Suresh Kishanrao | Unicef - Academia.edu (original) (raw)

Papers by Suresh Kishanrao

Journal of quality in health care & economics, 2024

Fertility has been one of man's desired attributes since the beginning of recorded history and re... more Fertility has been one of man's desired attributes since the beginning of recorded history and remains a driving need for young couples to prove their fertility as soon as possible after marriage. Though this trend is changing a bit over a decade, due to some people with higher education, getting married late, working couple and some who are intentionally delaying parenthood. In India, pregnancy is usually viewed as a normal physiologic phenomenon, that does not require any intervention by professionals, unless there is some problem in conceiving, or pregnancy going to full term or in birthing. Most Indian families believe that they have little or no control over their pregnancies or outcomes. The importance of motherhood in traditional patriarchal cultures is rooted in the teachings of all the religions. The World Health Organisation (WHO) has recognised infertility as a public health issue. Although biological factors are the primary cause, factors like social, health, and lifestyle factors do have an adverse effect on a couple's ability to reproduce. The current fertility rate for India in 2024 is 2.122 births per woman, in 2023 it was 2.139 births per woman, in 2022 it was 2.159, in 2021 = 2.179 births per woman, and 2.159 in 2020, witnessing a reduction of 0.95% each year. Replacement level fertility needed to maintain a stable population size, is estimated to be 2.1. below which the population starts declining as we see in China (1.705 in 2023) today. High levels of infertility will generate low desire for contraception. Fertility and infertility are social conditions which are intricately connected. Where fertility is highly valued, infertility will conversely be devalued. Infertile across Indian women in 2019-21 (NFHS-5) by duration of marriage varied from i) women married for ≥1 year = 42.9%, ii) married for ≥2 years =30.7% Married for ≥3 years =24.1%, married duration ≥4 years =20.7% and married for ≥5 years = 18.7%. Age at marriage, biological factors, and lifestyle factors are strongly linked to infertility. People with higher education levels, late marriages, working couple and those intentionally delaying parenthood are more likely to experience primary infertility. Materials and Methods: This article is based on authors experience of guiding four cases of primary sterility in last 5 years. For different reasons first case has succeeded, second is progressing towards success, third is 30% hopeful as the cause is not necessarily associated with infertility and in the fourth all efforts have failed except IVF which the couple could not afford. The case studies suggest that Infertility in India needs to be Public Health Concern!

Archives of cancer science and therapy, Apr 12, 2024

Oral Cancer (OC) or squamous cell carcinoma of the oral cavity accounts for approximately 3% of a... more Oral Cancer (OC) or squamous cell carcinoma of the oral cavity accounts for approximately 3% of all cancers worldwide, with increased incidence in developing countries. The use of tobacco is directly associated with approximately 80% of oral cancers, especially in older men over 40 years of age. As nearly one-third of the Indian population over 15 years consume smokeless tobacco in one or the other forms, a recent increase has been observed in OC incidence among women and young adults.

Lately, the sexual behaviors of young & homosexuals have resulted in the emergence of oropharyngeal cancers due to infection with HPV 16.

About 60% of oral cancer cases in India have a five-year survival rate, and this can be improved to 70% to 90% by mere early detection in stages I and II and with various treatment modalities. Despite the well-known benefits of oral cancer screening for the whole population in developing countries remains controversial. It is imperative to address the cultural barriers and societal norms, which limit the acceptability and participation in screening programs in India and many developing countries.

This unique challenge of increasing OC morbidity in India and developing countries
requires horizontal integration of the health systems with new services focused on cancer control, which gives the best chance for long-term survival, improved outcomes, and affordable care!

This article is based on the author’s experience of overseeing 1 case of early detection and 2 cases of delayed diagnosis, outcomes and relevant literature review, and current guidelines for the management of OC.

Deleted Journal, Feb 28, 2023

Clinical orthopaedics and trauma care, Aug 22, 2023

The first regional anaesthetic technique performed was spinal anaesthesia, and the first operatio... more The first regional anaesthetic technique performed was spinal anaesthesia, and the first operation under spinal anaesthesia was in 1898 in Germany by August Bier. Spinal anaesthesia (SPA) is in common use worldwide for surgical procedures involving the lower abdomen, pelvis, perineal and lower extremities. It is beneficial for procedures below the umbilicus. Currently more than 50% global surgical patients undergo spinal anaesthesia every year. It is estimated that in USA 50 million individual were given spinal anaesthesia in 2022 and in India 60% of surgeries were performed under RA in 2021 as per a recent survey. Benefits of Spinal anaesthesia include prompt recovery, early return of normal functions, low chances of a blood clot following surgery and has less incidence of sickness, vomiting, when compared to a general anaesthetic for similar procedure. While acknowledging the benefits of SPA, Anaesthetists should be aware of and must inform clients of common side effects like acute back pain after spinal injection, that resolves with simple measures, Nausea, vomiting, headache and hypotension and Low-frequency hearing loss. One of the rare complications called Transient Neurologic Symptoms (TNS) with symptoms of, exclusive pain in buttocks, thighs, legs, few hours to ~ 1 day, lasting up to 10 days. After initial pain patient may notice numbness usually in left buttock area and weakness in gluteal muscles involved, that may prolong for 6 months to a year. The incidence India is quoted as 10-12 cases per lakh spinal anaesthesia procedures mainly caesarean sections. This article is of one such case the author is managing since a month. A 26-year-old lady primigravida, underwent caesarean section for the delivery 2 months ago. She was more concerned about the premature baby's feeding challenges, but coincidentally brought to author's notice. She has been put on a few o lower limb and abdominal muscle strengthening exercises and supplemented Tablet Neurobion (vit B12) forte one tablet a day. As of 22 /08/23 she has improved muscle power (20%) able to sit up with the support of upper and Numbness has also improved a bit. Material & Methods: One rare case of TNS, clinical diagnosis, management, Physiotherapy, Literature review and case report studies.

Archives of Ophthalmology and Optometry, Dec 31, 2022

Journal of quality in health care & economics, Dec 31, 2022

Nearly every person experiences at least one episode of cough every year in their lifetime. Most,... more Nearly every person experiences at least one episode of cough every year in their lifetime. Most, people seek care outside home only after trying known home remedies, especially when cough disturbs their sleep due to postnasal drip. Available data suggest that an average Indian adult has 3 episodes of cough per year, while an average child has 7-10 such episodes every year. The COVID-19 pandemic has increased the magnitude of cough across the world since early 2020. The most annoying part about a cough is "phlegm or mucus." Mucus forms a protective lining in certain parts of our body, protects our body from foreign invaders by trapping the irritants and expel them in a cough. Excessive Phlegm or mucus is produced as a response to an irritant from the environment like allergies, smoke, smoking, dust, and infections. Excess phlegm or difficulty to expel phlegm can be tackled as per its cause or origin. No doctor or a health care worker, in his/her clinical practice has a day without seeing a patient with cough. The diagnostic tests are either not available, or unaffordable, if available and used take a long time for definitive diagnosis. Another problem is of self-medication with innumerable number of over-the-counter cough syrups. Most practitioners know about the types of coughs, their symptomatic treatment and over the counter cough syrups and mucolytics, but very few know, the Ideal rationale of managing cough. Having analysed six varieties of coughs namely i) Cough due to postnasal drip in an elderly person ii & iii) Cough of Community acquired Pneumonia in a child and an adult by antibiotics iv) Cough in an elderly person managed by traditional approach of using roasted Guava fruit v) A case of Cough variant Asthma vi) Cough among Covid 19 cases and vii) Cough in COPD case in an elderly, the author is recommending a simple symptoms based logarithmic approach for differentiating various conditions causing cough and managing them empirically. This article highlights the need for a rational approach for small settings or individual practitioners. Materials & Methodology: This review is based on the review of literature on the ideal rationale of managing cough, own learning from personal practice and practices observed among colleagues, in public sector teaching institutes and private sector hospitals. The article addresses the general practitioner's dilemma of diagnosis and management by simple symptoms based logarithmic approach and managing empirically.

Open journal of pediatrics and child health, Mar 15, 2024

(ACS); acute heart failure (AHF); acute kidney injury (AKI); chronic kidney disease (CKD); cardio... more (ACS); acute heart failure (AHF); acute kidney injury (AKI); chronic kidney disease (CKD); cardiorenal syndrome (CRS); Cardio-pulmonary-Renal syndrome (CPRI) heart failure (HF); and left ventricular hypertrophy (LVH) Case Report 1 Our male patient is a 65-year-old man with known diabetes and hypertension for over 20 years. He was on a pilgrimage to Prayag, Uttar Pradesh was forced to be readmitted to a private hospital with the complaints of giddiness, breathless etc. by the tour operators. His medical history was significant for uncontrolled diabetes, severe hyperlipidaemia not treated and CKD with a baseline creatinine level of 3.5-5 mg/dl. Key laboratory investigations included i) Procalcitonin-7.39ng/ml indicative of high risk of progressing to severe systemic infections as against a referral range of <0.1ng/ml ii) TLC of19850 against a range of 4-11,000iii) Serum Urea-205mg/dl ,iv) serum creatinine 12.17 mg/dl, v) Serum Potassium 6.58 meg/l vi serum Calcium-8.3mg/ vii) Serum Uric acid-16.8mg/Dl viii) Serum Cholesterol 66.6/mg/dl, HDL-18.2mg/ dl, LDL-22.02/dl and ix) Hb%-11.2 and x) Serum Troponin 2074.2ng/L as against an upper limit of 19 ng/L upper reference limit for 99 percentile. Repat tests after 6 hours showed worrisome

Biomedical Journal of Scientific and Technical Research, Jun 5, 2023

Oral cancer (OC) or squamous cell carcinoma of the oral cavity accounts for approximately 3% of a... more Oral cancer (OC) or squamous cell carcinoma of the oral cavity accounts for approximately 3% of all cancers worldwide, with increased incidence in developing countries. Oral cancer is the most common cancer in India and Karnataka amongst men, and the fifth most frequently occurring cancer among women. The use of tobacco is directly associated with approximately 80% of oral cancers especially in older men over 40 years of age. Nearly one third (30%) of Indian population over 15 years consume tobacco in one or the other forms. A recent increase is observed in OC incidence among women and young adults due to consumption of smokeless tobacco. Recent sexual behaviours of young and homosexuals have resulted in the emergence of oropharyngeal cancers due to infection with HPV 16, a sexually transmitted virus. Even though OCs are increasing in India and globally the benefits of introducing oral cancer screening for the whole population in developing countries remains controversial. As it is imperative to address the cultural barriers and societal norms, which limit the acceptability and participation in screening programs Indian Council for Medical Research (ICMR) is supporting community-based screening starting with high-risk groups in 2022 and general community in 2023. The unique challenges posed by the rise in OC morbidity in India, requires horizontal integration of the health systems with new services focused on cancer control. Materials & Methods: This article is based on the situation analysis literature in India and Karnataka, and a project proposal in one of the blocks of a district in Karnataka India. This novel project is planning to empower Accredited Social Health Activists (ASHAs) for household level screening for oral lesions and building referral mechanisms for early diagnosis and treatment oral cancers. Project being in a formative stage any inputs to improve are welcomed.

Congestive Heart Failure (CHF) is a common complex clinical syndrome that underlines the inabilit... more Congestive Heart Failure (CHF) is a common complex clinical syndrome that underlines the inability of the heart to perform its circulatory function with the desired efficiency due to structural and/or functional alterations. There is paucity of good and reliable data in India and many developing countries on heart failure. The management of heart failurehas evolved over the years with the advent of new drugs and devices.But there is a need to uneartha true and meaningful nationaldata on the risk factors,available treatment options,and challenges in management that could be addressed to take advantage of the recent advances. CHF is a disease of the “elderly,” frequently occurs in the setting of normal ejection fraction, and has a poor prognosis, regardless of the level of systolic function. The highest prevalence of CHF is reported among Indigenous Australian population (5.3%), Germany (4%) and Canada 3.6%, Turkey 2.9%, and USA 2.6% as compared to only 0.3% in Indian population. Overall, more than 5 persons aged 60 to 69 and 10 persons per 1,000 population after 65 years of age suffer from CHF. The incidence of CHF is equally frequent in men and women globally, but it is more amongelderly women in India comparedto elderly men. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. CHF not only increases the risk of mortality, morbidity and worsens the patient’s quality of life, but also puts a huge burden on the overall healthcare system. We need to acknowledge the fact that diagnostic and therapeutic methods available are also underused in the community. This review article is the result of witnessing the heart failure in 4 individuals in January 2023. Their symptomsand signs included Shortness of breath with routine activity like walking or household chores, fatigue, and weakness, Pedal oedema, rapid or irregular heartbeat, fluctuating Blood Pressure and Blood sugar levels, reduced ability to exercise and vomiting and aspirational pneumonia. The exponential rise in the incidence of uncontrolled hypertension and DM over the last couple of years has shaped the trajectory of HF development seen today. The key risk factors and causes of HF in our cases included hypertension (HT), diabetes mellitus (DM); chronic kidney disease (CKD). With the bestpossible management practices in cities likeBengaluru and Mysuru in Karnataka we could save only two of the 4 cases,both first-time hospitalized patients. Materials & Methods: The third week of January2023 (17-25 January), the author had a misfortune being a witnessfor 3 women and one man between 64-85 years of age’s hospitalized for CHF with an outcome of 50% of them succumbing to CHF. This manuscript is a review of available information on the websites of World Heart Federation 2020, WHO, Global burden of disease 2019 report, ICC - National Heart Failure Registry, Reports of the Best Charities that fight Heart Diseases in 2023 including American Heart Association, The Children’s Heart Foundation, British Heart Foundation, Mended Hearts, Women Heart, Needy heart Foundation Bangalore and published papers in Indiaas evidences.

Cureus Journal of Medical Science, 2017

Many health planners, local bodies and general literate people see urban population as one unit o... more Many health planners, local bodies and general literate people see urban population as one unit of literate, financially sound and well informed population, seeking health care when needed; Health infrastructure is more than required. Cumulative data is the reason for this misconception while the actual situation among urban poor may be worse than their rural counterparts. Urban health would make the biggest impact in global health and is also the most challenging particularly taking care of the population at highest risk. Government influences the health of urban populations by providing municipal services, regulating activities that affect health, and setting the parameters for urban development. Government policies can exacerbate or reduce social inequality and support living conditions that promote or damage health. City governments and urban populations have limited resources to face multiple problems (e.g., in education, employment, crime prevention, environmental protection, and sanitation). Urban public health planners need to define disparity reduction as an explicit goal. Countrywide two important recent initiatives namely Pradhan Mantri Bhartiya Janaushadhi Pariyojana 20152 and National Health Protection Scheme (NHPS)3 have promised better sickness care more Accessible, Acceptable and Affordable.

Advanced research in gastroenterology & hepatology, Jan 12, 2022

Abdominal bloating is a very common and troublesome symptom of all ages, but it has not been full... more Abdominal bloating is a very common and troublesome symptom of all ages, but it has not been fully understood to date. Bloating is usually associated with functional gastrointestinal disorders or organic diseases, but it may also appear with no specific reasons. Studies have revealed that 15-30% of the general United States (US) population experiences bloating symptoms, compared with about 15% reported in an Asian population. Tummy bloating every day, unless you have eaten too much or are menstruating, is not okay, and it amounts to a gut disorder. The pathophysiology of bloating remains ambiguous, although some evidence supports the potential mechanisms, like gut hypersensitivity, impaired gas handling, altered gut microbiota, and abnormal abdominal-phrenic reflexes have been put forth. No treatment is of unequivocally beneficial to all. Dietary intervention is important in relieving symptom in patients with bloating. Medical treatment with some prokinetics, rifaximin, lubiprostone and linaclotide could be considered in the treatment of bloating. In this manuscript I have tried to analyse 5 cases of abdominal bloating including autobiographical cases in the last 2 decades and their medical management. GI system pathological causes are kept out of the purview of this article.

EC Gastroenterology and Digestive System, Jul 19, 2021

Irritable bowel syndrome (IBS) is a disorder affecting commonly the large intestine, and manifest... more Irritable bowel syndrome (IBS) is a disorder affecting commonly the large intestine, and manifests as stomach-ache, gaseous distension of the abdomen, often diarrhoea, and sometimes constipation. The diagnosis is generally made on presenting symptoms and excluding other known causes of such symptoms. Some people can win over their symptoms by diet alteration, lifestyle changes, and minimizing stress situations. Severe symptoms are treated with medication and counselling. I present one such case of a professionally busy spinster lady complaining of pain in epigastric region of the abdomen, gaseous distension, frequent diarrhoea and constipation episodes and uneasiness starting in April 2020. The problem starts after she retires in 2018 from a remarkably busy schedule of heading a government Polytechnic after 30 odd years of services. Her work culture changes and gets more leisure time, not able to keep herself busy and being a spinster not much of family support. After multiple consultations in a northern district of Karnataka she lands in Bengaluru for detailed checkup and confirmation of diagnosis and treatment plan. Ruling out all-possible causes of the symptoms, through battery of investigations, endoscopy, Colonoscopy, CT Scan of abdomen and Pelvis, echocardiography, KFT, LFT, etc a final diagnosis of IBS is arrived at and under observation for over a month

Journal of quality in health care & economics, 2022

Th global dilemma of Covid 19 pandemic, is just 30-40% of COVID-19 cases have been disaggregated ... more Th global dilemma of Covid 19 pandemic, is just 30-40% of COVID-19 cases have been disaggregated by both sex and age. Many anecdotal studies in different countries indicate a higher incidence, mortality, and fatality rates among men than among women. These rates vary widely by region, country, and men are at greater risk of COVID-19 death. The proportion of male and female Covid 19 patients was 51: 49 as against the proportion of Covid 19 deaths was 55:45. The mortality and fatality rates increased with age and were most predominant in men 50 years of age or older. Studies from around the world show that pregnant women are no more likely to get COVID-19 than other healthy adults. Only 1/3 of infected pregnant women had mild cold or flu-like symptoms. CDC data showed a highest number of COVID-19-related deaths in pregnant people in August 2021. It indicated that 97% of pregnant people hospitalized, either for illness or labour and delivery, with confirmed SARS-CoV-2 infection were unvaccinated. While worldwide Covid 19 vaccination emergency use was granted in December 2020, for the pregnant women it was withheld until from December 14, 2020, to February 28, 2021, about 36,000 pregnant women were tested for safety issue and emergency use was cleared in April 2021 by USFDA. Most Covid 19 infected pregnant women will be asymptomatic or have a mild disease and recover without any need for hospitalization. In less than 5% cases rapid deterioration in health occurs that sometimes affects the foetus too. In case of severe disease, like all other patients, pregnant women needed hospitalization, ICU care and ventilator support. The possibility of premature delivery, low birth weight (< 2.5 kg) and in rare situations, still birth increases. Pregnant women Older than 35 years of age, Obese, having an underlying medical condition such as diabetes or high blood pressure and have a history of clotting in the limbs are at higher risk. Given the fact India is home for 27 million pregnancies each year, I estimate that at least 2.7 million women faced the consequences of Covid 19. The GOI and State Governments have accepted lack of exact data about Covid 19 among pregnant women and its consequences in the last 2 years. All component of maternal care did suffer throughout the country. Data suggested that women who were pregnant or recently pregnant are at an increased risk for severe illness from COVID-19 when compared to people who are not pregnant. Indian Government approved vaccinating pregnant women on 2 July 2021. A recent response in Rajya Sabha indicates that as of 2 February 2022 28.22 lakh dose were reported to have been given to pregnant women and 11.68 Lakhs of them had got both doses. With the birth of 25 + million children India accounts for nearly about 27 million pregnancies each year. As of 2/7/21, the day GOI cleared vaccination for pregnant women the country had an estimated 16 million (60% of annual pregnancies that could have been recognized as pregnant) pregnant women and added 2 .2 million pregnancies every month, taking the total of eligible to 25 million in the last 7 months of which we protected only 1.17 million a meagre 5%. Among those vaccinated by 31 January 2022, 64 had some adverse reactions of which 38 were severe in nature. Materials & Methods: Review of publications from different countries and press reports in major City editions of popular daily newspapers like Times of India, Hindu, Hindustan Times, India Express, Economic times etc. Periodical press releases and statements in Parliament and State Assemblies. Anecdotal studies form the scientific basis for this article.

Acta Scientific Women's Health, Jun 3, 2021

Asthma is generally considered as a disease of childhood, but it may be first diagnosed in the ad... more Asthma is generally considered as a disease of childhood, but it may be first diagnosed in the adults and even senior citizens, then it is called as Late-onset asthma, that may begin even in the eighth and ninth decades of life. When late onset occurs, symptoms are more likely to be moderate to severe. Some studies of older persons who have asthma have shown that as a group, as many as 40% have their first attack after the age of 40 years. We present one such case of A-60year-old woman, nurse by profession. She was diagnosed with asthma at the age of 57 years and was given an inhaler for her mild shortness of breath and a non-productive cough that used to be worse at night. In the last one year her symptoms worsened slightly and persisted over several months. She has wheezing sound while breathing and her family members have noticed that her sleep gets disturbed due to breathlessness. The current asthma episode was considered as moderate persistence asthma and treated with Aerocart (Beclomethasone Dipropionate and Levalbuterol) inhaler and Salbutamol syrup 10ml and steam inhalation (by adding Eucalyptus oil). For co-morbidity of diabetes was given Glykind M 500mg (a combination of Gliclazide 80 mg and Metformin Hydrochloride 500 mg-1/2 tablet morning and evening) taking for 2 years. Has been advised to continue the regimen regularly and periodic reviews.

International Journal of Public Health and Safety, 2020

On an auspicious day of Eid-Ul Fitr the 25th May 2020 India got Jersey no-10, an extremely popula... more On an auspicious day of Eid-Ul Fitr the 25th May 2020 India got Jersey no-10, an extremely popular number in the sports arena. India holds the 9th position among the countries affected by the COVID-19 Pandemic as on 28th May 2020. Government of India confirmed a biggest 24 hrs spike of 7713 cases on 29th May 2020 to reach a total tally of 168,780. The death total crossed the number of 4978. Thus the case count quadrupled and deaths tripled in the first 25 days since 1 May 2020 when special trains started ferrying labourers from the badly effected cities to their native villages, followed within a week bringing back by flights Indians and expatriates from abroad. The overall recovery rates have reached around 48.5% of the affected cases to a total of 82,000 on date. While the public health professionals in the country do not feel we are fighting against any enemy but highly infectious virus infection that we don't know much about and neither there is established treatment or prevention except simple epidemiological ways of minimizing the transmission through social distancing, wearing masks when mingling with others, hand hygiene and cough etiquette. On the other hand, our political and bureaucratic seem to understand a war metaphor when it comes to confronting great challenges. But this COVID-19 pandemic is neither a war nor, a known enemy to strategize the victory. Today we are experimenting many options of treating serious patients in dedicated hospitals protecting the health personnel attending them using personal protective equipment (PPE). While global and national efforts are being made aggressively to make an effective vaccine available or over next 6-12 months the community spread of infection will lead to herd immunity as against many other viruses like SARS, NIPHA, MERS etc. that we have learnt to live with. Basically, I would drive a message home that we do not have to fight or win any war as much as we need to learn to make peace with its existence in our world for long.

Global journal of obesity, diabetes and metabolic syndrome, Apr 27, 2021

Background India contributes approximately 42 million cases out of a global burden of 463 million... more Background India contributes approximately 42 million cases out of a global burden of 463 million cases and it is ranked fi rst in the list of the ten nations most affected with diabetes. Diabetic foot diseases including Diabetic foot ulceration (DFU) are common complications among poorly managed or long duration diabetes patients in India. Diabetic foot affects approximately 15% of diabetic patients during their lifetime [1]. Among diabetes patients peripheral nerve damages often occur leading to loss of pain sensation, and damages to skin by pressure or injury leading the ulceration without their knowledge. Foot ulceration and its poor management leads to 85 percent of diabetesrelated amputations of lower limbs. Individual characteristics like overweight, alcohol and tobacco consumption accelerate the process of foot ulcers development. Vascular disease can complicate a foot ulcer, reducing the body's ability to heal and increasing the risk for an infection. Consistent high blood glucose levels reduce the body's ability to fi ght off a potential infection and delays the healing process. Several social and cultural practices like barefoot walking, squatting on the fl oor for long hours by certain professionals like tailors, priests, house maids etc. add to risk factors. Inadequate facilities for diabetes screening, blood sugar monitoring and management and foot care on one hand and use of the available facilities for diabetes care and education, and poor socioeconomic conditions are the main causes for foot ulcers in developing countries including India. Case presentation A young woman of thirty-eight-year-old, tailor by profession, reported with an oozing swelling over left malleolus (ankle) in January 2020. She is used to sit on the ground, crossed legs on fl oor for cutting the clothes for stitching. The posture led to lot of pressure on the left lateral (malleolus) at the knob on outside of the ankle. She was a known type 2 diabetic since April 2019 on oral anti-diabetic's therapy and

Biomedical Journal of Scientific and Technical Research, Apr 27, 2023

Headaches, medially known as cephalalgia, is one of the most common disorders of the nervous syst... more Headaches, medially known as cephalalgia, is one of the most common disorders of the nervous system. Approximately half of all adults have had a headache during the past year, and it is the sixth cause of disability in the world. It is the most disabling conditions and can have a substantial impact on quality of life of those affected. If it occurs repeatedly, it may be called as headache disorder. The latest International Classification of Headache Disorders has broadly classified headache disorders into primary and secondary based on their origin. Primary headache the subject of this paper is triggered by lifestyle factors, like alcohol, particularly red wine, processed meats that contain nitrates, changes in sleep or lack of sleep, poor posture, skipped meals & stress. Majority of those with headache have primary headache disorder especially migraine, tension-type headache, and medication-overuse headache. The tension-type headache (TTH), episodic TTH of less than 15 days/month, is reported by more than 70% in some populations. Stress is one of the main aggravating factors across geographies, more so in millennials and females. The Global Burden of Disease Study 2019 estimated that migraine caused 41.1 million YLDs 5.4% of Total YLDs, and tensiontype headache 5.5 million years of life lived with disability. Headache disorders are most troublesome in the productive years of life with lost working days and reduced productivity. Without proper treatment, can become chronic or recurring affecting the well-being of an individual and predispose them to other illnesses. Self-care with simple analgesics in managing primary headache disorders can help reduce frequency of attack and severity with positive effect on physical symptoms and functional capacity. Paracetamol (acetaminophen) is a safe analgesic with good gastrointestinal tolerance and is first line option. Caffeine's anti-nociception enhancing effect when given with acetaminophen significantly improves efficacy over use of paracetamol alone. Ninety percent of headaches seen in practice are due to a primary headache disorder where there are no confirmatory tests, and neuroimaging studies, if done, are normal. In this review use of a logarithm is suggested that makes first an emphasis on the recognition of red flags that help in the identification of secondary headaches, referral or management and expects establishing good referral mechanisms in the health system. This also emphasises most importantly a good history taking that allows the physician to recognize a pattern that in turn leads to the correct diagnosis for better management. A comprehensive history needs time, interest, focus and establishment of rapport with the patient. When to ask what question to elicit which information, is an art that is acquired by practice and improves with experience. Methods & Materials: This review is based on eight case studies of various types of headaches, and literature review and a logarithm suggested by Physicians Association of India and Neurologists Association of India

Medical journal of clinical trials & case studies, 2021

Enteric fever is an important public health problem in developing and underdeveloped countries. I... more Enteric fever is an important public health problem in developing and underdeveloped countries. It is mainly caused due to contaminated food or water and poor personal and food hygiene. Despite a century-old history of the diseases, the progress in its diagnostic tools is limited, age-old Widal test and treatment by empirical Antibiotic therapy continues to be the choice. Here, we present one such case managed in a smaller setting with serological diagnosis and empirical Antibiotic therapy. A 26-year-old male working graduate with a one-week history of evening rise of temperature with chills, heaviness of head and pain abdomen lasting for about one hour, associated with loose stools (5-6times), Nausea, loss of taste and severe body ache in early March 2021. He gave frequent travel history and consumption of street food and poor sleep for a week before the presentation. Typhoid was suspected based on clinical features, Widal test and other supportive blood tests. The same tests were repeated three times over 2 weeks to monitor the prognosis of the condition. The case was treated by cephalosporin, Antipyretics, Fluoroquinolone and Macrolide, temperature became normal after 3 days of day-care, followed up after 5 days & 8 days and confirmed to be back to Normalcy.