to distant parts of the body. Cancer starts when abnormal cells grow unchecked by the body system.

Most breast cancers are ductal (starting in the cells that line the ducts), while other are lobular (cells that line the breast lobules)

A lump is more likely to be a sign of breast cancer if it is:

    ● painless (may sometimes be painful), hard and has uneven edges

    ● doesn’t move around, seems to be attached to skin or muscle

    ● associated with nipple discharge, either clear, milky or bloody

    ● persistent pain in your breast or armpit

    ● dimpling of the skin of your breast, changes in the appearance of the nipple, ridges or pitting of the skin of the breast (resembling the skin of an orange)

    ● retraction of the nipple (the nipple is turned slightly

    ● change in the size or shape of your breast

    ● lump in the armpit

Breast cancer may also be asymptomatic (giving no symptoms), but picked up at routine mammography screening.

RISK FACTORS FOR BREAST CANCER

1. Patient’s History: This includes:
    a. previous history of breast cancer
    b. age (the risk for breast cancer increases with age)
    c. family history of breast cancer in one or more close relatives
    d. history of radiation therapy to the chest region
    e. continuous combined HRT (hormone replacement therapy) increases risk
    f. Early menarche, Late menopause
    g. not having breast-fed before

2. Genetic factors: 5% to 10% of breast cancer cases have been shown to be related to inherited gene changes

3. Abnormal findings on previous breast biopsies, such as ductal carcinoma in situ (DCIS), Lobular carcinoma in situ (LCIS), proliferative disease.

INVESTIGATIONS

ULTRASOUND SCAN
This is usually recommended in women younger than 35 years because they have denser breasts, which makes it difficult to get a good picture on a mammogram.
Ultrasound is also used to distinguish between a solid mass and a cyst.

MAMMOGRAM
This is an X-ray of the breast

BIOPSY
The only way to confirm that a lump is non-cancerous, is to take a tissue sample (biopsy)
There are several ways to perform biopsies
    ● Fine needle aspiration – a needle is injected into the breast mass and fluid is withdrawn
    ● Core needle aspiration – A hollow needle is used and a core of breast tissue is extracted.
    ● Excisional biopsy – this is a direct tissue sample, where all of a significant portion of the abnormal area is removed in a surgical procedure.

TREATMENT

1. Breast Infection: Use of warm compresses and antibiotics

2. Breast abscess: incision and drainage by a doctor.

3. Fibroadenomas: these are usually removed in order to distinguish them from cancer.

4. Breast cyst: They usually resolve spontaneously or they may be aspirated with a needle and syringe.

5. Fibrocystic changes: These usually don’t require any treatment, unless a new lump develops which must be thoroughly investigated to rule out cancer. A baseline mammogram is often done. Analgesics can help with the pain.

6. Breast cancer: This requires urgent treatment and treatment depends on the type of cancer, the size and location. The treatment for invasive breast cancer usually involves some combination of surgery, radiation therapy, chemotherapy, hormone therapy and/or targeted (biological) therapy.

PREVENTION

    ● Routine mammograms are recommended for women 50 years and above, every three years.
    ● If you have a family history of close relatives with breast cancer, you may need early screening.

    ● Ultrasound scans are recommended for women under the age of 35 years.

    ● Breast awareness is important so that you can identify any problems in your breast and have them checked out as soon as possible. Ensure monthly self breast examinations.

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DEGENERATIVE DISEASE OF THE SPINE (Cervical/Lumbar Spondylosis)

What does this really mean?

Referred in most lay circles as Arthritis, this is described as a progressive degeneration of the cervical or lumbar vertebrae.
The spine has several bones stacked on each other called vertebra. In between them are pad like cushions called discs which prevent these from rubbing against each other. In cervical and lumbar spondylosis, these bones and discs undergo varying degree of ‘wear and tear’.
Outside the vertebra are the nerve roots which send signals to the arms, legs, hands, and feet.

What are the common causes/risk factors?

Age: Though seen in older population, younger people may be affected. Eighty percent of people above 40years have the characteristic x-ray features.
Level of activity/ occupation: Most mechanical jobs that require lifting have been observed to either contribute to the incidence of or worsen the symptoms of cervical/lumber spondylosis.
Body Mass Index: Few studies have shown that the higher the body mass index (being overweight and obese), the more likely the chances of degenerative spinal diseases.
Smoking: Smoking has been implicated in severe disc degeneration.
Hereditary: This also has been implicated but evidence has been poor in this regard.

Symptoms

Most are asymptomatic (without symptoms) but the others present with neck pain, back pain/ discomfort. Because of the degenerative nature, other spine conditions can develop from there.

In general, symptoms of a degenerating spine include:

    ● Spinal deformity.
    ● Limited motion.
    ● Pain (back and neck pain).
        o Intermittent or continuous.
        o With movement or at rest.

    ● Nerve injuries.
        o Weakness of the upper or lower limbs.
        o Sensory loss.

        o Bladder and bowel function problems.
        o Sexual dysfunction.

Other common mimics of cervical/lumbar spondylosis

    ● Myalgia: referred to as muscle pain. For example whiplash injury of the neck
    ● Postural disturbance
    ● Disc disease: including disc prolapse
    ● Osteoporosis: demineralization of bone.

Diagnosis

Diagnosis of degenerative spine conditions usually starts with history and examination, followed by an X-ray study of the backbones.
Magnetic resonance imaging (MRI) is used to view discs, nerves and the spinal canal space. Computed tomography (CT) scan may be used to resolve any inconsistencies between the MRI and the patient’s symptoms. Sometimes disc studies, also known as discograms, may be ordered to determine if a patient’s pain is being caused by a damaged spinal disc.

Treatment options

Medications: Anti-inflammatory analgesics, skeletal muscle relaxants, and antidepressants.
Exercises: Stretches, chiropractic, and spine manipulations.
Minimal invasive procedures: Steroid injections, denervation through radiofrequency.
Surgery: Includes spinal decompression, kininectomy discectomy, laminotomy, and osteophyte removal.

Prevention

Since it is degenerative, prevention is almost impossible. However, lifestyle modifications like weight reduction, avoidance or cessation of smoking, adopting good sitting postures, avoiding lifting heavy objects etc. can delay onset of, as well as relieve symptoms.

Follow up

Clinical examinations are usually done routinely. Radiological investigations are employed if new symptoms appears.

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WHAT IS HEART FAILURE?

Heart failure, occurs when the heart muscle, for some reason, doesn’t pump blood as well as it should. Heart failure develops over time as the heart’s pumping action grows weaker. The condition can affect the right side of the heart only, or it can affect both sides of the heart. Most cases involve both sides of the heart.

WHAT CAUSES HEART FAILURE?

Conditions that damage or overwork the heart muscle can cause heart failure. Over time, the heart weakens. It is not able to fill with and/or pump blood as well as it should.
Causes of heart failure include:

1. Coronary Heart Disease

Coronary heart disease is a condition in which a waxy substance called plaque builds up inside the arteries supplying blood to the heart. This reduces blood flow to the heart muscle, thereby weakening the heart muscle.

2. High Blood Pressure

A sustained high blood pressure leads to thickening of the heart muscles which on the long run weakens the heart and lead to its failure.

3. Pulmonary hypertension

Heart failure can also be caused by pulmonary hypertension (raised blood pressure in the blood vessels that supply the lungs). This condition can damage the right side of your heart, leading to heart failure. In some cases the pulmonary hypertension itself is caused by an existing heart condition.

4. Faulty heart valves.

The valves of the heart keep blood flowing in the proper direction through the heart. A damaged valve forces the heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken the heart.

5. Damage to the heart muscle (cardiomyopathy).

Heart muscle damage (cardiomyopathy) can have many causes, including several diseases, infections, alcohol abuse and the toxic effect of drugs, such as cocaine or some drugs used for chemotherapy.

6. Myocarditis.

Myocarditis is an inflammation of the heart muscle. It is most commonly caused by a virus and can lead to left-sided heart failure.

7. Congenital heart defects (Heart defects you’re born with).

If the heart and its chambers or valves haven’t formed correctly, the healthy parts of the heart have to work harder to pump blood through the heart, which, in turn, may lead to heart failure.

8. Abnormal heart rhythms (heart arrhythmias).

Abnormal heart rhythms may cause the heart to beat too fast, which creates extra work for the heart. Over time, the heart may weaken, leading to heart failure. A slow heartbeat may prevent the heart from getting enough blood out to the body and may also lead to heart failure.

WHAT ARE THE SYMPTOMS OF HEART FAILURE?

Heart failure signs and symptoms may include:
    ● Shortness of breath (dyspnea) on exertion or at rest.
    ● Fatigue and weakness
    ● Swelling (oedema) in the legs, ankles and feet
    ● Rapid or irregular heartbeat
    ● Reduced ability to exercise.
    ● Persistent cough or wheezing with white or pink blood-tinged phlegm.
    ● Increased need to urinate at night.
    ● Swelling of your abdomen (ascites)
    ● Sudden weight gain from fluid retention
    ● Sudden, severe shortness of breath and coughing up pink, foamy mucus
    ● Chest pain if the heart failure is caused by a heart attack.

HOW IS HEART FAILURE DIAGNOSED?

    1. Medical history and physical examination.
    2. In most cases, further tests are required to confirm the diagnosis and guide how presenting symptoms are controlled. These include:
        ● blood tests
        ● electrocardiogram (ECG)
        ● chest x-ray
        ● echocardiogram
        ● coronary angiogram

HOW IS HEART FAILURE TREATED?

Treatment for heart failure depends on the type and severity of the heart failure.
The goals of treatment for all stages of heart failure include:
    ● Treating the underlying cause, such as coronary heart disease, high blood pressure.
    ● Reducing symptoms.
    ● Stopping the heart failure from getting worse.
    ● Increasing lifespan and improving quality of life.
Treatment usually include lifestyle changes, use of prescription medications, and in severe cases, medical procedures or surgery may be needed.

Heart-Healthy Lifestyle Changes

● Stop smoking: Smoking damages blood vessels, raises blood pressure, reduces the amount of oxygen in blood and makes the heart beat faster.
● Eat a healthy diet: Aim to eat a diet that includes fruits and vegetables, whole grains, fat-tree or low-fat dairy products, and lean proteins.
● Restrict salt in your diet: Too much sodium contributes to water retention, which makes the heart work harder and causes shortness of breath and swollen legs, ankles and feet.
● Maintain a healthy weight: Knowing the body mass index (BMI) helps to find out if one has a healthy weight in relation to height and gives an estimate of the total body fat. Body mass index is calculated as weight in kilograms divided by square of the height measured in metres. A general goal to aim for a BMI of between 18.5 and 25.
● Limit alcohol and fluids: Alcohol can weaken the heart muscle and increase risk of abnormal heart rhythms. In severe heart failure, a limit may be placed on the amount of fluids taken.
● Be active: Moderate aerobic activity helps keep the rest of your body healthy and conditioned, reducing the demands on the heart muscle.
● Reduce stress: When anxious or upset, the heart beats faster, breathing is heavier and blood pressure often goes up. This can make heart failure worse, since the heart is already having trouble meeting the body’s demands.
● Sleep easy: With shortness of breath, especially at night, sleep with the head propped up using a pillow or a wedge.

MEDICAL PROCEDURES AND SURGERY

In some severe cases, doctors recommend surgery to treat the underlying problem that led to heart failure. Some treatments being studied and used in certain people include coronary bypass surgery, heart valve repair or replacement, implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT) or biventricular pacing, heart pumps and heart transplant.

COMPLICATIONS OF HEART FAILURE

Complications can include:
● Kidney damage: Heart failure can reduce the blood flow to the kidneys, which can eventually cause kidney failure if left untreated.
● Heart valve problems: The valves of the heart, which keep blood flowing in the proper direction through the heart, may not function properly if the heart is enlarged or if the pressure in the heart is very high due to heart failure.
● Liver damage: Heart failure can lead to a buildup of fluid that puts too much pressure on the liver. This fluid backup can lead to scarring, which makes it more difficult for the liver to function properly.

HOW TO PREVENT HEART FAILURE

To reduce risk of developing heart disease, and prevent progression of underlying heart diseases to heart failure:
    ● Avoid using illegal drugs.
    ● Be physically active.
    ● Avoid/reduce alcohol intake
    ● Follow a heart-healthy eating plan.
    ● Quit smoking. Also, avoid second hand (passive) smoking.
    ● Maintain a healthy weight.
    ● Treat and control any conditions that can cause heart failure. Take medicines as your doctor prescribes.
    ● Regular doctor’s visits for ongoing care.

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Hernia refers to a condition where an organ or tissue (intestines, fats) exits through the wall of a cavity (e.g. anterior abdominal wall) where it normally resides.
It can occur in any part of the body and initially presents as a painless swelling.
The most common location for hernias is the groin, which refers to the region directly adjacent to the genitals (between the abdomen and the thighs).

Types

1. Abdominal Hernias

Tissues such as intestines can break through weak points in the abdomen resulting in hernias. They are the most common group of hernias and can be further divided into:
    i. Inguinal hernias – this is the most common form, the inguinal region is part of the groin where the abdomen joins with the thigh.
Sometimes the inguinal hernia can extend to involve the scrotum, this is referred to as an inguinoscrotal hernia.

    ii. Umbilical hernias – Common in children and can sometimes resolve without treatment as the child grows.
    iii. Incisional hernia – this can occur following poor wound healing after surgery.
2. Others

There are several other less common forms including-
    Femoral hernias – occurs in the upper thigh
    Hiatal hernias – involves the diaphragm

Causes

Hernias usually occur with a combination of a weak cavity wall and increased pressure/strain in the same space. Some examples of these risk factors are:
    ● Inappropriate heavy lifting (weights and during manual labour)
    ● Straining when passing faeces or urine
    ● Longstanding cough up to 3months or more (e.g tuberculosis, cystic fibrosis)
    ● Obesity
    ● Smoking
    ● Poor posture
    ● Trauma
    ● Birth defects
    ● Connective tissue diseases
    ● Previous surgery.

Identifying Hernias

Hernias usually present initially as a bulge or soft swelling in the affected areas that increases or reduces in size with different forms of activity.
In children this change in size can often be seen while the child is crying.
Other pointers in addition to the swelling include discomfort/pain in the affected area, redness or even a heavy dragging feeling. There might also be constipation, vomiting and fever which are usually signs of a complication.
However, hernias occur without symptoms, especially those occurring strictly inside the body.

Diagnosis

Hernias can mostly be diagnosed by physical examination. On rare occasions however, Computed Tomography scans and special X-rays(barium X-rays) are used.

Treatment

The definitive treatment for hernia is surgery, and the procedure is referred to as herniorraphy.

Risks

If hernias are left for a long time, the organ (e.g intestines) can become trapped in the abnormal position resulting in poor blood supply. This is referred to as a strangulated hernia and it is an emergency.

Prevention

Simple steps include proper diet, avoid unassisted lifting of heavy objects, prompt treatment of a longstanding cough, proper weight management and cessation of smoking.

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DEFINITION

A miscarriage is the loss of a fetus before age of viability, usually 20th week of pregnancy. It can be spontaneous or induced.

Symptoms

Symptoms of a miscarriage include:
    ● Vaginal bleeding which progresses from light to heavy
    ● Severe abdominal cramps
    ● Abdominal pain
    ● Lower back pain
    ● Sudden decrease in signs of pregnancy.

Causes

Some of the causes include:
Genetic: Chromosomal abnormalities are found in more than half of embryos/fetus miscarried in the first 13 weeks of pregnancy. Genetic problems are more likely to occur with older parents; this may account for the higher rates observed in older women.
Uterine abnormalities: Uterine malformation, growths in the uterus (fibroids), or cervical incompetent- a miscarriage from an incompetent cervix usually occurs in the second trimester).
Reproductive tract infections: Mycoplasma genitalium infection is associated with increased risk of preterm birth, and spontaneous miscarriage.
Autoimmume diseases: An example include antiphospholipid antibody syndrome (APS) in which a person’s immune system mistakenly makes antibodies to certain substances involved in normal blood clotting. APS can cause repeated miscarriage and fetal deaths.

RISKS FACTORS

    ● Lifestyle (i.e. smoking, malnutrition, drug use, excessive caffeine and exposure to radiation or toxic substances)
    ● Maternal age (over age 35)
    ● Maternal trauma to the abdomen
    ● Maternal health problems such as diabetes mellitus, thyroid disorders, polycystic ovarian syndrome, genital infections like chlamydia infection etc
    ● History of previous miscarriages
    ● Multiple pregnancy.

Forms of miscarriage

Threatened miscarriage: Uterine bleeding accompanied by cramping or lower backache and closed cervix.
Inevitable or incomplete miscarriage: Abdominal or back pain accompanied by bleeding with an open cervix. Bleeding and cramps may persist if the miscarriage is not complete.
Complete miscarriage: A completed miscarriage is when the embryo or products of conception have emptied out of the uterus. Bleeding should subside quickly.
Missed miscarriage: Embryonic death has occurred but there is no bleeding or expulsion of the dead fetus. There is loss of pregnancy symptoms.
Recurrent miscarriage (RM): Defined as 3 or more consecutive first trimester miscarriages. This can affect 1% of couples trying to conceive.
Blighted Ovum: Also called an anembryonic pregnancy. A fertilized egg implants into the uterine wall, but fetal development never begins. A gestational sac is seen on ultrasound scan but there is no fetal pole.

Management

Ultrasonography: is needed to exclude ectopic pregnancy.
No treatment is necessary for a diagnosis of complete miscarriage
In cases of an incomplete miscarriage, empty sac (blighted ovum), or missed abortion there are three treatment options:
    ● Watchful waiting: In most cases (65–80%), the product of conception will pass out naturally within two to six weeks.
    ● Medical management: This involves the use of oral tablet or vaginal pessaries to encourage completion of the natural process. Majority of cases treated in this way will achieve complete expulsion within a few days.
    ● Surgical treatment: is the fastest way to complete the process. It involves dilation of the cervix (if not already dilated) and evacuation of the uterine content.

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Myocardial infarction refers to a condition where irreversible damage occurs in the heart muscles due to inadequate blood supply. This is the condition commonly referred to as heart attacks.
It occurs when the artery supplying blood to the heart is blocked completely or partially by blood clots or fats or other materials such as air on rare occasions.

Identifying Myocardial Infarction

It usually occurs as a left sided or central chest pain, which may be sharp, squeezing or even burning in nature. This pain might simultaneously spread to the back, neck, shoulder, jaw and even the 4th and 5th finger of the left hand.
Chest pain can continue for up to one hour and is not relieved by rest (in the case of angina, pain is relieved with rest)
Sometimes in the days preceding the heart attack patient may experience extreme tiredness during routine actions (climbing stairs and short walks) and chest discomfort as well as a feeling of unwellness.
Other things that may be present during a heart attack include, fast breathing, racing pulse, cough, production of foaming saliva and profuse sweating.

Risk Factors

Some conditions can make people more prone to heart attacks, examples include hypertension, diabetes, obesity, substance abuse (cocaine, smoking etc.), and lack of exercise. The risk is also increased in people born with heart defects and people with aggressive personality types.

What to do

Myocardial infarction (heart attack) is an emergency. If a person is noted with some of the above stated symptoms the priority is to transport the person to the hospital without delay.
The following actions can be taken while transporting the patient;
    ● Patient should be lying down with the head and torso elevated (this can be achieved by using pillows)
    ● Ensure good ventilation in the meantime.
    ● Patients on medications to relieve such pain should take the mediation (e,g, nitroglycerin) on the way to the hospital.

At the hospital

Patient would require;
    ● Supportive care; Oxygen, intravenous fluids
    ● Specialist care from a cardiologist
    ● Investigations such as cardiac enzymes and ECG.
    ● Drugs
    ● And in some cases surgery.

Possible Outcome

Myocardial infarction is a serious medical condition and the risk of death is high up to 30% in the first 24 hours therefore emphasis should be on prevention.

Prevention

    ● Smoking should be stopped as it increases risk significantly
    ● Treating underlying conditions such diabetes and hypertension where present.
    ● Good diet (low fat and salt and high fibre).
    ● Exercise
    ● Seek a doctor’s opinion on any unexplained chest pain

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Definition

Stroke, also known as a cerebrovascular accident (CVA) or ‘brain attack’ is a medical emergency in which there is reduced blood supply to an area of the brain causing severe injury or death of the brain cells involved.

Types

    ● Ischaemic stroke: this occurs when a blood clot narrows or completely blocks an artery supplying a part of the brain. This will lead to death of brain cells due to their lack of blood and oxygen.
    ● Haemorrhagic stroke: this type occurs when there is a burst or leak in an artery supplying a part of the brain. This reduces the blood that is to get to the area supplied and the blood also irritates the brain tissue which it touches. This is commonly caused by rupture of weak points in arteries called ANEURYSMS, but could also be from abnormally formed blood vessels called artero-venous malformations (AVM).
    ● Transient Ischaemic Attack (TIA): also known as a ‘mini stroke’, this is when someone manifests symptoms of a stroke that lasts about five minutes to several hours and then patient completely recovers. A TIA usually resolves in less than 24 hours but is still treated as an emergency to reduce patient’s risk of having a stroke later. If left unattended, many people who had a TIA would have a stroke in three months.

Risk factors

High blood pressure or poorly controlled hypertension is the commonest cause of stroke. Others are smoking, obesity, high blood cholesterol, previous TIA, lack of exercise, diabetes mellitus, excessive alcohol consumption, smoking etc.

Symptoms

When you notice these in yourself or in someone else, you need to get yourself or the person to the hospital immediately;
    ● Sudden drooping or sagging of one side of the face
    ● Sudden weakness of one arm (when he/she tries to raise both arms and one drops)
    ● Sudden slurred speech or inability to speak well or understand
    ● Reduced level of consciousness

Other symptoms include weakness of one side of the body, sudden severe headache (like never felt before), sudden confused state, inability to swallow.

Diagnosis

Diagnosis of stroke can be achieved with patient’s history (of onset of symptoms) and physical examination in the clinic. Although history in some patients might not be helpful if they were alone at onset of symptoms and not able to communicate. Tests done to confirm a stroke would include a Computed Tomography scan or Magnetic Resonance Imaging.

Treatment

Prompt presentation to the hospital, about 3-4 hours from onset of a stroke is life-saving and will see that treatment to deter the progression of stroke, reduction/ resolution of most symptoms is achieved.
Also, the risk factors are addressed like raised pressure, high blood cholesterol, poorly controlled diabetes mellitus and so on. Surgery may be needed to re-open narrowed blood vessels; this reduces the chances of blood clot formation.
After a stroke, a patient may be placed on blood thinners to prevent blood clots from forming thereby preventing future reoccurrence of a stroke. This he would have to take for a long time and would need routine checkups.

Post-stroke treatment

Most people who have had a stroke will be left with some form of disability, needing proper rehabilitation in the form of physiotherapy, speech therapy, occupational rehabilitation for full recovery. Some may never regain those functions that they lost while a stroke occurred. But routine checks and proper follow-up treatment need to be strictly adhered to, to reduce the risks of a repeat stroke which would be more debilitating or downright fatal.

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