ABSTRACT
Elevated pH and elevated plasma bicarbonate level above normal characterise metabolic alkalosis. When bicarbonate is elevated pCO2 must also be elevated to maintain pH to its normal range. Therefore with metabolic alkalosis, the compensation is to decrease alveolar ventilation, and increase pCO2. The causes of metabolic alkalosis are gastro-intestinal hydrogen and chloride loss and due to renal cause. For metabolic alkalosis to continue both generation and maintenance of high levels of bicarbonate are necessary. The diagnosis of metabolic alkalosis is established by noting pH, serum bicarbonate (elevated) and pCO2 (compensatory) elevation. To establish the causes it is necessary to determine intravascular volume, supine and standing blood pressure and renin angiotension alolosterone axis. In chloride responsive alkalosis in which the conditions are extracellular volume depletion, hypokalaemia and hypochloraemia correction of intravascular volume with sodium chloride is needed. In severe metabolic alkalosis of any cause dilute hydrochloric acid (0.1 N HCl) may be infused intravenously but haemolysis may be a complication. In emergency situation with severe hypokalaemia dialysis with higher K+, Cl- and low HCO3- bath will be appropriate.
Subject(s)
Acid-Base Equilibrium/physiology , Alkalosis/diagnosis , Bicarbonates/metabolism , Chlorine/blood , Diagnosis, Differential , Humans , Hyperaldosteronism/complications , Hypokalemia/complications , Potassium/metabolism , Risk Assessment , Risk FactorsABSTRACT
A study was conducted to see the bacteriological profile in 172 cases of chronic dacryocystitis attending eye outpatients department of Midnapore Medical College and Hospital and NRS Medical College and Hospital, Kolkata. The patients underwent clinical examination of the eyes and lacrimal system, with particular attention to drainage system. The culture and sensitivity test was done from the material, which regurgitated through the punctum following pressure on sac. Out of 172 cases, 66(38.4%) were found with epiphora, 44 cases (25.9%) of epiphora with mass, 8 cases (4.6%) with epiphora mass with cellulitis and in 54 (31.4%) with chronic conjunctivitis. Bactriologically, 142 patients (82.5%) were revealed with pure culture, mixed culture in 18 cases (10.5%) and no growth of organism in 12 cases (7.0%). Staphylococcus aureus was found primary pathogen in disease process. Candida albicans were seen in 4 cases (2.3%).
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Chronic Disease , Dacryocystitis/microbiology , Female , Humans , Male , Middle AgedABSTRACT
Laboratory investigations are very important tools in the diagnosis of rheumatic diseases. Nowadays a large number of tests are available. The authors have discussed some important tests of value in day to day practice.
Subject(s)
Acute-Phase Proteins , Autoantibodies/analysis , Blood Sedimentation , Complement Activation , Humans , Rheumatic Diseases/diagnosis , Synovial Fluid/chemistryABSTRACT
To study the occurrence and incidence of different ocular manifestations in rheumatoid arthritis a random cross-sectional study was carried out among 54 patients with active rheumatoid arthritis. The patients were examined thoroughly to detect any ocular disease associated with rheumatoid arthritis. Complete ocular examination with special emphasis on anterior segment evaluation and tearfilm study was done. Two-thirds of the patients examined had some kind of visual problem at presentation. Three patients (5.55%) had marked dry eye with another 20 (37.03%) having borderline tear deficiency. Two cases ( 3.70% ) of episcleritis were also seen. No cases of scleritis or retinopathy were found. The most common ocular association with rheumatoid arthritis was secondary Sjogren's syndrome. Other conditions include episcleritis and marginal keratitis.
Subject(s)
Adult , Arthritis, Rheumatoid/complications , Cross-Sectional Studies , Eye Diseases/etiology , Humans , Middle AgedABSTRACT
Hypertension is a common clinical problem with great implications for public health. It is a silent killer and often remains asymptomatic. So regular BP check-up is a must. Complications of untreated hypertension include ventricular hypertrophy, heart failure and accelerated atherosclerosis, cerebrovascular disease and stroke, renal failure and retinopathy. Primary care physicians have immense duty to perform in this regard because they are the first to encounter them in various stages of the disease. Hypertension can present per se or in emergencies (as in crisis) or in disguise of a complication (like anaemia and renal failure). Control of hypertension and delaying the development of complications should be their first goal. Lastly, some hypertensives with complications may require referral to advanced centres.
Subject(s)
Humans , Hypertension/classification , Primary Health CareABSTRACT
Major complications of diabetes mellitus--classified as microvascular and macrovascular, are more or less well understood. But musculoskeletal syndromes of diabetes are not rare and they are a major cause of morbidity. Musculoskeletal pain is a universal experience. Soft tissue rheumatism such as rotator cuff lesion of the shoulder, carpal tunnel syndrome and stenosing tenosynovitis are more common in subjects with diabetes mellitus. Articular musculoskeletal disorders also occur more frequently in diabetes mellitus. Careful history and physical examination are essential in reaching a specific diagnosis. Unnecessary investigations are expensive, may cause anxiety to the patients and if taken out of clinical context, lead to over-diagnosis and over-treatment. This article briefly covers the association between musculoskeletal disorders and diabetes mellitus.