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INTROCDUCTION

TYPHOID FEVER
Typhoid fever, also known as enteric fever, is a potentially fatal multi systemic illness caused primarily by Salmonella typhi. The protean manifestations of typhoid fever make this disease a true diagnostic challenge. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation. Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within one month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications. S typhi has been a major human pathogen for thousands of years, thriving in conditions of poor sanitation, crowding, and social chaos. It may have responsible for the Great Plague of Athens at the end of the Pelopennesian War. The nameS typhi is derived from the ancient Greek typhos, an ethereal smoke or cloud that was believed to cause disease and madness. In the advanced stages of typhoid fever, the patient's level of consciousness is truly clouded. Although antibiotics have markedly reduced the frequency of typhoid fever in the developed world, it remains endemic in developing countries. S typhi has no non human vectors. The following are modes of transmission: Oral transmission via food or beverages handled by an individual who chronically sheds the bacteria through stool or, less commonly, urine Hand-to-mouth transmission after using a contaminated toilet and neglecting hand hygiene Oral transmission via sewage-contaminated water or shellfish (especially in the developing world) An inoculum as small as 100,000 organisms causes infection in more than 50% of healthy volunteers. How do patients get typhoid fever? Typhoid fever is contracted by the ingestion of the bacteria in contaminated food or water. Patients with acute illness can contaminate the surrounding water supply through stool, which contains a high concentration of the bacteria. Contamination of the water supply can, in turn, taint the food supply. About 3%-5% of patients become carriers of the bacteria after the acute illness. Some patients suffer a very mild illness that goes unrecognized. These patients can become longterm carriers of the bacteria. The bacterium multiplies in the gallbladder, bile ducts, or liver and passes into the bowel. The bacteria can survive for weeks in water or dried sewage. These chronic carriers may have no symptoms and can be the source of new outbreaks of typhoid fever for many years. How does the bacterium cause disease, and how is it diagnosed? After the ingestion of contaminated food or water, the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily. The bacteria are carried by white blood cells in the liver, spleen, and bone marrow. The bacteria then multiply in the cells of these organs and reenter the bloodstream. Patients develop symptoms, including fever, when the organism reenters the bloodstream. Bacteria invade the gallbladder, biliary system, and the lymphatic tissue of the bowel. Here, they multiply in high numbers. The bacteria pass into the intestinal tract and can be identified for diagnosis in cultures from the stool tested in the laboratory. Stool cultures are sensitive in the early and late stages of the disease but often must be supplemented with blood cultures to make the definite diagnosis. What are the symptoms of typhoid fever?

The incubation period is usually one to two weeks, and the duration of the illness is about four to six weeks. The patient experiences poor appetite; abdominal pain; headaches; generalized aches and pains; fever, often up to 104 F; lethargy (usually only if untreated); intestinal bleeding or perforation (after two to three weeks of the disease); Diarrhea or constipation. People with typhoid fever usually have a sustained fever as high as 103 F-104 F (39 C-40 C). Chest congestion develops in many patients, and abdominal pain and discomfort are common. The fever becomes constant. Improvement occurs in the third and fourth week in those without complications. About 10% of patients have recurrent symptoms (relapse) after feeling better for one to two weeks. Relapses are actually more common in individuals treated with antibiotics. What is the treatment for typhoid fever, and what is the prognosis? Typhoid fever is treated with antibiotics that kill the Salmonella bacteria. Prior to the use of antibiotics, the fatality rate was 20%. Death occurred from overwhelming infection, pneumonia, intestinal bleeding, or intestinal perforation. With antibiotics and supportive care, mortality has been reduced to 1%-2%. With appropriate antibiotic therapy, there is usually improvement within one to two days and recovery within seven to 10 days. Several antibiotics are effective for the treatment of typhoid fever. Chloramphenicol was the original drug of choice for many years. Because of rare serious side effects, chloramphenicol has been replaced by other effective antibiotics. The choice of antibiotics needs to be guided by identifying the geographic region where the organism was acquired and the results of cultures once available. (Certain strains from South America show a significant resistance to some antibiotics.) Ciprofloxacin (Cipro) is the most frequently used drug in the U.S. for nonpregnant patients. Ceftriaxone (Rocephin), an intramuscular injection medication, is an alternative for pregnant patients.Ampicillin (Omnipen, Polycillin, Principen) and trimethoprimsulfamethoxazole (Bactrim, Septra) are frequently prescribed antibiotics although resistance has been reported in recent years. If relapses occur, patients are retreated with antibiotics. The carrier state, which occurs in 3%-5% of those infected, can be treated with prolonged antibiotics. Often, removal of the gallbladder, the site of chronic infection, will cure the carrier state.

DAIBETES MELLITUS TYPE 2


What is diabetes? Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels that result from defects in insulin secretion, or its action, or both. Diabetes mellitus, commonly referred to as diabetes (as it will be in this article) was first identified as a disease associated with "sweet urine," and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine. Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. In patients with diabetes, the absence or insufficient production of insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime. What is the impact of diabetes? Over time, diabetes can lead to blindness, kidney failure, and nerve damage. These types of damage are the result of damage to small vessels, referred to as micro vascular disease. Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries

(atherosclerosis), leading to strokes, coronary heart disease, and other large blood vessel diseases. This is referred to as macro vascular disease. Diabetes affects approximately 26 million people in the United States, while another 79 million gave prediabetes. In addition, an estimated additional 7 million people in the United States have diabetes and don't even know it. From an economic perspective, the total annual cost of diabetes in 2011 was estimated to be 174 billion dollars in the United States. This included 116 billion in direct medical costs (healthcare costs) for people with diabetes and another 58 billion in other costs due to disability, premature death, or work loss. Medical expenses for people with diabetes ate over two times higher than those for people who do not have diabetes. Remember, these numbers reflect only the population in the United States. Globally, the statistics are staggering. What causes diabetes? Insufficient production of insulin (either absolutely or relative to the body's needs), production of defective insulin (which is uncommon), or the inability of cells to use insulin properly and efficiently leads to hyperglycemia and diabetes. This latter condition affects mostly the cells of muscle and fat tissues, and results in a condition known as insulin resistance. This is the primary problem in type 2 diabetes. The absolute lack of insulin, usually secondary to a destructive process affecting the insulin-producing beta cells in the pancreas, is the main disorder in type 1 diabetes. In type 2 diabetes, there also is a steady decline of beta cells that adds to the process of elevated blood sugars. Essentially, if someone is resistant to insulin, the body can, to some degree, increase production of insulin and overcome the level of resistance. After time, if production decreases and insulin cannot be released as vigorously, hyperglycemia develops. Glucose is a simple sugar found in food. Glucose is an essential nutrient that provides energy for the proper functioning of the body cells. Carbohydrates are broken down in the small intestine and the glucose in digested food is then absorbed by the intestinal cells into the bloodstream, and is carried by the bloodstream to all the cells in the body where it is utilized. However, glucose cannot enter the cells alone and needs insulin to aid in its transport into the cells. Without insulin, the cells become starved of glucose energy despite the presence of abundant glucose in the bloodstream. In certain types of diabetes, the cells' inability to utilize glucose gives rise to the ironic situation of "starvation in the midst of plenty". The abundant, unutilized glucose is wastefully excreted in the urine. Insulin is a hormone that is produced by specialized cells (beta cells) of the pancreas. (The pancreas is a deep-seated organ in the abdomen located behind the stomach.) In addition to helping glucose enter the cells, insulin is also important in tightly regulating the level of glucose in the blood. After a meal, the blood glucose level rises. In response to the increased glucose level, the pancreas normally releases more insulin into the bloodstream to help glucose enter the cells and lower blood glucose levels after a meal. When the blood glucose levels are lowered, the insulin release from the pancreas is turned down. It is important to note that even in the fasting state there is a low steady release of insulin than fluctuates a bit and helps to maintain a steady blood sugar level during fasting. In normal individuals, such a regulatory system helps to keep blood glucose levels in a tightly controlled range. As outlined above, in patients with diabetes, the insulin is either absent, relatively insufficient for the body's needs, or not used properly by the body. All of these factors cause elevated levels of blood glucose (hyperglycemia).

What are diabetes symptoms? The early symptoms of untreated diabetes are related to elevated blood sugar levels, and loss of glucose in the urine. High amounts of glucose in the urine can cause increased urine output and lead to dehydration. Dehydration causes increased thirst and water consumption. The inability of insulin to perform normally has effects on protein, fat and carbohydrate metabolism. Insulin is an anabolic hormone, that is, one that encourages storage of fat and protein. A relative or absolute insulin deficiency eventually leads to weight loss despite an increase in appetite. Some untreated diabetes patients also complain of fatigue, nausea andvomiting. Patients with diabetes are prone to developing infections of the bladder, skin, and vaginal areas. Fluctuations in blood glucose levels can lead to blurred vision. Extremely elevated glucose levels can lead to lethargy and coma. How is diabetes diagnosed? The fasting blood glucose (sugar) test is the preferred way to diagnose diabetes. It is easy to perform and convenient. After the person has fasted overnight (at least 8 hours), a single sample of blood is drawn and sent to the laboratory for analysis. This can also be done accurately in a doctor's office using a glucose meter. Normal fasting plasma glucose levels are less than 100 milligrams per deciliter (mg/dl). Fasting plasma glucose levels of more than 126 mg/dl on two or more tests on different days indicate diabetes. A random blood glucose test can also be used to diagnose diabetes. A blood glucose level of 200 mg/dl or higher indicates diabetes. When fasting blood glucose stays above 100mg/dl, but in the range of 100-126mg/dl, this is known as impaired fasting glucose (IFG). While patients with IFG do not have the diagnosis of diabetes, this condition carries with it its own risks and concerns, and is addressed elsewhere. The oral glucose tolerance test Though not routinely used anymore, the oral glucose tolerance test (OGTT)is a gold standard for making the diagnosis of type 2 diabetes. It is still commonly used for diagnosing gestational diabetes and in conditions of pre-diabetes, such as polycystic ovary syndrome. With an oral glucose tolerance test, the person fasts overnight (at least eight but not more than 16 hours). Then first, the fasting plasma glucose is tested. After this test, the person receives 75 grams of glucose. There are several methods employed by obstetricians to do this test, but the one described here is standard. Usually, the glucose is in a sweet-tasting liquid that the person drinks. Blood samples are taken at specific intervals to measure the blood glucose. For the test to give reliable results:

The person must be in good health (not have any other illnesses, not even a cold). The person should be normally active (not lying down, for example, as an inpatient in a hospital), and The person should not be taking medicines that could affect the blood glucose. The morning of the test, the person should not smoke or drink coffee. The classic oral glucose tolerance test measures blood glucose levels five times over a period of three hours. Some physicians simply get a baseline blood sample followed by a sample two hours after drinking the glucose solution. In a person without diabetes, the glucose levels rise and then fall quickly. In someone with diabetes, glucose levels rise higher than normal and fail to come back down as fast. People with glucose levels between normal and diabetic have impaired glucose tolerance (IGT). People with impaired glucose tolerance do not have diabetes, but are at high risk for progressing to diabetes. Each year, 1% to 5% of people whose test results show impaired glucose tolerance actually eventually develop diabetes. Weight loss and exercise may help people with impaired glucose tolerance return their glucose levels to normal. In addition, some physicians advocate the use of medications, such asmetformin (Glucophage), to help prevent/delay the onset of overt diabetes. Research has shown that impaired glucose tolerance itself may be a risk factor for the development of heart disease. In the medical community, most physicians are now understanding that impaired glucose tolerance is nor simply a precursor of diabetes, but is its own clinical disease entity that requires treatment and monitoring. Evaluating the results of the oral glucose tolerance test Glucose tolerance tests may lead to one of the following diagnoses: Normal response: A person is said to have a normal response when the 2-hour glucose level is less than 140 mg/dl, and all values between 0 and 2 hours are less than 200 mg/dl. Impaired glucose tolerance: A person is said to have impaired glucose tolerance when the fasting plasma glucose is less than 126 mg/dl and the 2-hour glucose level is between 140 and 199 mg/dl. Diabetes: A person has diabetes when two diagnostic tests done on different days show that the blood glucose level is high. Gestational diabetes: A pregnant woman has gestational diabetes when she has any two of the following:, a fasting plasma glucose of 92 mg/dl or more, a 1-hour glucose level of 180 mg/dl or more, or a 2-hour glucose level of 153 mg/dl, or more.

PERITONITIS
Peritonitis is an inflammation of the peritoneum, the thin membrane that lines the abdominal wall and covers the organs inside. The inflammation is caused by a bacterial or fungal infection of this membrane. There are two major types of peritonitis. Primary peritonitis is caused by the spread of an infection from the blood and lymph nodes to the peritoneum. This type of peritonitis is rare -- less than 1% of all cases of peritonitis. The more common type of peritonitis, called secondary peritonitis, happens when the infection comes into the peritoneum from the gastrointestinal or biliary tract. Both cases of peritonitis are very serious and can be life threatening if not treated quickly. SIGNS AND SYMPTOMS: Abdominal pain and tenderness The main manifestations of peritonitis are acute abdominal pain, abdominal tenderness, and abdominal guarding, which are exacerbated by moving the peritoneum, e.g., coughing (forced cough may be used as a test), flexing one's hips, or eliciting the Blumberg sign (a.k.a. rebound tenderness, meaning that pressing a hand on the abdomen elicits less pain than releasing the hand abruptly, which will aggravate the pain, as the peritoneum snaps back into place). The presence of these signs in a patient is sometimes referred to as peritonism.The localization of these

manifestations depends on whether peritonitis is localized (e.g., appendicitis or diverticulitis before perforation), or generalized to the whole abdomen. In either case, pain typically starts as a generalized abdominal pain (with involvement of poorly localizing innervation of the visceral peritoneal layer), and may become localized later (with the involvement of the somatically innervated parietal peritoneal layer). Peritonitis is an example of an acute abdomen.

Collateral manifestations Diffuse abdominal rigidity ("washboard abdomen") is often present, especially in generalized peritonitis, Fever, Sinus tachycardia, Development of ileus paralyticus (i.e., intestinal paralysis), which also causes nausea, vomiting and bloating TREATMENT: Peritonitis you have symptoms of peritonitis, you should get immediate emergency medical help. You will likely need to be hospitalized for treatment. You may need surgery to get rid of the source of infection, such as an inflamed appendix, or to repair a tear in the walls of the gastrointestinal or biliary tract. Antibiotics are used to control infection. Complementary therapies may be used along with conventional medicine when recovering from peritonitis. Medications Your doctor will prescribe antibiotics to kill bacteria and keep the infection from spreading. The antibiotics prescribed may depend on the type of peritonitis and the organism causing the condition. Surgery and Other Procedures People with peritonitis often need surgery to remove infected tissue and repair damaged organs. Nutrition and Dietary Supplements Peritonitis is a medical emergency and should be treated by a medical doctor. Do not try to treat peritonitis with herbs or supplements. However, a comprehensive treatment plan for recovering from peritonitis may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using. These good nutrition habits may help you recover from any serious illness: Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers). Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables. Avoid refined foods, such as white breads, pastas, and especially sugar. Eat fewer red meats and more lean meats, cold-water fish, tofu, or beans for protein. Use healthy oils in foods, such as olive oil or vegetable oil. Avoid caffeine, alcohol, and tobacco. Drink 6 - 8 glasses of filtered water daily. Ask your doctor about taking a multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium. Probiotic supplement (containing Lactobacillus acidophilus among other species), 5 - 10 billion CFUs (colony forming units) a day, for gastrointestinal and immune health. Probiotics can be especially helpful when taking antibiotics, because probiotics can help restore the balance of "good" bacteria in the intestines

BIBASAL PHEUMONIA
The walking pneumonia is a type of infection which can even sometime make the condition of patient miserable. The walking pneumonia is called one of the least scary types of the pneumonia. This is just because of the fact that it is a mild form of pneumonia which does usually not needed any form of hospitalization to the patients. Sometime people get infected and suffer from this disease and still they are unaware that they are suffering from this disease. Hence it can be said that the meaning is clear from the word walking itself. In spite of being the walking pneumonia contagious the viruses causing it are not always responsible for it. The walking pneumonia bacteria usually cause infection in the upper respiration. For some patients especially those with compromised immune system are more prone to get these bacteria into the lungs of them. Hence it can be said that actually the virus causing pneumonia is contagious but it is less likely to happen to transfer this bacteria from one person to other and cause the disease. Flu or common colds are the things usually caused by these viruses to other people if they are transmitted to them by any means. Symptoms and Treatment Method of Viral Pneumonia The viral pneumonia is a type of pneumonia which causes swelling, irritation and inflammation in the lungs which is mainly cause by a virus. All the visible symptoms of the viral pneumonia are supposed to begin slowly from the little ignorable state. They are usually not at all severe in starting. Common viral pneumonia symptoms include Cough / mucus is more common along with a few pneumonias A form of high or just mild fever is also felt by the patients The shaking chills Shortness of the breath which usually occurs on climbing to the stairs Confusion is also a problem for the older people Clammy skin and the excessive sweating Headache Low energy, fatigue and loss of appetite Stabbing or very sharp pain in the chest which usually worsens on breathing deeply or when coughing Fatigue The treatment of viral pneumonia usually include Oxygen Using the humidifier Increased fluid These are the primary medication techniques that are also supposed to work for almost each case of pneumonia mild or severe. For the serious infection in order to get a breathing help and to prevent the dehydration it becomes necessary for the patients to stay at the hospitals. Instead there are few people who like to control it at their homes if the disease is not so severe. For home control some anti-inflammatory drug like aspirin can be given but it is good not to give this to children. In spite of this getting plenty of rests along with taking plenty of fluids are other important factors to cure viral pneumonia at home. Bacterial pneumonia symptoms and treatment There are a number of symptoms that can be used to identify that whether a particular person is suffering from bacterial pneumonia or not. The major symptoms of bacterial pneumonia include High fever Headache Yellow or thick green phlegm Phlegm producing cough

Clammy skin Chills Loss of appetite Fatigue Shortness of breath Shallow breathing Sweating and The stabbing pain in the chest Poor feeding, increased breathing, grunting on breathing, chest retraction, chest pain, vomiting and high fever is the symptoms visible among the infants if they suffer from the bacterial pneumonia. Treatment of the bacterial pneumonia is quite necessary otherwise it can cause the life threatening disease to the patients. Taking the antibiotics is considered as the best treatment method if someone is suffering from the bacterial pneumonia. However after control it is also recommended to consult from the doctor because sometime the bacterial pneumonia can recur after you end taking these antibiotics. Symptoms To Diagnose The Pneumonia Pneumonia is a type of infection of lungs which is usually caused by any of the microorganisms. The microorganisms causing pneumonia includes fungi, viruses and bacteria. Sharp pain in the chest on inspiration (breath in), fever, and cough together with the sputum production are some of the major symptoms related to the pneumonia. On hearing any abnormal sounds through the chest doctor usually suspect the disease and the confirmation is done through the chest X-ray test. The symptom of pneumonia varies as per the formation of condition of occurrence. Symptoms that develop quickly are usually develop through some of the bacteria called general symptoms of pneumonia which are Single time shaking chills which is usually followed by the fever Pain in the chest on the side of the infective lung. Some people do also feel sever pain in their abdomens whenever they suffer from pneumonia. Initial dry cough followed by the phlegm Muscle aches, vomiting and nausea Fast heartbeat and the rapid breathing Shortness of the breath The symptoms of pneumonia disease during a medical emergency condition can be as follows Blood in the phlegm Cyanotic skin A high fever Heavy and the labored breathing Reduced mental function as well as the mental confusion is also felt as an emergency medical condition in pneumonia by the elderly people. Loss in the weight and Fast hear beat What are the factors causing pneumonia? The viruses and the bacteria are diagnosed to be the primary cause of pneumonia. On breathing the pneumonia germs in the lungs and if the immune system is unable to identify them as a foreign substance then they get settled in a little airy space there called sacs. Once they get settled here they do also starts continuously multiplying. Now when the white blood cells come to the sacs to attack on the infection but the sacs does already contains viruses hence the sacs get filled with the pus and fluid. Now since the sacs are full of these foreign substances it causes pneumonia to occur to that particular person. The primary cause of pneumonia is supposed to be by the viral, fungi or bacteria. A little description about them is given below.

Pneumonia causes through bacteria attacks most commonly to those people who are addicted to the alcohol. It is a type of pneumonia which usually occurs either during the fall months or during the summer months. The pneumonia usually occurs to those people around the world who are living with their compromised or weakened immune system because they are simply more prone to it.

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