COMMON COLD

The common cold (also known as nasopharyngitis, rhinopharyngitis, acute coryza, or a cold) is a viral infectious disease of the upper respiratory tract which affects primarily the nose. Symptoms include coughing, sore throat, runny nose, and fever which usually resolve in seven to ten days, with some symptoms lasting up to three weeks. Well over 200 viruses are implicated in the cause of the common cold; the rhinoviruses are the most common.

Upper respiratory tract infections are loosely divided by the areas they affect, with the common cold primarily affecting the nose, the throat (pharyngitis), and the sinuses (sinusitis). Symptoms are mostly due to the body's immune response to the infection rather than to tissue destruction by the viruses themselves. The primary method of prevention is by hand washing with some evidence to support the effectiveness of wearing face masks.

No cure for the common cold exists, but the symptoms can be treated. It is the most frequent infectious disease in humans with the average adult contracting two to three colds a year and the average child contracting between six and twelve. These infections have been with humanity since antiquity.

SYMPTOMS

Symptoms of a common cold usually appear about one to three days after exposure to a cold-causing virus. Signs and symptoms of a common cold may include:

• Runny or stuffy nose
• Itchy or sore throat
• Cough
• Congestion
• Slight body aches or a mild headache
• Sneezing
• Watery eyes
• Low-grade fever
• Mild fatigue
• The discharge from your nose may become thicker and yellow or green in color as a common cold runs its course. What makes a cold different from other viral infections is that you generally won't have a high fever. You're also unlikely to experience significant fatigue from a common cold.

TREATMENT

There are currently no medications or herbal remedies which have been conclusively demonstrated to shorten the duration of infection.Treatment thus comprises symptomatic relief.Getting plenty of rest, drinking fluids to maintain hydration, and gargling with warm salt water, are reasonable conservative measures.Much of the benefit from treatment is however attributed to the placebo effect.

Symptomatic

Treatments that help alleviate symptoms include simple analgesics and antipyretics such as ibuprofen and acetaminophen/paracetamol.Evidence does not show that cough medicines are any more effective than simple analgesics and they are not recommended for use in children due to a lack of evidence supporting effectiveness and the potential for harm.In 2009, Canada restricted the use of over-the-counter cough and cold medication in children six years and under due to concerns regarding risks and unproven benefits.In adults there is insufficient evidence to support the use of cough medications.The misuse of dextromethorphan (an over-the-counter cough medicine) has led to its ban in a number of countries.

In adults the symptoms of a runny nose can be reduced by first-generation antihistamines; however, they are associated with adverse effects such as drowsiness.Other decongestants such as pseudoephedrine are also effective in this population.Ipratropium nasal spray may reduce the symptoms of a runny nose but there is little effect on stuffiness.Second-generation antihistamines however do not appear to be effective.

Due to lack of studies, it is not known whether increased fluid intake improves symptoms or shortens respiratory illness and a similar lack of data exists for the use of heated humidified air.One study has found chest vapor rub to be effective at providing some symptomatic relief of nocturnal cough, congestion, and sleep difficulty.

Antibiotics and antivirals

Antibiotics have no effect against viral infections and thus have no effect against the viruses that cause the common cold.Due to their side effects they cause overall harm; however, they are still frequently prescribed.Some of the reasons that antibiotics are so commonly prescribed include: people's expectations for them, physicians' desire to do something, and the difficulty in excluding complications that may be amenable to antibiotics.There are no effective antiviral drugs for the common cold even though some preliminary research has shown benefit.

Alternative treatments

While there are many alternative treatments used for the common cold, there is insufficient scientific evidence to support the use of most. As of 2010 there is insufficient evidence to recommend for or against either honey or nasal irrigation.Studies suggested that zinc, if taken within 24 hours of the onset of symptoms, reduces the duration and severity of the common cold in healthy people.Due to wide differences between the studies, further research may be needed to determine how and when zinc may be effective.Vitamin C's effect on the common cold while extensively researched is disappointing, except in limited circumstances, specifically, individuals exercising vigorously in cold environments.Evidence about the usefulness of echinacea is inconsistent.Different types of echinacea supplements may vary in their effectiveness. It is unknown if garlic is effective.A single trial of vitamin D did not find benefit.

PNEUMONIA

Pneumonia is an inflammation of the lungs caused by infection. Bacteria, viruses, fungi or parasites can cause pneumonia. Pneumonia is a particular concern if you're older than 65 or have a chronic illness or weak immune system. It can also occur in young, healthy people.

Pneumonia can range in seriousness from mild to life-threatening. Pneumonia often is a complication of another condition, such as the flu. Antibiotics can treat most common forms of bacterial pneumonias, but antibiotic-resistant strains are a growing problem. The best approach is to try to prevent infection.

SYMPTOMS

Pneumonia often mimics the flu, beginning with a cough and a fever, so you may not realize you have a more serious condition. Symptoms can vary depending on your age and general health.

The signs and symptoms of pneumonia may include:

• Fever
• Lower-than-normal body temperature in older people
• Cough
• Shortness of breath
• Sweating
• Shaking chills
• Chest pain that fluctuates with breathing (pleurisy)
• Headache
• Muscle pain
• Fatigue

Chest x ray

DIAGNOSIS

• Physical exam. During the exam, your doctor listens to your lungs with a stethoscope to check for abnormal bubbling or crackling sounds (rales) and for rumblings (rhonchi) that signal the presence of thick liquid.
• Chest X-rays. X-rays can confirm the presence of pneumonia and determine the extent and location of the infection.
• Blood and mucus tests. You may have a blood test to measure your white cell count and look for the presence of viruses, bacteria or other organisms. Your doctor also may examine a sample of your mucus or your blood to help identify the particular microorganism that's causing your illness.

TREATMENT

Typically, oral antibiotics, rest, simple analgesics, and fluids suffice for complete resolution.However, those with other medical conditions, the elderly, or those with significant trouble breathing may require more advanced care. If the symptoms worsen, the pneumonia does not improve with home treatment, or complications occur, hospitalization may be required.Worldwide, approximately 7–13% of cases in children result in hospitalization.while in the developed world between 22 and 42% of adults with community-acquired pneumonia are admitted.The CURB-65 score is useful for determining the need for admission in adults.If the score is 0 or 1 people can typically be managed at home, if it is 2 a short hospital stay or close follow-up is needed, if it is 3–5 hospitalization is recommended. In children those with respiratory distress or oxygen saturations of less than 90% should be hospitalized.The utility of chest physiotherapy in pneumonia has not yet been determined.Non-invasive ventilation may be beneficial in those admitted to the intensive care unit. Over-the-counter cough medicine has not been found to be effective nor has the use of zinc in children.There is insufficient evidence for mucolytics.

Bacterial

Antibiotics improve outcomes in those with bacterial pneumonia.Antibiotic choice depends initially on the characteristics of the person affected, such as age, underlying health, and the location the infection was acquired. In the UK, empiric treatment with amoxicillin is recommended as the first line for community-acquired pneumonia, with doxycycline or clarithromycin as alternatives.In North America, where the "atypical" forms of community-acquired pneumonia are more common, macrolides (such as azithromycin or erythromycin), and doxycycline have displaced amoxicillin as first-line outpatient treatment in adults.In children with mild or moderate symptoms amoxicillin remains the first line. The use of fluoroquinolones in uncomplicated cases is discouraged due to concerns about side effects and generating resistance in light of there being no greater clinical benefit.The duration of treatment has traditionally been seven to ten days, but increasing evidence suggests that shorter courses (three to five days) are similarly effective.Recommended for hospital-acquired pneumonia include third- and fourth-generation cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, and vancomycin.These antibiotics are often given intravenously and used in combination.In those treated in hospital more than 90% improve with the initial antibiotics.

Viral

Neuraminidase inhibitors may be used to treat viral pneumonia caused by influenza viruses (influenza A and influenza B).No specific antiviral medications are recommended for other types of community acquired viral pneumonias including SARS coronavirus, adenovirus, hantavirus, and parainfluenza virus.Influenza A may be treated with rimantadine or amantadine, while influenza A or B may be treated with oseltamivir, zanamivir or peramivir.These are of most benefit if they are started within 48 hours of the onset of symptoms.Many strains of H5N1 influenza A, also known as avian influenza or "bird flu," have shown resistance to rimantadine and amantadine.The use of antibiotics in viral pneumonia is recommended by some experts as it is impossible to rule out a complicating bacterial infection.The British Thoracic Society recommends that antibiotics be withheld in those with mild disease. The use of corticosteroids is controversial.

Aspiration

In general, aspiration pneumonitis is treated conservatively with antibiotics indicated only for aspiration pneumonia.The choice of antibiotic will depend on several factors, including the suspected causative organism and whether pneumonia was acquired in the community or developed in a hospital setting. Common options include clindamycin, a combination of a beta-lactam antibiotic and metronidazole, or an aminoglycoside.Corticosteroids are sometimes used in aspiration pneumonia, but there is limited evidence to support their effectiveness.

HYPERTENSION

High blood pressure is a common condition in which the force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.

Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

You can have high blood pressure (hypertension) for years without any symptoms. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

High blood pressure typically develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.


JNC CLASSIFICATION OF HYPERTENSION

• Normal: systolic BP <120 and diastolic BP <80
• Prehypertension: SBP 120-139 or DBP 80-89
• Stage 1 hypertension: SBP 140-159 or DBP 90-99
• Stage 2 hypertension: SBP 160 or DBP 100

Signs and symptoms

Hypertension is rarely accompanied by any symptoms, and its identification is usually through screening, or when seeking healthcare for an unrelated problem. A proportion of people with high blood pressure report headaches (particularly at the back of the head and in the morning), as well as lightheadedness, vertigo, tinnitus (buzzing or hissing in the ears), altered vision or fainting episodes.These symptoms however are more likely to be related to associated anxiety than the high blood pressure itself.

On physical examination, hypertension may be suspected on the basis of the presence of hypertensive retinopathy detected by examination of the optic fundus found in the back of the eye using ophthalmoscopy.Classically, the severity of the hypertensive retinopathy changes is graded from grade I–IV, although the milder types may be difficult to distinguish from each other.Ophthalmoscopy findings may also give some indication as to how long a person has been hypertensive.

TREATMENT

Lifestyle changes

Whether you're on the road to developing high blood pressure (prehypertension) or you already have high blood pressure (hypertension), you can benefit from lifestyle changes that can lower your blood pressure. People who have prehypertension have a systolic pressure (top number) ranging from 120 to 139 millimeters of mercury (mm Hg) or a diastolic pressure (bottom number) ranging from 80 to 89 mm Hg.

Even if your doctor prescribes medications to control your blood pressure, he or she will likely recommend you make lifestyle changes as well. Lifestyle changes can reduce or eliminate your need for medications to control your blood pressure. To make these changes:

• Don't smoke
• Eat a healthy diet, focusing on fruits, vegetables and low-fat dairy products, and especially, control the salt in your diet
• Maintain a healthy weight
• Exercise by getting 30 minutes of moderate activity — even if you need to break up your activity into three 10-minute sessions — on most days of the week
• Limit the amount of alcohol you drink — one drink a day for women and two a day for men
• You probably won't need to take high blood pressure medications if you have prehypertension and are otherwise healthy. However, if you have prehypertension and diabetes, kidney disease or heart disease, your doctor might prescribe medications to lower your blood pressure to a more desirable level.

Medication

If you have stage 1 high blood pressure, you have a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg. If both numbers are in this range, you also have stage 1 high blood pressure. The first change you can make is to adopt healthy lifestyle changes to help decrease your numbers. Your doctor will likely prescribe medications, as well.

(1)Diuretics (water pills)
Your doctor may first suggest diuretics — also called water pills. Diuretics work by flushing excess water and sodium from the body, thus lowering blood pressure, which may be enough along with lifestyle changes to control your blood pressure.

Although three types of diuretics are available, the first choice is usually a thiazide diuretic. Thiazide diuretics typically have fewer side effects than do other types of diuretics. They also offer strong protection against conditions that high blood pressure can cause, such as stroke and heart failure.

(2)Other medications
A diuretic may be the only high blood pressure medication you need. But under some circumstances, your doctor may also recommend another medication or may add another medication. Those choices include:

(#)Angiotensin-converting enzyme (ACE) inhibitors. These allow blood vessels to widen by preventing a hormone called angiotensin from affecting blood vessels. Frequently prescribed ACE inhibitors include captopril (Capoten), lisinopril (Prinivil, Zestril) and ramipril (Altace).

(#)Angiotensin II receptor blockers. These help blood vessels relax by blocking the action of angiotensin. Frequently prescribed angiotensin II receptor blockers include losartan (Cozaar), olmesartan (Benicar) and valsartan (Diovan).

(#)Beta blockers. These work by blocking certain nerve and hormonal signals to the heart and blood vessels, thus lowering blood pressure. Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and penbutolol (Levatol).

(#)Calcium channel blockers. These prevent calcium from going into heart and blood vessel muscle cells, thus causing the cells to relax, which lowers blood pressure. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR) and nifedipine (Adalat, Procardia).

(#)Renin inhibitors.  Renin is an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren (Tekturna) slows down the production of renin, reducing its ability to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren with ACE inhibitors or ARBs.

TONSILLITIS

Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side. Signs and symptoms of tonsillitis include swollen tonsils, sore throat, difficulty swallowing and tender lymph nodes on the sides of the neck.

Most cases of tonsillitis are caused by infection with a common virus, but bacterial infections also may cause tonsillitis.

Because appropriate treatment for tonsillitis depends on the cause, it's important to get a prompt and accurate diagnosis. Surgery to remove tonsils, once a common procedure to treat tonsillitis, is usually performed only when tonsillitis occurs frequently, doesn't respond to other treatments or causes serious complications.

Symptoms
Tonsillitis most commonly affects children between preschool ages and the mid-teenage years. Common signs and symptoms of tonsillitis include:

• Red, swollen tonsils
• White or yellow coating or patches on the tonsils
• Sore throat
• Difficult or painful swallowing
• Fever
• Enlarged, tender glands (lymph nodes) in the neck
• A scratchy, muffled or throaty voice
• Bad breath
• Stomachache, particularly in younger children
• Stiff neck
• Headache

In young children who are unable to describe how they feel, signs of tonsillitis may include:

• Drooling due to difficult or painful swallowing
• Refusal to eat
• Unusual fussiness

Treatment

Treatments to reduce the discomfort from tonsillitis symptoms include:

pain relief, anti-inflammatory, fever reducing medications (acetaminophen/paracetamol and/or ibuprofen)
sore throat relief (warm salt water gargle, lozenges, and iced/cold liquids)
If the tonsillitis is caused by group A streptococus, then antibiotics are useful with penicillin or amoxicillin being first line.Cephalosporins and macrolides are considered good alternatives to penicillin in the acute setting.A macrolide such as erythromycin is used for people allergic to penicillin. Individuals who fail penicillin therapy may respond to treatment effective against beta-lactamase producing bacteria such as clindamycin or amoxicillin-clavulanate. Aerobic and anaerobic beta lactamase producing bacteria that reside in the tonsillar tissues can "shield" group A streptococcus from penicillins.When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week; however, symptoms may last for up to two weeks. Chronic cases may be treated with tonsillectomy (surgical removal of tonsils) as a choice for treatment.

DIABETES METTITUS

Universal symbol for diabetes

Diabetes mellitus, or simply diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).      

There are three main types of diabetes mellitus (DM).

Type 1 DM results from the body's failure to produce insulin, and presently requires the person to inject insulin or wear an insulin pump. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes".
Type 2 DM results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. This form was previously referred to as non insulin-dependent diabetes mellitus (NIDDM) or "adult-onset diabetes".
The third main form, gestational diabetes occurs when pregnant women without a previous diagnosis of diabetes develop a high blood glucose level. It may precede development of type 2 DM.
Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.

SYMPTOMS

(1) Increased thirst
(2) Frequent urination
(3) Extreme hunger
(4) Unexplained weight loss
(5) Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough insulin)
(6) Fatigue
(7) Blurred vision
(8) Slow-healing sores
(9) Mild high blood pressure
(10) Frequent infections, such as gum or skin infections and vaginal or bladder infections


TREATMENT

Lifestyle

There are roles for patient education, dietetic support, sensible exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.

Medications

Oral medications
Main article: Anti-diabetic medication
Metformin is generally recommended as a first line treatment for type 2 diabetes, as there is good evidence that it decreases mortality. Routine use of aspirin, however, has not been found to improve outcomes in uncomplicated
Insulin
Type 1 diabetes is typically treated with a combinations of regular and NPH insulin, or synthetic insulin analogs. When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications.Doses of insulin are then increased to effect.