Acute coronary syndrome (ACS)
These include –
A transfusion is putting blood or some part of it in a vein through an intravenous (IV) line or access.
Transfusions of blood and blood products temporarily replace parts of the blood when a person has been bleeding, or when their body cannot make enough blood. The blood usually comes from another person, called a donor.
People usually donate whole blood – blood taken right out of a vein through a needle. This whole blood may be called a unit or pint of blood, and equals about 450 millilitres or 16.7 ounces. But whole blood is rarely given as a transfusion. Blood has many parts, such as red blood cells, white blood cells, platelets, plasma, clotting factors, and small proteins.
Red Blood Cell Transfusion: This is done when the haemoglobin level is low. Normal haemoglobin level is 12-18g/dl. When haemoglobin level is less than 8g/dl, red blood cell transfusion may be considered. Following surgery, there may be a need for red blood cell transfusion depending on patient’s haemoglobin level before or after the surgery.Red Blood Cell Transfusion: This is done when the haemoglobin level is low. Normal haemoglobin level is 12-18g/dl. When haemoglobin level is less than 8g/dl, red blood cell transfusion may be considered. Following surgery, there may be a need for red blood cell transfusion depending on patient’s haemoglobin level before or after the surgery.
Plasma Transfusion: Plasma is the liquid portion of the blood in which red and white cells including platelets are suspended. It is rich in clotting factors and commonly given to patients who are bleeding because their blood is not clotting the way it should.
Platelet Transfusion: Platelet are fragments of cells in blood involved in preventing bleeding. Normal platelet cell count is 150,000 to 400,000/mm3. If level is less than 20,000/mm3 as in some cancer patients, then it is necessary to do platelet transfusion once surgery is required.
Cryoprecipitate Transfusion: Cryoprecipitate is the name given to a small fraction of plasma that separates out (precipitates), when plasma is frozen and then thawed in the refrigerator. Cryoprecipitate can be given to replace several blood clotting factors such as: a) Factor viii (missing in hemophiliac A patient) b) Vonwillebrand Factor (needed to help platelet work) c) Fibrinogen (a substance that can solidify into a clot)
White Blood Cell Transfusion: Chemotherapy (cancer treatment) can damage cells in the bone marrow, and patients getting such treatment often have low white blood cell counts. White blood cells, especially the type called neutrophils, are very important in fighting infections. Patients with very low neutrophils can therefore benefit from white blood cell transfusion.However, Instead of transfusing white blood cells, doctors now commonly use drugs to help the body make its own neutrophils.
Transfusion of blood sometimes causes transfusion reaction. There are several types of reaction and some are worse than others. Also, some are immediate while others could be delayed reactions. Complication of blood transfusion includes-
a) Allergic Reaction: most common reactions seen is itching. This can be treated with antihistamines medications.
b) Febrile Reaction: This is the occurrence of fever within 24hrs of transfusion. There could be headache, nausea, chills or general feeling of discomfort accompanying this fever.
c) Transfusion Related Acute Lung Injury (TRALI): The main symptom is trouble with breathing which can be life threatening. If suspected during blood transfusion, the transfusion is usually stopped. Its treatment could require oxygen, fluid and sometimes support with a breathing machine (Ventilator).
d) Acute Immune Haemolytic Reaction: It is the most serious type of transfusion reaction, but it is very rare. It happens when donor and patient blood do not match. Such patient can have chills, fever, chest and lower back pain, kidney damage resulting in dialysis.
e) Delayed haemolytic reaction: This type of reaction occurs when the body slowly attacks an antigens (other than ABO antigens) which it receives from the transfusion. It usually occurs between one to four weeks after transfusion. It can manifest with a drop in haemoglobin level, fever and jaundice.
f) Infection: Blood transfusion can transmit infections caused by bacteria, viruses and parasites. Examples include malaria, hepatitis B&C viral infections, HIV, and syphilis. However, in standard healthcare practice, blood and blood products are routinely screened and certified free from such infections before transfusion.
Breast lumps can be caused by infections, injuries, non-cancerous growths and cancer. There are many causes of breast lump, some are harmless/benign, while others are dangerous. Every breast lump should be evaluated by a doctor to exclude or establish a diagnosis of cancer.
1. Fibroadenoma – solid, usually painless growth most commonly seen in women 30-35 years old. May occur as a result of excessive growth of glands and connective tissue within the breast tissue.
2. Breast cyst – fluid-filled sac within the breast tissue. May vary in size during the menstrual period and may be tender.
3. Mastitis – usually seen in lactating mother, following bacterial infection of cracked nipples, resulting in inflammation of the breast tissue.
4. Breast abscess – following inflammation of the breast tissue (mastitis), a deep pocket of pus may form and present like a lump.
5. Fibrocystic changes – a group of benign conditions that affects the breast, presenting with breast pain, breast lump (usually cystic), increase in breast size and lumpiness of the breast. It is usually more pronounced during the menstrual period and symptoms usually disappear after menstruation.
6. Lipoma – this is a fatty growth that develops within the fat tissue of the breast. It usually doesn’t require any treatment.
7. Fat necrosis – trauma to the breast can damage the fat cell in the breast tissue and form a lump. Fat necrosis can also occur at the site of a previous biopsy.
Breast cancer is a malignant tumour (cancerous growth) that starts in the cells of the breast and has the ability to invade surrounding cells and spread to distant parts of the body. Cancer starts when abnormal cells grow unchecked by the body system.
Most breast cancers are ductal (starting in the cells that line the ducts), while other are lobular (cells that line the breast lobules)
A lump is more likely to be a sign of breast cancer if it is:
● painless (may sometimes be painful), hard and has uneven edges
● doesn’t move around, seems to be attached to skin or muscle
● associated with nipple discharge, either clear, milky or bloody
● persistent pain in your breast or armpit
● dimpling of the skin of your breast, changes in the appearance of the nipple, ridges or pitting of the skin of the breast (resembling the skin of an orange)
● retraction of the nipple (the nipple is turned slightly
● change in the size or shape of your breast
● lump in the armpit
Breast cancer may also be asymptomatic (giving no symptoms), but picked up at routine mammography screening.
1. Patient’s History: This includes:
a. previous history of breast cancer
b. age (the risk for breast cancer increases with age)
c. family history of breast cancer in one or more close relatives
d. history of radiation therapy to the chest region
e. continuous combined HRT (hormone replacement therapy) increases risk
f. Early menarche, Late menopause
g. not having breast-fed before
2. Genetic factors: 5% to 10% of breast cancer cases have been shown to be related to inherited gene changes
3. Abnormal findings on previous breast biopsies, such as ductal carcinoma in situ (DCIS), Lobular carcinoma in situ (LCIS), proliferative disease.
This is usually recommended in women younger than 35 years because they have denser breasts, which makes it difficult to get a good picture on a mammogram.
Ultrasound is also used to distinguish between a solid mass and a cyst.
This is an X-ray of the breast
The only way to confirm that a lump is non-cancerous, is to take a tissue sample (biopsy)
There are several ways to perform biopsies
● Fine needle aspiration – a needle is injected into the breast mass and fluid is withdrawn
● Core needle aspiration – A hollow needle is used and a core of breast tissue is extracted.
● Excisional biopsy – this is a direct tissue sample, where all of a significant portion of the abnormal area is removed in a surgical procedure.
1. Breast Infection: Use of warm compresses and antibiotics
2. Breast abscess: incision and drainage by a doctor.
3. Fibroadenomas: these are usually removed in order to distinguish them from cancer.
4. Breast cyst: They usually resolve spontaneously or they may be aspirated with a needle and syringe.
5. Fibrocystic changes: These usually don’t require any treatment, unless a new lump develops which must be thoroughly investigated to rule out cancer. A baseline mammogram is often done. Analgesics can help with the pain.
6. Breast cancer: This requires urgent treatment and treatment depends on the type of cancer, the size and location. The treatment for invasive breast cancer usually involves some combination of surgery, radiation therapy, chemotherapy, hormone therapy and/or targeted (biological) therapy.
● Routine mammograms are recommended for women 50 years and above, every three years.
● If you have a family history of close relatives with breast cancer, you may need early screening.
● Ultrasound scans are recommended for women under the age of 35 years.
● Breast awareness is important so that you can identify any problems in your breast and have them checked out as soon as possible. Ensure monthly self breast examinations.download documment
Referred in most lay circles as Arthritis, this is described as a progressive degeneration of the cervical or lumbar vertebrae.
The spine has several bones stacked on each other called vertebra. In between them are pad like cushions called discs which prevent these from rubbing against each other. In cervical and lumbar spondylosis, these bones and discs undergo varying degree of ‘wear and tear’.
Outside the vertebra are the nerve roots which send signals to the arms, legs, hands, and feet.
Age: Though seen in older population, younger people may be affected. Eighty percent of people above 40years have the characteristic x-ray features.
Level of activity/ occupation: Most mechanical jobs that require lifting have been observed to either contribute to the incidence of or worsen the symptoms of cervical/lumber spondylosis.
Body Mass Index: Few studies have shown that the higher the body mass index (being overweight and obese), the more likely the chances of degenerative spinal diseases.
Smoking: Smoking has been implicated in severe disc degeneration.
Hereditary: This also has been implicated but evidence has been poor in this regard.
Most are asymptomatic (without symptoms) but the others present with neck pain, back pain/ discomfort. Because of the degenerative nature, other spine conditions can develop from there.
In general, symptoms of a degenerating spine include:
● Spinal deformity.
● Limited motion.
● Pain (back and neck pain).
o Intermittent or continuous.
o With movement or at rest.
● Nerve injuries.
o Weakness of the upper or lower limbs.
o Sensory loss.
o Bladder and bowel function problems.
o Sexual dysfunction.
● Myalgia: referred to as muscle pain. For example whiplash injury of the neck
● Postural disturbance
● Disc disease: including disc prolapse
● Osteoporosis: demineralization of bone.
Diagnosis of degenerative spine conditions usually starts with history and examination, followed by an X-ray study of the backbones.
Magnetic resonance imaging (MRI) is used to view discs, nerves and the spinal canal space. Computed tomography (CT) scan may be used to resolve any inconsistencies between the MRI and the patient’s symptoms. Sometimes disc studies, also known as discograms, may be ordered to determine if a patient’s pain is being caused by a damaged spinal disc.
Medications: Anti-inflammatory analgesics, skeletal muscle relaxants, and antidepressants.
Exercises: Stretches, chiropractic, and spine manipulations.
Minimal invasive procedures: Steroid injections, denervation through radiofrequency.
Surgery: Includes spinal decompression, kininectomy discectomy, laminotomy, and osteophyte removal.
Since it is degenerative, prevention is almost impossible. However, lifestyle modifications like weight reduction, avoidance or cessation of smoking, adopting good sitting postures, avoiding lifting heavy objects etc. can delay onset of, as well as relieve symptoms.
Clinical examinations are usually done routinely. Radiological investigations are employed if new symptoms appears.download documment
Heart failure, occurs when the heart muscle, for some reason, doesn’t pump blood as well as it should. Heart failure develops over time as the heart’s pumping action grows weaker. The condition can affect the right side of the heart only, or it can affect both sides of the heart. Most cases involve both sides of the heart.
Conditions that damage or overwork the heart muscle can cause heart failure. Over time, the heart weakens. It is not able to fill with and/or pump blood as well as it should.
Causes of heart failure include:
Coronary heart disease is a condition in which a waxy substance called plaque builds up inside the arteries supplying blood to the heart. This reduces blood flow to the heart muscle, thereby weakening the heart muscle.
A sustained high blood pressure leads to thickening of the heart muscles which on the long run weakens the heart and lead to its failure.
Heart failure can also be caused by pulmonary hypertension (raised blood pressure in the blood vessels that supply the lungs). This condition can damage the right side of your heart, leading to heart failure. In some cases the pulmonary hypertension itself is caused by an existing heart condition.
The valves of the heart keep blood flowing in the proper direction through the heart. A damaged valve forces the heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken the heart.
Heart muscle damage (cardiomyopathy) can have many causes, including several diseases, infections, alcohol abuse and the toxic effect of drugs, such as cocaine or some drugs used for chemotherapy.
Myocarditis is an inflammation of the heart muscle. It is most commonly caused by a virus and can lead to left-sided heart failure.
If the heart and its chambers or valves haven’t formed correctly, the healthy parts of the heart have to work harder to pump blood through the heart, which, in turn, may lead to heart failure.
Abnormal heart rhythms may cause the heart to beat too fast, which creates extra work for the heart. Over time, the heart may weaken, leading to heart failure. A slow heartbeat may prevent the heart from getting enough blood out to the body and may also lead to heart failure.
Heart failure signs and symptoms may include:
● Shortness of breath (dyspnea) on exertion or at rest.
● Fatigue and weakness
● Swelling (oedema) in the legs, ankles and feet
● Rapid or irregular heartbeat
● Reduced ability to exercise.
● Persistent cough or wheezing with white or pink blood-tinged phlegm.
● Increased need to urinate at night.
● Swelling of your abdomen (ascites)
● Sudden weight gain from fluid retention
● Sudden, severe shortness of breath and coughing up pink, foamy mucus
● Chest pain if the heart failure is caused by a heart attack.
1. Medical history and physical examination.
2. In most cases, further tests are required to confirm the diagnosis and guide how presenting symptoms are controlled. These include:
● blood tests
● electrocardiogram (ECG)
● chest x-ray
● coronary angiogram
Treatment for heart failure depends on the type and severity of the heart failure.
The goals of treatment for all stages of heart failure include:
● Treating the underlying cause, such as coronary heart disease, high blood pressure.
● Reducing symptoms.
● Stopping the heart failure from getting worse.
● Increasing lifespan and improving quality of life.
Treatment usually include lifestyle changes, use of prescription medications, and in severe cases, medical procedures or surgery may be needed.
● Stop smoking: Smoking damages blood vessels, raises blood pressure, reduces the amount of oxygen in blood and makes the heart beat faster.
● Eat a healthy diet: Aim to eat a diet that includes fruits and vegetables, whole grains, fat-tree or low-fat dairy products, and lean proteins.
● Restrict salt in your diet: Too much sodium contributes to water retention, which makes the heart work harder and causes shortness of breath and swollen legs, ankles and feet.
● Maintain a healthy weight: Knowing the body mass index (BMI) helps to find out if one has a healthy weight in relation to height and gives an estimate of the total body fat. Body mass index is calculated as weight in kilograms divided by square of the height measured in metres. A general goal to aim for a BMI of between 18.5 and 25.
● Limit alcohol and fluids: Alcohol can weaken the heart muscle and increase risk of abnormal heart rhythms. In severe heart failure, a limit may be placed on the amount of fluids taken.
● Be active: Moderate aerobic activity helps keep the rest of your body healthy and conditioned, reducing the demands on the heart muscle.
● Reduce stress: When anxious or upset, the heart beats faster, breathing is heavier and blood pressure often goes up. This can make heart failure worse, since the heart is already having trouble meeting the body’s demands.
● Sleep easy: With shortness of breath, especially at night, sleep with the head propped up using a pillow or a wedge.
In some severe cases, doctors recommend surgery to treat the underlying problem that led to heart failure. Some treatments being studied and used in certain people include coronary bypass surgery, heart valve repair or replacement, implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT) or biventricular pacing, heart pumps and heart transplant.
Complications can include:
● Kidney damage: Heart failure can reduce the blood flow to the kidneys, which can eventually cause kidney failure if left untreated.
● Heart valve problems: The valves of the heart, which keep blood flowing in the proper direction through the heart, may not function properly if the heart is enlarged or if the pressure in the heart is very high due to heart failure.
● Liver damage: Heart failure can lead to a buildup of fluid that puts too much pressure on the liver. This fluid backup can lead to scarring, which makes it more difficult for the liver to function properly.
To reduce risk of developing heart disease, and prevent progression of underlying heart diseases to heart failure:
● Avoid using illegal drugs.
● Be physically active.
● Avoid/reduce alcohol intake
● Follow a heart-healthy eating plan.
● Quit smoking. Also, avoid second hand (passive) smoking.
● Maintain a healthy weight.
● Treat and control any conditions that can cause heart failure. Take medicines as your doctor prescribes.
● Regular doctor’s visits for ongoing care.
Hernia refers to a condition where an organ or tissue (intestines, fats) exits through the wall of a cavity (e.g. anterior abdominal wall) where it normally resides.
It can occur in any part of the body and initially presents as a painless swelling.
The most common location for hernias is the groin, which refers to the region directly adjacent to the genitals (between the abdomen and the thighs).
Hernias usually occur with a combination of a weak cavity wall and increased pressure/strain in the same space. Some examples of these risk factors are:
Hernias usually present initially as a bulge or soft swelling in the affected areas that increases or reduces in size with different forms of activity.
In children this change in size can often be seen while the child is crying.
Other pointers in addition to the swelling include discomfort/pain in the affected area, redness or even a heavy dragging feeling. There might also be constipation, vomiting and fever which are usually signs of a complication.
However, hernias occur without symptoms, especially those occurring strictly inside the body.
Hernias can mostly be diagnosed by physical examination. On rare occasions however, Computed Tomography scans and special X-rays (barium X-rays) are used.
The definitive treatment for hernia is surgery, and the procedure is referred to as herniorrhaphy.
If hernias are left for a long time, the organ (e.g. intestines) can become trapped in the abnormal position resulting in poor blood supply. This is referred to as a strangulated hernia and it is an emergency.
Simple steps include proper diet, avoid unassisted lifting of heavy objects, prompt treatment of a longstanding cough, proper weight management and cessation of smoking.
A miscarriage is the loss of a foetus before age of viability, usually 20th week of pregnancy. It can be spontaneous or induced.
Symptoms of a miscarriage include:
Some of the causes include:
FORMS OF MISCARRIAGE
Myocardial infarction refers to a condition where irreversible damage occurs in the heart muscles due to inadequate blood supply. This is the condition commonly referred to as heart attacks.
It occurs when the artery supplying blood to the heart is blocked completely or partially by blood clots or fats or other materials such as air on rare occasions.
Identifying Myocardial Infarction
It usually occurs as a left sided or central chest pain, which may be sharp, squeezing or even burning in nature. This pain might simultaneously spread to the back, neck, shoulder, jaw and even the 4th and 5th finger of the left hand.
Chest pain can continue for up to one hour and is not relieved by rest (in the case of angina, pain is relieved with rest)
Sometimes in the days preceding the heart attack patient may experience extreme tiredness during routine actions (climbing stairs and short walks) and chest discomfort as well as a feeling of unwellness.
Other things that may be present during a heart attack include, fast breathing, racing pulse, cough, production of foaming saliva and profuse sweating.
Some conditions can make people more prone to heart attacks, examples include hypertension, diabetes, obesity, substance abuse (cocaine, smoking etc.), and lack of exercise. The risk is also increased in people born with heart defects and people with aggressive personality types.
What to do
Myocardial infarction (heart attack) is an emergency. If a person is noted with some of the above stated symptoms the priority is to transport the person to the hospital without delay.
The following actions can be taken while transporting the patient:
At the hospital
Patient would require:
Myocardial infarction is a serious medical condition and the risk of death is high up to 30% in the first 24 hours therefore emphasis should be on prevention.
Stroke, also known as a cerebrovascular accident (CVA) or ‘brain attack’ is a medical emergency in which there is reduced blood supply to an area of the brain causing severe injury or death of the brain cells involved.
High blood pressure or poorly controlled hypertension is the commonest cause of stroke. Others are smoking, obesity, high blood cholesterol, previous TIA, lack of exercise, diabetes mellitus, excessive alcohol consumption, smoking etc.
When you notice these in yourself or in someone else, you need to get yourself or the person to the hospital immediately:
Diagnosis of stroke can be achieved with patient’s history (of onset of symptoms) and physical examination in the clinic. Although history in some patients might not be helpful if they were alone at onset of symptoms and not able to communicate. Tests done to confirm a stroke would include a Computed Tomography scan or Magnetic Resonance Imaging.
Prompt presentation to the hospital, about 3-4 hours from onset of a stroke is lifesaving and will see that treatment to deter the progression of stroke, reduction/ resolution of most symptoms is achieved. Also, the risk factors are addressed like raised pressure, high blood cholesterol, poorly controlled diabetes mellitus and so on. Surgery may be needed to re-open narrowed blood vessels; this reduces the chances of blood clot formation. After a stroke, a patient may be placed on blood thinners to prevent blood clots from forming thereby preventing future reoccurrence of a stroke. This he would have to take for a long time and would need routine check-ups.
Most people who have had a stroke will be left with some form of disability, needing proper rehabilitation in the form of physiotherapy, speech therapy, occupational rehabilitation for full recovery. Some may never regain those functions that they lost while a stroke occurred. But routine checks and proper follow-up treatment need to be strictly adhered to, to reduce the risks of a repeat stroke which would be more debilitating or downright fatal.download documment
The use of endoscopy has revolutionized medical diagnosis and treatment, in that it aids quick and easy diagnoses, reduces the need for tests involving radiation (e.g CT scan) and helps achieve quicker and bloodless surgeries, thereby reducing hospital stay. It can be used to investigate symptoms or to perform certain types of surgeries.
Endoscopies are performed using an endoscope which is a long, thin, flexible tube with a light and a camera at one end.
WHY DO I NEED AN ENDOSCOPY?
Your doctor might recommend an endoscopy if you have any of these:
It is known as GASTROSCOPY if the oesophagus, stomach, or earlier part of the small intestine need to be looked at.
It is known as COLONOSCOPY if the bowels need to be looked at.
There are some other types of endoscopies which are used for other parts of the body:
BEFORE AN ENDOSCOPY
Before an endoscopy is carried out, your stomach will need to be empty. You will probably be asked to fast for several hours before the procedure. If a colonoscopy is to be done, you will be given a laxative to clear your bowels.
Sometimes antibiotics are prescribed.
Medicines which thin the blood may need to be stopped, to reduce the risk of bleeding.
It usually does not require overnight stay in the hospital, but you will be expected to have someone who can take you home, as you are likely to be sedated.
DURING AN ENDOSCOPY
This is usually not a painful procedure. It is done with the patient awake. You will usually be given a sedative to keep you calm and comfortable, as well as a local anaesthetic administered to numb the specific area of the body.
The endoscope is then gently passed into the required area – mouth and throat; or the bottom. The procedure normally lasts between 15 and 45 minutes.
AFTER AN ENDOSCOPY
You can go home shortly after the procedure but if you had a sedative you will need to rest for 1 to 2 hours.
If you had a sedative, you should have someone to take you home.
You may have some nausea and feeling of bloatedness. You may also have a sore throat for a couple of days.
You should rest for the day but should usually be able to resume normal work the following day.
WHAT ARE THE RISKS?
Complications following an endoscopy are rare but some of the possible risks include reactions to any of the drugs used or bleeding.
Other possible complications include fever, vomiting, abdominal pain, difficulty swallowing, very dark stools. If you experience these or any other symptoms you should contact your doctor.