Psychological distress in Prolapse inter vertebral disc.

The overall lifetime prevalence of back pain exceeds 70% in all industrial countries and the consequences include loss of 1.4 working days per person / per year; 10-15% of all sickness absence; Approximately 25% of the populations between the ages 40 to 50 have shown evidence of a Prolapse Inter Vertebral Disc on MRI scan, most of which were a symptomatic at the time. Study psychological distress in PIVD cases. Methods: A Clinical study of 81 cases of Prolapse Inter Vertebral Disc was done at APHA Super specialty clinic, Hyderabad and private clinic from 2006-2009 Results: 17.28% belongs to 45-49 years age , followed by 14.81% in 40-45 years age group, Gender females were more, Occupation: Non manual workers: 22, home makers: 27 manual workers: 32, social Group was: Low socioeconomic: 26,middle class: 37,upper middle class: 18, smokers were more than 50%, 90% were having psychological distress with apprehension about future, it was more in dropped out cases of 6.2% , remedies Lycopodium 30 , Kali carb 21 were leading, Result were as follows Relief of 76--99% in 30 cases, 51--75% in 30, 26-- 50% in 30, 0--25% in 10 cases and No dropped out were 6.2%. Ultimate answer was Pain reduction 90%, Work return 90%, increased physical function 60% and psychological wellbeing in 60 % cases. Discussion: Conventional systems of medicine have its limitation in tackling these disorders, and their approach in the treatment of disc prolapse is to provide temporary relief than a permanent cure through drugs and Microdisectomy, which a common Indian cannot afford. Homoeopathic system of medicine provides hope for a more permanent cure and relief if the treatment is planned methodically; in this system of medicine mental symptoms are given top priority. Conclusions: It found the holistic approach of Homoeopathy is very much pragmatic in dealing with PIVD disorders with psychological distress; still there is a lot to do to further validate the homoeopathic literature13
**** for full length article ref Asian journal of Homoeopathy,vol 4 no 4 (13) Nov 2010 -Jan 2011.

Uncertainty in primary level of prevention OF SWINE FLU

Demand for preventive medicine is enormously more from all quarters, but there was delay in selecting the Genus Epidemicus. Various homoeopaths gave different preventive medicines as shown above. This may be due to restrictions to see positive cases by health authorities. Even when symptoms were repertorised few remedies were coming, even this was also not taken into consideration. Mean while chemists exploited the situation as described above. Lastly on August 31, 2009 the Group of Experts (CCRH) inter-alia has recommended that homoeopathy medicine Arsenicum album could be taken as prophylactic medicine against Flu like illnesses, a senior health ministry official said. It has recommended one dose of Arsenicum album 30, daily on an empty stomach for three days. The dose should be repeated after one month by following the same schedule in case flu like conditions prevails in the area. Very few segments are following the above instructions. Social and preventive department of every homoeopathic college should take up this challenging work of primary level of prevention to save the desperate humanity who can be victims of said Epidemic.
Detailed article published in Vital Informer2010

wonders of homoeopathy an evidenced based study-Dr G R Mohan

19th of November 2010,It is a thrilling movement for me as my book titled “wonders of homoeopathy an evidenced based study “written by me was accepted to publish by ‘ New central book agency (p) ltd, Kolkata , the day happened to be birth day of smt Indira Gandhi ,our beloved former prime minister of India.

200th year of Celebrations of Organon of medicine at Devs Homoeopathic Medical College, Ankireddy palli, A P

On 24th December2010 Staff and students of Devs Homoeopathic Medical College, Ankireddy palli, RR District, Andhrapradesh celebrated 200th year of Organon of medicine. An elocution competition was conducted on this Eve. Ten students participated. They spoke on importance of organon medicine.

Devs homoeopathic medical college,Vanbhojan

4th December we staff members and students celebrated Kartika Vanbhojan. Vanbhojan, is a kind of ritual annual picnic undertaken during Kartika masam in Andhra Pradesh. To remove fear among students who joined our new college ( Devs homoeopathic medical college, Ankireddy palli,RR District,AP),were also invited.Even though I was the sponsor, Dr Hanumantha rao took all the pains in spotting the location and arranging delicious lunch at Deva nagar. Prof Shankar, Dr H Rao along with other staff members entertained the students, in turn students reciprocated with songs, Dr Satya dev President and Dr Vasu dev Vice president of Devs Educational Society graced the event. Both congratulated the new students who joined BHMS course and advised to do hard work to serve the suffering humanity.

Glaucoma case cured by homoeopathy

Glocoma Case 3:6
Glaucoma affects the optic nerve and cause vision loss. An elevated IOP is the most important risk factor for the development of Glaucoma. Normal IOP is can range from 10-21 mm Hg. Laser trabeculoplasty will not cure glaucoma. In most cases it brings the eye pressure back under control by improving drainage of fluid from the eye. Once the optic nerve has been damaged, it cannot be repaired. In Homoeopathic system there are quite good number of remedies, one of these is Osmium is a metal of the Platinum group. Which has reduced IOP.
Prescribing totality was as follows,
Gen air open >
Eyes Pain burning
Vision dim
Glaucoma
Vision Colors before eyes
Eye pain general touch <
Photophobia
Belladonna 17/7, Phosphorus 14/7 (complete rep, Hompath classic 8)
18/09/04 Belladonna 200c,25/09/04 Phosphorus 0/1, 5doses, 07/10/04 Phosphorus 0/3, 5doses did not give expected relief of symptoms.
Case was reviewed and Boericke and Clarke materia medicas were referred and osmium 30, 5doses was given on the bases of “Increase in intra-ocular tension, dim sight, and photophobia. Violent supra and infra-orbital neuralgia, violent pains and lachrymation. Green colors around the light. Always found. Open air helps the smarting in eyes”.
25/10/04 patient was cheerful and said he is better by 40—50%, still vision was poor but it was comparatively better after osmium. Osmium 200c was given 3doses with 10days placebo. 08/11/04 case was sent ophthalmologist for IOP measurement and advice. IOP has reduced; ophthalmologist has advised him to continue the same treatment.6

AIDS DAY CONDUCTED

WORLD AIDS DAY CONDUCTED AT DEVS HOMOEOPATHIC MEDICAL COLLEGE,

AIDS day was conducted in DEVS HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL, on 1-12-2010(Wednesday). Ankireddy Palli, R.R.Dist., On this occasion elocution competition was conducted among the students. Dr.G.R.Mohan , Principal of the college sponsored prizes for the winners.
Ms RAPOLU SWETHA won the first prize,second prize won by Ms ALEKHYA and third prize by Mr NARESH

DEVS HOMOEOPATHIC DISPENCERY INAUGARETED

Under the auspices of Dev’s Homeopathic Medical College and Hospital, Ankireddypalli. A satellite homeopathic dispensary is inaugurated in Ankireddypalli village on 01 – 12 – 2010, Wednesday by Shri. Satyanarayana, Surpanch of the village. Many prominent persons of the village attended the function.
Shri. Mallesh Dupty. Surpanch, Dr. N. Satyadev, Director of the Devs Medical Educational Society and Smt. Lakshmi Devi Satyadev lightened the lamp.
Dr. N. Satyadev said many medical camps will be conducted in future to meet the needs of the rural population and to achieve health to all.
Dr. G.R. Mohan principal, devs homeopathic medical college appealed the gathering to utilize the medical facilities offered by the dispensary.
Dr. M. Ramakrishna Professor and medical superintendent of Devs Homeopathic Medical College and hospital recorded the first case and dispensed.

Psoriasis case treated with Homoeopathy

Skin disease infrequently kills, But Often produces unhappiness, Usually loss of work and social Deprivation as well as considerable Physical discomfort.

In conventional system of medicine scope of treatment is very less in psoriatic skin diseases; In Homoeopathic system psoriatic skin diseases can be treated successfully. Case below is an evidenced based example how homoeopathy can cure a case of psoriatic skin diseases

Patient Ms T, aged 33y,house wife, came on (03/01/2009)with eruptions over ears, scalp, hands , neck ,hairline margin with itching, patient was thirst less, Weight was 47 Kgs,

Case was diagnosed as Psoriasis by local dermatologist.

F/H: DM & HTN

The case was repertorised by Phataks method

Reportorial analysis is : Graphites 20/2, Pulsatilla 20/2, sepia 21/2,

3/01/09 : eruption over ears, scalp, hands with itching ,sadness, Pulsatilla was selected giving importance to Thirst less ,aversion to water Pulsatilla 30,3 doses were given placebo for 30 days, diet advice was given.

06/02/09 – eruption increased with itching, oozing was present, and Graphites 30, 3 doses, Placebo for 15 days, advice about diet and personal cleanliness was given.

21/05/09 Due domestic problems she came late after one month and half, she was better for some time and again itching, oozing started in the same places, Graphites 30,3 doses, Placebo for 15 days,

30/07/09 oozing is lees, itching is less, sadness still persisting Graphites 200, 3 doses, Placebo for 30days were given

03/08/09 no oozing, itching is less, sadness is less, scalp still scales are seen, hair fall still persisting, Graphites 200, 3 doses, Placebo for 30days were given.

30/10/09 no oozing, occasional itching, sadness is less, scalp scales are few seen, hair fall better, Placebo for 30days were given

24/11/09: itching increased,

Graphites IM, 1doses, Placebo for 30days were given

25/12/09 skin totally cleared from eruptions, Placebo for 30days was given

29/06/2010 she came after 6 months after stopping medication (as shown in visual)

Complete article published in : please visit it at: http://ezine.homeorizon.com/homeopathy-and-dermatology.php, Volume: 3, Issue: 10, Aug, 2010

Psoriasis case treated with Homoeopathy

Psoriasis case treated with Homoeopathy

Skin disease infrequently kills, But Often produces unhappiness, Usually loss of work and social Deprivation as well as considerable Physical discomfort.

In conventional system of medicine scope of treatment is very less in psoriatic skin diseases; In Homoeopathic system psoriatic skin diseases can be treated successfully. Case below is an evidenced based example how homoeopathy can cure a case of psoriatic skin diseases

Patient Ms T, aged 33y,house wife, came on (03/01/2009)with eruptions over ears, scalp, hands , neck ,hairline margin with itching, patient was thirst less, Weight was 47 Kgs,

Case was diagnosed as Psoriasis by local dermatologist.

F/H: DM & HTN

The case was repertorised by Phataks method

Reportorial analysis is : Graphites 20/2, Pulsatilla 20/2, sepia 21/2,

3/01/09 : eruption over ears, scalp, hands with itching ,sadness, Pulsatilla was selected giving importance to Thirst less ,aversion to water Pulsatilla 30,3 doses were given placebo for 30 days, diet advice was given.

06/02/09 – eruption increased with itching, oozing was present, and Graphites 30, 3 doses, Placebo for 15 days, advice about diet and personal cleanliness was given.

21/05/09 Due domestic problems she came late after one month and half, she was better for some time and again itching, oozing started in the same places, Graphites 30,3 doses, Placebo for 15 days,

30/07/09 oozing is lees, itching is less, sadness still persisting Graphites 200, 3 doses, Placebo for 30days were given

03/08/09 no oozing, itching is less, sadness is less, scalp still scales are seen, hair fall still persisting, Graphites 200, 3 doses, Placebo for 30days were given.

30/10/09 no oozing, occasional itching, sadness is less, scalp scales are few seen, hair fall better, Placebo for 30days were given

24/11/09: itching increased,

Graphites IM, 1doses, Placebo for 30days were given

25/12/09 skin totally cleared from eruptions, Placebo for 30days was given

29/06/2010 she came after 6 months after stopping medication (as shown in visual)

.

Psoriasis case treated with Homoeopathy

Patient Ms T, aged 33y,house wife, came on (03/01/2009)with eruptions over ears, scalp, hands , neck ,hairline margin with itching, patient was thirst less, Weight was 47 Kgs,

Case was diagnosed as Psoriasis by local dermatologist.

F/H: DM & HTN

The case was repertorised by Phataks method

Reportorial analysis is : Graphites 20/2, Pulsatilla 20/2, sepia 21/2,

3/01/09 : eruption over ears, scalp, hands with itching ,sadness, Pulsatilla was selected giving importance to Thirst less ,aversion to water Pulsatilla 30,3 doses were given placebo for 30 days, diet advice was given.

06/02/09 – eruption increased with itching, oozing was present, and Graphites 30, 3 doses, Placebo for 15 days, advice about diet and personal cleanliness was given.

21/05/09 Due domestic problems she came late after one month and half, she was better for some time and again itching, oozing started in the same places, Graphites 30,3 doses, Placebo for 15 days,

30/07/09 oozing is lees, itching is less, sadness still persisting Graphites 200, 3 doses, Placebo for 30days were given

03/08/09 no oozing, itching is less, sadness is less, scalp still scales are seen, hair fall still persisting, Graphites 200, 3 doses, Placebo for 30days were given.

30/10/09 no oozing, occasional itching, sadness is less, scalp scales are few seen, hair fall better, Placebo for 30days were given

24/11/09: itching increased,

Graphites IM, 1doses, Placebo for 30days were given

25/12/09 skin totally cleared from eruptions, Placebo for 30days was given

29/06/2010 she came after 6 months after stopping medication (as shown in visual)

Psoriasis case treated with homoeopathy

Patient Ms T, aged 33y,house wife, came on (03/01/2009)with eruptions over ears, scalp, hands , neck ,hairline margin with itching, patient was thirst less, Weight was 47 Kgs,

Case was diagnosed as Psoriasis by local dermatologist.

F/H: DM & HTN

The case was repertorised by Phataks method

Reportorial analysis is : Graphites 20/2, Pulsatilla 20/2, sepia 21/2,

3/01/09 : eruption over ears, scalp, hands with itching ,sadness, Pulsatilla was selected giving importance to Thirst less ,aversion to water Pulsatilla 30,3 doses were given placebo for 30 days, diet advice was given.

06/02/09 – eruption increased with itching, oozing was present, and Graphites 30, 3 doses, Placebo for 15 days, advice about diet and personal cleanliness was given.

21/05/09 Due domestic problems she came late after one month and half, she was better for some time and again itching, oozing started in the same places, Graphites 30,3 doses, Placebo for 15 days,

30/07/09 oozing is lees, itching is less, sadness still persisting Graphites 200, 3 doses, Placebo for 30days were given.

03/08/09 no oozing, itching is less, sadness is less, scalp still scales are seen, hair fall still persisting, Graphites 200, 3 doses, Placebo for 30days were given.

30/10/09 no oozing , occasional itching ,sadness is less ,scalp scales are few seen, hair fall better , Placebo for 30days were given.

24/11/09 : itching increased,

Graphites IM,1doses,Placebo for 30days were given

25/12/09 skin totally cleared from eruptions, Placebo for 30days was given

29/06/2010 she came after 6 months after stopping medication (as shown in visual

***** original power point presentation published in August , 2010, Hpathy ezine,

Acute abdomen, Dr Ramachandrarao second memorial Oration, AP Homoeopath association,Hyderabad

Acute abdomen.

Dr.A.Y.Chary.

M.S,F.I.C.S.

Former Director of Medical Education – Govt. of A.P

Dean DR. VRK Women’s’ Medical college.

Hyderabad.

Definition.

Acute abdomen is a clinical condition of varied aetiology in which the pt. presents with an urgent episode of abdominal problem, which requires immediate evaluation and treatment, if not is associated with real morbidity and mortality.

Incidence.

50% of all surgical emergencies that come to any major hospital are due to acute abdomen. It constitutes as a major component of non traumatic emergencies. No age is bar from presentation and equally common in both sexes but the causes related to female genital system playing a major role in incidence in female pts. The presentation is atypical in extremes of age with related morbidity and mortality. Some causative factors and incidence is more to some geographical areas and it is important to note the fact while making the diagnosis.

Causes.

Diseases causing and presenting clinically as acute abdomen are varied and may differ from male to female, age wise and geographically. As abdomen is known as Pandora’s Box, some surprises are always present as causative factors. The presentation may be entirely because of a problem away from the abdomen and clinically may present as acute abdomen.

The causes can be broadly grouped into

a. Inflammatory.

b. Perforation or disruption

c. Intestinal obstruction.

d. Vascular

e. Miscellaneous.

a.inflammatory.

They account for the major cause for acute abdomen. Any organ within the abdomen which is inflamed can present as an acute abdomen. The common conditions are –

Acute appendicitis.

Acute cholecystitis.

Pancreatitis.

Diverticulitis.

Regional ileitis.

pyelonephritis

b. perforation or disruption.

Duodenal ulcer.

Gastric ulcer.

Anastomatic ulcer.

Intestinal – typhoid, tuberculosis.

Malignancy.

Gangrenous bowel.

Their clinical mode of presentation is due to peritonitis that sets in.

c. obstruction.

Small bowel obstruction.

Large bowel obstruction.

Luminal obstruction – secondary to stones, clots, foreign bodies.

Vascular obstruction.

The obstruction can be with in the wall, in the lumen, or outside the lumen leading to kinking and obstruction. The obstruction can be mechanical or paralytic which can set in late stages of peritonitis.

d. miscellaneous.

The causes can be non surgical and away from the abdomen with typical presentation and becomes difficult to make a diagnosis correctly clinically.

Lower lobe pneumonia.

Uncontrolled diabetes.

Porphyrias.

Sickle cell disease.

Filariasis.

Hypercalcemia.

Long term usage of steroids.

Spinal problem

Testicular torsion.

Certain causes are exclusively present in female sex which are related to genital tract, like

Ruptured ectopic pregnancy.

Ruptured ovarian follicle –Mittelschmerz.

Twisted ovarian cyst.

Pelvic inflammations.

Endometriosis.

In children.

Following conditions can present as acute abdomen.

Intususception.

Worms.

Non specific mesenteric adenitis.

Meckel’s diverticuliyis.

Mumps.

In elderly.

Apart from the above causes, malignancy and vascular causes may play a role in the presentation. With advancing age, obstructive urological causes like BPH may be the presenting cause.

Geographically.

Sickle cell disease is more prevalent in Middle East, worms and filariasis more common in tropical countries and developing countries and one should keep in mind these conditions while making diagnosis.

Clinically.

The presentation is always sudden, urgent and acute. In some, previous history of similar episodes may be present. A thorough elicitation of clinical history is very important for proper diagnosis and management. Following are the common symptoms with which a pt of acute abdomen presents.

a. Pain.

b. Nausea

c. Vomiting

d. Distention of abdomen.

e. Disturbed bowel motility – constipation, loose motions

f. Fever – low grade, high grade with chills and rigors.

g. Associated organ symptoms – jaundice, hematuria, chyluria

Pain.

Most common presentation. Pt. presents to the hospital because of the sudden development of pain. The severity depends upon the pathology. It could be a

“Burning” type which is classically seen with inflammatory pathology, “colicky “which is classically seen with obstruction commonly due to a calculus. The pain may get radiate to the back, towards the groin, may get referred to back, shoulder. There may be shift in the perception of pain from umbilical region to rt. Iliac fossa as classically seen with ac. Appendicitis. The pain may get aggravated in relation to natural acts like breathing, passage of urine etc. The pain usually increases in intensity as the time passes by depending upon the pathology. Sudden subsidence of the pain with no improvement in the condition may denote setting up of gangrene in a case of intestinal obstruction. The site of presence of the pain may give a rough idea about the anatomical structure involved in the pathology.

Nausea and vomiting.

Commonly associated symptoms in acute abdomen. Nausea and vomiting can be secondary to a reflex phenomenon due to inflammatory pathology or colic. Mechanical obstruction is always associated with vomiting, higher the levethe peritoneuml of obstruction, more will be vomiting. Important to note the nature of vomitus – plain fluid, bile, blood, or feculent.

If pain is first and then vomiting, it could be secondary to an inflammatory pathology. If vomiting first and then the pain, it could be secondary to any obstruction.

Distention.

Varying degree of distention of abdomen is common with intestinal obstruction and peritonitis. It may involve whole of the abdomen or localized to upper, middle or lower abdomen depending upon the level of obstruction.

Bowel symptoms.

Majority of acute abdominal conditions present with varying degrees of constipation. With intestinal obstruction the pt may present with absolute constipation. With pelvic inflammation the presentation can be with loose motions.

Other symptoms.

The pt. may present with dysura, frequency or frank hematuria with pain if the pathology is confined to urinary system. A female pt may present with shock if it is a case of ruptured ectopic pregnancy.

Examination.

A thorough clinical examination is performed to come to a provisional diagnosis. Look for jaundice, anemia and shock. Record blood pressure and temperature and pulse as basic evaluation. Expose entire abdomen and hernial orifices and look for movement with respiration of all the quadrants of abdomen, areas of tenderness, rebound tenderness, local guarding and rigidity, obliteration of liver dullness which all indicates under lying inflammation of peritoneum secondary to plain inflammation or perforation of a hollow viscus. Look for distention, visible peristalisis, exaggerated intestinal sounds all suggesting the possibility of obstruction. Look at the hernial sites and exclude any obstructed hernia. Special signs may be noted as Cullen’s sign, Grey turner’s sign with acute pancreatitis, Rovsing’s sign with acute appendicitis, Boa’s sign with acute cholecystitis. Palpate testis and the cord and exclude any torsion, inflammation of the cord. Do a vaginal examination in female and rectal examination and note for any tenderness, bulge, discharge, or blood. Examine the chest and exclude any lower lobe pneumonia, examine the spine and asses the pt’s psychological status as some pts may mimic as acute abdomen.

After clinical examination one can come to a reasonable provisional diagnosis of acute abdomen and require to be substantiated by investigations.

Investigations.

These are ordered to confirm or exclude the clinical diagnosis and should be used judiciously so as to minimize the pts’ suffering.

Radiological.

This forms the basic level of investigation and 80-90% of the cases can be diagnosed. A simple plain film gives maximum information in acute abdomen.

Plain film of the abdomen.

Single most informative investigation. Can be taken as a supine film in case of obstruction or an erect film incase of perforation. One can detect “free” gas beneath the domes of diaphragm denoting a perforation of a hollow viscus, “air fluid” levels in a case of obstruction, presence of radio opaque shadows in the region of kidney, ureter,bladder, gall bladder, pancreas. Can show volvulous of large bowel, ischemia of the bowel etc.

An x-ray chest is helpful to exclude the possibility of any lung pathology.

Contrast films.

Gastrgraffin based contrast films may demonstrate perforation, level of obstruction etc. intravenous urograms may confirm the presence of radio opaque shadows as renal, ureteric or vesical calculi. Contrast films are not ordered as a routine in emergency situation.

Scans.

These non invasive investigations are quite handy to come to a diagnosis at the earliest and help in the management.

Ultra sound scan.

Basic scan that is ordered. Helpful in identifying calculous cholecystits and urinary calculi. Its role is of paramount importance in the diagnosis of gynaec and obgy problems like ectopic pregnancy. Not of much help in the diagnosis of pancreatic and intestinal pathology.

C.T.scan

Ct scan with and without contrast gives an accurate assessment for pancreatic and intestinal pathology. Helpful tool in the management.

MRI scan.

Useful in the assessment of ischemia of the bowel and to exclude and spinal problem

Endoscopic evaluation.

An upper G.I or a lower G.I endoscopy may be required in some special situations as a diagnostic and therapeutic tool.

Laparoscopy.

Laparoscopic evaluation may be required both as diagnostic and therapeutic option in some cases of perforation, adhesive obstruction, and to diagnose pelvic pain in a female pt. This modality is being put to practice commonly in recent times.

Lab investigations.

These investigations are helpful in the diagnosis due to their altered values and also act as a basic level information about the pt. they include cbp, complete urine examination, blood sugar, urea estimations, serum creatinine, amylase, lipase levels and serum electrolytes and liver function tests, calcium estimations. A high total count and rise in neutrophil count indicates inflammatory pathology. In acute pancreatitis serum amylase and lipase levels are elevated.

The clinical picture, examination along with the investigations will give in majority of the cases a definitive diagnosis so as to fashion the treatment. There are always some vagaries attached which do not fall into classical presentation and a good clinical experience sometimes helps in solving the problem and managing it.

Management.

Once the diagnosis is made, an initial assessment of the nature of the condition is to be made. Is it a major surgical problem or a minor one has to be decided? Colic’s of various natures fall into the category of minor problem and can be managed as a day care. Majority of the presentations require to be admitted to surgical observation come treatment wards.

Colic’s are managed by giving antispasmodics parenterally and starting i.v fluids and sedating the pt. Biliary colic with associated block of the cbd may require endoscopic sphincterotomy and extraction of the stone from cbd. An appropriate antibiotic coverage is mandatory. Ureteric stones with colic are managed with stenting and extraction of the stone. Once the colic subsides further evaluation for the cause and subsequent management is planned.

All the pts who require surgery or intensive care management are hospitalized and following protocol is followed in preparing the pt. for surgery.

a. nil per oral

b. naso gastric tube aspiration – more important with obstructions

c. Correction of shock and fluid and electrolyte and acid base imbalance.

d. Pre operative broad spectrum antibiotic.

e. Preparation of the part to be operated.

f. Grouping and typing and reserving necessary units of blood for the nature o

g. f disease status and surgery.

Surgical procedures.

Various surgical procedures are available depending upon the presentation and nature of the causative factor. The aim should be to perform optimal , necessary surgery and sometimes to bare minimal procedure to overcome the emergency situation to tide over the crisis with a view to correct the problem in totality at a second stage procedure. The well being of the pt should be the supreme concern.

Presently some of these surgical procedures are being performed laparoscopically with good results. Inflamed appendix and gallbladder are surgically removed. Perforations of hollow viscus are closed with omental patch. Sometimes intestinal perforations confined to a segment may require local resections. Adhesolysis, separation, division, untwisting of the loops, correction of internal herniation , resection and anastmosis , bypass or a colostomy, ileostomy may be required in cases of intestinal obstruction of various causes. Ruptured ectopic pregnancy is excised after stabilizing the pt. some of these conditions require thorough peritoneal lavage with saline and drainage. If the bowel happens to be gangrenous, may require to be exteriorized. The surgeon with his expertise should decide on the table what is advisable to that pt. and should be executed with all firmness.

Post operatively these pts should be managed in surgical intensive care.

Conservative management.

Some conditions like acute pancreatitis are managed conservatively and as and when an indication develops are subjected to surgery. Appendicular mass is managed conservatively and once the lump subsides interval appendectomy can be planned. Some of the of the sub acute obstructions may be managed conservatively.

Summary.

Acute abdomen is one of the commonest of presentation of surgical emergency. A detailed clinical history with thorough clinical examination with judicious use of available investigations will clinch the diagnosis in majority of the case. With a good preparation, the pts. are to be managed conservatively or by definitive surgery with a specific aim of circumventing the problem and saving the life of the pt.

Newer modalities of investigation, techniques are evolving as a good armamentarium for the surgeon.

Some of the common conditions and their presentation.

Acute appendicitis

a. Common presentation.

b. Commonly in young but no age is bar.

c. Pain around umbilicus and later shifts to rt. Iliac fossa.

d. Nausea and vomiting.

e. Mild constipation

f. Rt.iliac fossa tenderness, guarding or rebound at Mc.Burney point.

g. Leukocytosis, neutrophil leukocytosis.

h. U.s scan can diagnose and exclude other conditions.

i. Vagaries.

. Infants and children – no localization. Danger of perforation and peritonitis.

Elderly – gangrene and perforation common, high grade fever.

Obese pts – delay in diagnosis.

Pregnancy – tenderness at a higher point.

Perforation

a. sudden pain, may be associated with shock

b. Nausea and vomiting.

c. Previous history of ulcer pain.

d. Tenderness and guarding of rt. Hypochondrium

e. Obliterated liver dullness

f. Silent abdomen.

g. Diagnosis by plain erect film abdomen.

Intestinal obstruction.

a. colicky abdominal pain.

b. Vomiting

c. Abdominal distention.

d. Visible peristalisis

e. Empty rectum.

f. Disturbed fluid and electrolyte balance.

g. Plain film erect, supine, CT diagnostic.

Ectopic pregnancy.

a. H/o amenorrhea.

b. Pain lower abdomen with shock.

c. Pallor

d. Lower and pelvic examination – tenderness.

e. U.S scan diagnostic.

Lifestyle diseases and Homeopathy

This year’s theme of world health organisation is “Urbanization: a challenge for public health “

WHO health defined as “Health is a state of complete physical, mental and social well-being not merely absence of disease or infirmity In Present Rapid urbanization all the three are lacking. Leading to Lifestyle diseases

Lifestyle diseases (diseases of civilization) are a result of an inappropriate relationship of people with their environment. The onset of these lifestyle diseases is insidious, they take years to develop, and once encountered do not lend themselves easily to cure. Common causes of Lifestyle diseases are going from natural diet to artificial diet like junk food , reduction in physical activity and substance abuse like tobacco smoking and alcohol to relive stress.

The top 10 Lifestyle diseases are Alzheimer's disease, Arteriosclerosis, Cancer, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease, Diabetes, Heart Disease, Chronic Renal Failure, obesity and Stroke. The World Health Organisation (WHO) has warned that more than 270 million people are susceptible to Lifestyle diseases .By 2020 Lifestyle diseases are expected to claim 7.63 million lives in India, compared to 3.78 million in 1990, a study said.

Stress in Urban areas is more, we can scan body of human being but not the mind, and for example parents are worried about their children return from school as accidents, violence are seen more , worried about future of their children in the competitive world. problem of unemployment in youth, marital disharmony, insecurity and violence in most of the days. 6 –11 years children facing stress at three levels, school, family, neighbourhood, which leading to adjustment problems in some groups of BPL. Cost of sim card of a mobile is cheaper than a nutritive fruit which is a must for a person . The urban population suffer from various communicable diseases such as Tuberculosis and HIV/AIDS, non communicable diseases, accidents and stress related problems. A recent study had estimated that nearly 11 per cent of India's urban population and three per cent of rural population above the age of 15 have diabetes. Factors in diet, lifestyle, and the house are thought to influence susceptibility to the diseases.

Homeopathic system has vast superiority over other systems in treating Lifestyle diseases and stress related diseases. Patents must be carefully interrogated on mental and physical constitution. The Psychic changes of the patients under the influence of his morbid state are very important. The Rare peculiar and strange symptoms are very important. The psychic sphere which is very important for therapeutically. Dr Hahnemann reminds one in this paragraph that the homeopath must take into account exciting, maintaining, and fundamental causes such as the miasms while recording the totality of the symptoms, causation of disease is very important in selecting the remedy. In Homoeopathic system remedies are prepared from various sources and these are proved on healthy human beings not like animal proving which is done in conventional system. Constitution of an individual is studied in detail (mental, physical aspects) and a constitutional remedy is prescribed. This helps in combating the known and unknown stress and other Life style diseases.

In all life style disorders maintaining factor are important factors in prolonging the disease process . like regular intake of more than required amount of salt, rich food, junk food, Purpose less eating more than required amount of food with less physical exercise leading to obesity, using substances like tobacco, alcohol to relive constant worry and anxiety due to various causes in day to day life.

It is the duty of a Physician to educate the people to avoid such (causa occasionalis) maintaing causes. In reality how mush a physician can succeed depends on the cooperation of the people. Attitude of the people should change. As quoted by Thomas Leonard

A lifestyle is what you pay for; a life is what pays you.”.