IPHREHAB : INFECTION, TYPHOID

IPHREHAB

TYPHOID

• Very common disease in our country
• Outbreaks are known to occur from time to time
• Pollution & Insanitary condition
• Present in animals except S.Typhi
• Transmitted by food, water, Milk
•  May be directly from one person to another

AETIOLOGY

• Caused by Salmonella Group of Organisms
• Reservoir are animals except for S.Typhi which is seen only in human beings
• There are 2000 Serotypes
• Faeco-oral route
• Tranmission through food, Flies & Fomites
• It involves Payer’s patches of small Intestines

CLINICAL PICTURE

• Fever is most common presenting symptom
• Fever is step ladder pattern
• Onset is insidious
• There is Malaise, Headache, Cough,  Drowsiness & Bodyaches
• Constipation common
• Relative Bradycardia
• Rash may appear on fifth day
• Toxaemia is Max. in 2nd Week
• Spleen is palpable
• Toxaemia increases in 3rd Week
• Coma may set in & may lead to death
• Antibiotics give the best results
• Carriers are well known

INVESTIGATIONS

• Complete Blood Leukopenia Increase in Lympho
• Blood Culture +ve  first week
• Widal’s  Test  2nd Week Rising titer is diagnostic
• Urine & Stool Culture

COMPLICATIONS

• Perforation
• Haemorrhage
• Osteomyelitis
• Meningitis
• Myocarditis
• Pneumonia
• Nephritis
• Hepatitis

MANAGEMENT

• General Management :- Analgesics for fever, Antiemetics (Perinorm) for vomiting
• Antibiotics Ciproflxacillin 500mg BD
• Cotrimoxazole 
• Amoxycillin
• Carrier Ciproflox for 4 weeks
• Prevention - Vaccination

IPHREHAB : ANKLE SPRAIN CAUSE AND TREATMENT

IPHREHAB

ANKLE SPRAIN:

An ankle sprain is a common injury and usually results when the ankle is twisted, or inverted. The term sprain signifies injury to the soft tissues, usually the ligaments, of the ankle. On the lateral side of the ankle, there are three ligaments that make up the lateral ligament complex. These include the anterior talofibular ligament (ATF), the calcaneo–fibular ligament (CF) and the posterior talofibular ligament (PTF). The very common inversion injury to the ankle usually injures the anterior talofibular ligament and the calcaneo–fibular ligament. The ATF ligament keeps the ankle from sliding forward and the CF ligament keeps the ankle from rolling over on its side.

Causes of Ankle Sprain

ANKLE SPRAIN

A ligament is made up of multiple strands of tissue–similar to a nylon rope. A sprain results in tearing of the ligaments. The tear can be a complete tear of all the strands of the ligament or a partial tear, where a portion of the strands of the ligament are torn. The ligament is weakened by the injury which depends on the degree of the tear. The lateral ligaments are by far the most commonly injured ligaments in a typical inversion injury of the ankle. An inversion injury simply means that the ankle tilts over to the inside (towards the other foot), and the pressure of all your body weight is forced onto the outside edge of the foot. This causes the ligaments on the outside of the ankle to stretch and possibly tear.

Symptoms of Ankle Sprain

Initially the ankle is swollen, becomes painful, and may turn eccyhmotic (bruised). The bruising, and the initial swelling, is due to ruptured blood vessels from the tearing of the soft tissues. Most of the initial swelling is actually bleeding into the surrounding tissues. This initial swelling due to bleeding then increases due to edema fluid leaking into the tissues as well over the next 24 hours.

Diagnosis of Ankle Sprain

The diagnosis of an ankle sprain is usually made by examination of the ankle and x–rays to make sure that there is no fracture of the ankle. If there is a complete rupture of the ligaments suspected, your doctor may order stress x–rays as well. These x–rays are taken while someone twists or stresses the ligaments.

Treatment of Ankle Sprain

Elevation will help control the swelling.

Gentle compression and ice will control swelling.

Mild pain relievers will help with the pain.

Crutches will prevent weight bearing.

Healing of the ligaments usually takes about six weeks. The swelling may be present for several months. A physical therapist may be suggested to help you regain full function of your injured ankle.

Treatment may vary depending on how bad your ankle sprain is.

 In each case, the first line of treatment is to calm the inflammation and halt the swelling. 

The RICE (Rest, Ice, Compression, Elevation) principle can help address each of these needs.

Rest: 

A brace or splint will keep the ankle in a safe position, helping you avoid more strain to the sore area. In severe cases, you may require a pair of crutches to limit weight through the foot.

Ice:

Cold therapy, in the form of an ice pack, can aid in slowing the inflammatory process and in limiting pain.

Compression:

An elastic wrap can compress the sore area, keeping the swelling to a minimum.

Elevation:

Keeping the ankle elevated above the level of your heart will help drain the extra fluid (edema) back into the blood system and reduce swelling.

Range of motion exercises:

As healing gets underway, it is important to begin a series of movement exercises for the range of motion (ROM). At first, you’ll work on simply bending and straightening the ankle. These exercises will keep the ankle from becoming stiff.

Strength progression: 

Next, you’ll begin strengthening the muscles around the ankle. Isometrics may be chosen in the early stages of rehabilitation. These are strengthening exercises in which the muscles are working but the joint stays still. Isometrics allow you to exercise with the ankle at different angles, helping you stay away from painful positions of the ankle. These exercises provide the benefit of reducing overall pain and swelling.

Balance exercises:

Balance exercises are especially important following an ankle ligament injury. Remember, healthy ligaments send information to the brain about the position of a joint. Once a ligament has been injured, these nerves are unable to receive and send the needed information to the brain. Balance exercises help retrain the new nerves and help you regain your proprioceptive sense around the joint.

IPHREHAB : What are Stretch Marks? Symptoms,Cause,Remedies and Diet

IPHREHAB

What are Stretch Marks? 

Stretch marks are skin lesions that occur when skin is pulled rapidly and the problem is caused by rapid weight gain. Although most of us tend to associate the problem of stretch marks with women, post-pregnancy, the problem is not restricted to women alone. The problem of stretch marks has become increasingly common with many being afflicted with the condition, particularly after resorting to fad diets and medications for rapid weight loss.

Symptoms of Stretch Marks

When skin is excessively pulled it hampers the production of collagen and elastin in the skin, causing them to thin out and weaken. This causes the skin to stretch and discolor. When stretch marks first appear, they take on an angry red color. The skin is stretched so much that it appears transparent and the blood vessels show through; this is what gives the marks the red color. Over time the blood vessels contract and leave the skin looking pale. This whitish color that replaces the red comes from the body fat that is visible through the stretched skin. 

Causes of Stretch Marks

This may be a result of pregnancy, when the skin gets pulled as the belly size increases, as a result of puberty in teens experiencing a growth spurt, a side effect of obesity or of illnesses like diabetes. Stretch marks usually appear on the abdomen and thighs.

Remedies for Stretch Marks

While stretch marks don’t vanish, they do fade with time. The use of over the counter creams and ointments helps the scars fade. One such effective ointment is cocoa butter cream. It is widely available and will help moisturize skin and is effective in smoothing out scars. In extreme cases patients seek laser therapy and surgery to correct the scars left on the body. These are painful and invasive treatments that serves no great cause. So instead of taking such a drastic step, it would be better to opt for simple and effective home remedies for stretch marks. Though the marks won’t vanish over night, they will fade away with proper treatment and dieting.

 Try some the following home remedies and observe the progress:

• Lavender Oil – Lavender oil is a highly recommended home remedy for stretch marks. Rubbing a few drops of lavender oil on the affected area twice a day ensures the scars fade quickly. Applying olive oil is also very effective.

• Sandalwood – A great preventive measure for stretch marks is applying sandalwood on the skin daily. It keeps the skin moisturized and prevents it from stretching.

Diet for Stretch Marks

An important aspect in the treatment of stretch marks is eating right. Eat foods that are good for your skin. These include fresh fruits and vegetables, especially those rich in Vitamin A, C and D. These foods improve skin tone and minimize blemishes. Zinc rich foods like nuts and fish also help diminish scars on skin. It is also of great importance that you drink lots of water through the day.

Suggestions for Stretch Marks

For anyone fighting off stretch marks, it is important to incorporate at least 30 minutes of exercise into your daily schedule. Exercising helps tone and firm up muscles, which in turn firms the skin. Yoga is a good option as it allows you to stretch and tone every muscle in the body.

IPHREHAB : Embolic infarction

IPHREHAB


Embolic infarction
This is one of the most common cause of stroke. In most cases of cerebral embolism, the embolic material consists of a fragment that has broken away from a thrombus within the heart. Embolism due to fat, tumor cells, fibrocartilage, amniotic fluid, or air is a rare occurrence and seldom enters into the differential diagnosis of stroke.

Clinical Picture

Of all strokes, those due to cerebral embolism develop most rapidly. The embolus strikes at any time of the day or night. Getting up to go to the bathroom is a time of danger. The neurologic picture will depend on the artery involved and the site of obstruction.

It  is important to repeat that an embolus may produce a severe neurologic deficit that is only temporary; symptoms disappear as the embolus fragments. In other words , embolism is a common cause of a single evanescent stroke that may reasonably be called a prolonged TIA. Also as already pointed out, several emboli can give rise to two or three transient  attacks of differing pattern or , rarely , of almost identical pattern.

Causes of cerebral embolism:

Cardiac origin

Noncardiac origin

Undetermined origin

Laboratory Findings

Not infrequently the first sign of myocardial infarction is the occurrence of embolism; therefore it is advisable that an ECG and echocardiogram be obtained in all patients with stroke of uncertain origin. Prolonged study of heart rhythm with Holter monitoring should be undertaken.

In some 30 percent of cases, cerebral embolism produces a hemorrhagic infarction. CT scanning or MRI may be helpful in showing the more intense hemorrhagic infarcts, particularly if the scan is repeated on the second or third day.

Course and prognosis

Most patients survive the initial insult, and in many the neurologic deficit may recede relatively rapidly, as  indicated above. The eventual prognosis is determined by the occurrence of further emboli and the gravity of the underlying illness- cardiac failure myocardial infarction, bacterial endocarditis  and so on.

Treatment and prevention

Three phases of therapy : General medical management in the acute phase, Measures directed to restoring the circulation Physical therapy and rehabilitation These are much the same as described above the prevention of atherothrombotic infarction.