IPHREHAB : OSTEOMALACIA & RICKETS WITH TREATMENT

IPHREHAB


OSTEOMALACIA & RICKETS

DEFINITION
It is a condition characterised  by defective bone mineralisation.
There is increased bone turnover.
It is usually due to Calcium & Vitamin D deficiency.
Condition is rare in USA, UK..
More common in Arab countries

DEFINITION

Rickets is seen in children before Puberty..

Osteomalacia is adult counterpart of Rickets..

Both have same aetiology :

There is failure or defective mineralisation of newly formed matrix

AETIOLOGY

Diet poor in calcium & Vitamin D

Malabsorption Syndromes Chronic Diarrhoea, Sprue,    Steatorrohoea, 

Tuberculosis of Intestines

Chronic  Renal Failure  

AETIOLOGY

Lack of Sunlight Exposure- Reduced Vit. D Conversion 

Hypophophatemia

Vitamin D Resistance Rickets

There is increased thickness of Osteoid Seams, reduces calcification –mineralisation is defective

VITAMIN D METABOLISM

Ultraviolet Rays 

Skin 7-DHC (dehydrocholesterol)

Vitamin D3

Liver  - converts into 25-hydroxylase

Inactive 25(OH) D3

Kidney- 25(OH) Vitamin D 1-a hydroylase

Biological Active 1,25 (OH)2 D3  

Increases absorption of calcium from gut

CLINICAL PICTURE

Delayed DEVELOPMENT-Short Stature

Decreased Muscular Tone (Hypotonia)

Craniotabes  6-12 years 

Frontal Bossing

Delayed Frontallae Closing

Enlargement of Epiphysis (Rickets Rosary)

CLINICAL PICTURE

Teeth are pitted Caries common

Pot-belly Abdomen

Carpopedal Spasms

Laryngeal Stridor

Tetany may be seen

Bone Pains – Defective spine

Waddling Gait

INVESTIGATIONS

Complete Blood Anaemia Common

Serum Calcium Low

Phosphates usually low 

Alkaline Phosphatase raised

X-ray of bones characterstic changes in children Epiphysis thined & distal end of bone widened SAUCER deformity

INVESTIGATIONS

In Adults bone X-ray may be normal or shows osteoporosis

In Children Pseudofractures & Looser’s zones (Radiolucent bands)  may be seen It affects the ribs, Axilliary border of Scapula, Pubic rami

X-Ray of Rickets

BOWED  LEGS

MANAGEMENT

Calcium 1-2 gm daily

Diet- 1 litre of milk

Vitamin D 60,000 IU (1.5 mg of D3) Daily Orally

For tetany IV Calcium gluconate is given

Response to treatment is excellent

Conservative Management

1.Dietary supplement:

2.Physiotherapy treatment :

 .Gentle range of motion exercise.

 .Gradual weaght bearing training.

 .Prevention from fall and injury.

 .Coordination and reconditioning.

 .Light endurance training.

IPHREHAB: HEALTH IS PHYSICAL, MENTAL, SOCIAL & SPIRITUAL WELL BEING

IPHREHAB
HEALTH IS PHYSICAL, MENTAL, SOCIAL & SPIRITUAL WELL BEING

HEALTH IS NOT MERELY THE BODY FREE FROM DISEASE HEALTH IS PHYSICAL, MENTAL, SOCIAL & SPIRITUAL WELL BEING

• WE HAVE COMPLETELY FORGOTTEN THE SPIRITUAL PART OF HEALTH
• WE FEEL THAT ONLY DISEASES ARE TO BE TREATED (TERTIARY CARE) MEDICAL  & SURGICAL

PLEASE REMEMBER

• PUBLIC HAS LOST FAITH IN DOCTORS
• DOCTORS BEHAVIOUR IS HIGHLY APPAULING
• DOCTORS ARE VERY BUSY HAVE NO TIME FOR PATIENTS
• DOCTORS DON’T TALK  ABOUT PREVENTION OF DISEASE
• BILLIONS ARE SPENT ON TERTIARY CARE HOSPITAL
• BUT NOT A SINGLE PENNY ON PRIMARY HOSPITAL

DOCTORS DON’T EXAMINE THEIR PATIENT

• CLINICAL EXAMINATION HAS BECOME  OBSOLETE
• INVESTIGATIONS ARE  KING OR MASTER
• DOCTORS ARE TECHNICIAN         
• NO MORE PHYSICIANS
• DOCTORS DO NOT GIVE SERVICE THEY HAVE BECOME BUSINESS PERSON
• INVESTIGATIONS HAVE ATTENDED ROYAL STATUS
• TREATMENT IS STARTED ON RESULT OF INVESTIGATIONS
• NO BODY KNOWS THAT MACHINES CAN BE WRONG
• ECG’s ARE INTERPRETED BY COMPUTER
• TMT & ECHO ARE ORDERED WHETHER NEEDED OR NOT

INVESTIGATIONS

• X-RAYS ARE NOT TO BE DONE. 
• CT SCAN  ARE ORDERED FOR CLEAR CUT CASE OF TUBERCULOSIS
• Dr. SAYS THAT EVERY ONE COMES TO THEIR CHAMBER IS ALWAYS  WITH CT SCAN

I FEEL IN ANY CASE DIAGNOSIS DEPEND ON

• HISTORY:-  IT  FORMS FOUNDATION OF DIAGNOSIS
• CLINICAL EXAMINATION IS LIKE CONSTRUCTION OF BUILDING
• INVESTIGATIONS ARE LIKE DECORATIVE PIECES

INVESTIGATIONS

• DAILY NEW TESTS ARE BEING  ADDED SUPPOSED  TO BE SUPERIOR THAN PREVIOUS ONE.
• NEW EQUIPMENTS  ARE ADDED IN GEOMETRICAL PROPORTION.
• THEY ARE ALL DUMPED IN THIRD WORLD COUNTRIES - SOUTH EAST ASIA
• INVESTIGATIONS  ARE GLORIFIED.

THERE  IS NO DRUG POLICY

• SPURIOUS DRUGS  MARKET IS WORTH MORE THEN  4000 CRORES
• ANTIBIOTICS ARE MISUSED
• SO ARE STEROIDS
• QUACKS ARE FLOURISHING UNDER NAME OF ALTERNATIVE MEDICINE

(DR.ANANT PHODKE THESIS Excellent Study Of Drug Supply & Use

50% of drugs prescribed are irrational or have no connection to disease

He short listed 27 Essential Drugs for 90% of General Diseases)

I BELIEVE IN OLD SAYING

• IF YOU THROW ALL THE  MEDICINES INTO THE THE SEA 
• IT WILL BE GOOD FOR HUMAN BEINGS AND BAD FOR FISH.

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 : PULMONARY EMBOLISM

IPHREHAB


PULMONARY EMBOLISM:

• PAIN CHEST
• PAIN SEVERE RESEMBLE  LIKE THAT OF MYOCARDIAL INFARCTION 
• DYSPNOEA-SEVERE
• COUGH
• HAEMOPTYSIS
• PLEURAL RUB

PULMONARY EMBOLISM

Flight-related Deep Vein Thrombosis (DVT) 

• AN IMPORTANT ENTITY
• KNOWN AS “ECONOMY CLASS SUNDROME”
• SEEN IN PERSONS ON LONG DISTANCE TRAVEL
• OBESE,, OEDEMATOUS
• DEHYDRATED
• COAGULATION DISORDERS

INVESTIGATIONS

1. COMPLETE HAEMOGRAM
2. BT, CT, PROTHROMBIN TIME
3. VENOGRAPHY
4. CT SCAN
5. MRI SCAN
6. ULTRA SOUND- can localize the clot.

Prevention of Pulmonary Embolism

• RISK OF PULM.  EMBOLISM IN PROX DEEP VEIN THROMBOSIS IS  50%
• IN CALF VEIN THAROMBOSIS IS 5-20
• ANTOCOAGULANTS;-  Heparin 7500 Units IV initially, followed by 1000 Units hourly. Should be maintained for 5-7 day

PULMONARY EMBOLISM

• Heparin can be given SC and should be for 3-5 months
• THROMBOLYSIS:- Streptokinase, Urokinase can be used. They are less effective.
• Warfarin can be used also for long time

• LOW DOSE HEPARIN may be very helpful. 5000 Units twice daily SC. It is also helpful in preventing embolsm in Surgical cases.
• ASPIRIN in low doses is also very helpful

MANAGEMENT :

Preventive

• STAND UP & WALK
• CALF MUSCLE EXERCISES
• LOT OF FLUIDS
• NO ALCOHOL
• NO SMOKING
• AVOID CROSS LEGS IN POSTURE
• WEAR LOOSE CLOTHING

MANAGEMENT

• PHYSIOTHERAPY
• REDUCE WEIGHT
• ELEVATE YOUR LEGS
• STOCKINGS
• ROLE OF ASPIRIN
• LOW DOSE HEPARIN
• WARFARIN

CONCLUSIONS

• DVT is very common condition
• It is common in elderly diabetic especially travelling by air on long flights
• IN USA 600,000 cases are diagnosed  every year
• 1% can lead to Pulm.Embolism
•  Pulm. Embolism  may be fatal
• It is Preventable
• Exercise & anticoagulant play important part.