General Medicine

What is Diabetes?

Diabetes is a chronic condition characterised by high blood glucose levels (hyperglycaemia). Diabetes occurs when the pancreas loses its ability to produce enough insulin (a type of hormone), or when the body does not respond to insulin action. When blood glucose (sugar) levels increase, after we eat, the pancreas secretes insulin to help body cells convert glucose into energy, or to store it.

In people with Diabetes, instead of the glucose being converted to energy, it remains in the blood, therefore leading to higher than normal blood glucose levels. People with Diabetes have an increased risk of developing cardiovascular (heart-related) diseases, because it is often associated with high blood pressure, high cholesterol levels and obesity.

There are three main types of Diabetes:

• Type 1 Diabetes occurs when no insulin is produced, known as insulin-dependent Diabetes
• Type 2 Diabetes occurs when insulin is ineffective, known as non-insulin-dependent Diabetes
• Gestational Diabetes Mellitus (GDM) occurs in 2-5% of pregnant women not previously diagnosed with Diabetes. It is often associated with Type 2 Diabetes.

Causes of Diabetes

Type 1 Diabetes is caused by the absolute lack of insulin in the body, due to the destruction of the pancreatic cells responsible for insulin secretion. Type 1 Diabetes is the most common cause of childhood diabetes. People with this form of diabetes require daily insulin injection to survive.

Type 2 Diabetes is marked by decreased levels of insulin or the inability of the body to use insulin properly (known as insulin resistance). The onset of this form of diabetes is usually gradual with symptoms generally appearing after the age of 40. Various risk factors can lead to Type 2 Diabetes including lack of physical activity, unhealthy diet, and obesity. People with Type 2 Diabetes often have a family history of the disease.

Gestational diabetes occurs in 2-5% of pregnant women who were not previously diagnosed with diabetes. It usually disappears after giving birth, however it is a marker of increased risk of developing Type 2 Diabetes later in life.

Symptoms

The most common symptoms of diabetes are:

• Blurry vision
• Constant hunger
• Extreme thirst, even after drinking plenty of water
• Feeling tired or weak constantly
• Frequent urination day and night
• Irritated and itchy skin around the genitals
• Numb hands and feet
• Reduced healing of cuts and wounds
• Weight loss despite normal appetite

Treatment in General Medicine

Type 1 Diabetes treatment includes:

• Daily insulin injection to survive

Type 2 Diabetes treatment mainly includes lifestyle changes to control blood glucose level:

• Eat a balanced and healthy diet: avoid food high in fats and cholesterol, increase intake of fruits and vegetables, and watch your sugar consumption
• Exercise regularly
• Maintain a healthy weight
• Oral medications may be prescribed by your doctor at the later stage of the disease to help control blood glucose level
• Approximately 40% of people with type 2 diabetes require insulin injections.

Complications of Diabetes

Heart disease Heart disease is the leading cause of diabetes-related deaths. Adults with diabetes have heart disease death rates about two to four times as high as that of adults without diabetes.

• Stroke: The risk of stroke is two to four times higher in people with diabetes.
• High blood pressure: An estimated 60% to 65% of people with diabetes have high blood pressure.
• Blindness
  • Diabetes is the leading cause of new cases of blindness in adults 20 to 74 years old.
  • Diabetic retinopathy causes from 12,000 to 24,000 new cases of blindness each year.
• Kidney disease Diabetes is the leading cause of end-stage renal disease, accounting for about 40% of new cases.
• Nervous system disease
  • About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage (which often includes impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems).
  • Severe forms of diabetic nerve disease are a major contributing cause of lower extremity amputations.
• Amputations: More than half of lower limb amputations in the United States occur among people with diabetes.
• Dental disease: Periodontal disease (a type of gum disease that can lead to tooth loss) occurs with greater frequency and severity among people with diabetes. Periodontal disease has been reported to occur among 30% of people aged 19 years or older with type 1 diabetes.
• Complications of pregnancy: The rate of major congenital malformations in babies born to women with preexisting diabetes varies from 0% to 5% among women who receive preconception care to 10% among women who do not receive preconception care.
• Other complications
  • Diabetes can directly cause acute life-threatening events, such as diabetic ketoacidosis* and hyperosmolar nonketotic coma.*
  • People with diabetes are more susceptible to many other illnesses. For example, they are more likely to die of pneumonia or influenza than people who do not have diabetes.

Remark: *Diabetic ketoacidosis and hyperosmolar nonketotic coma are medical conditions that can result from very high glucose level and biochemical imbalance in uncontrolled diabetes.

Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes and, much less commonly, of type 2 diabetes. DKA happens when your blood sugar is very high and acidic substances called ketones build up to dangerous levels in your body.

It’s less common in people with type 2 diabetes because insulin levels don’t usually drop so low; however, it can occur. DKA may be the first sign of type 1 diabetes, as people with this disease can’t make their own insulin.

Symptoms

• frequent urination
• extreme thirst
• high blood sugar levels
• high levels of ketones in the urine
• nausea or vomiting
• abdominal pain
• confusion
• fruity-smelling breath
• a flushed face
• fatigue
• rapid breathing
• dry mouth and skin

DKA is a medical emergency. Call your local emergency services immediately if you think you are experiencing DKA.

If left untreated, DKA can lead to a coma or death. If you use insulin, make sure you discuss the risk of DKA with your healthcare team and have a plan in place. If you have type 1 diabetes, you should have a supply of home urine ketone tests. You can buy these in drug stores or online.

If you have type 1 diabetes and have a blood sugar reading of over 250 milligrams per deciliter (mg/dL) twice, you should test your urine for ketones. You should also test if you are sick or planning on exercising and your blood sugar is 250 mg/dL or higher.

Call your doctor if moderate or high levels of ketones are present. Always seek medical help if you suspect you are progressing to DKA.

Treatment in General Medicine

The treatment for DKA usually involves a combination of approaches to normalize blood sugar and insulin levels. Infection can increase the risk of DKA. If your DKA is a result of an infection or illness, your doctor will treat that as well, usually with antibiotics.

Fluid replacement

At the hospital, your physician will likely give you fluids. If possible, they can give them orally, but you may have to receive fluids through an IV. Fluid replacement helps treat dehydration, which can cause even higher blood sugar levels.

Insulin therapy

Insulin will likely be administered to you intravenously until your blood sugar level falls below 240 mg/dL. When your blood sugar level is within an acceptable range, your doctor will work with you to help you avoid DKA in the future.

Electrolyte replacement

When your insulin levels are too low, your body’s electrolytes can also become abnormally low. Electrolytes are electrically charged minerals that help your body, including the heart and nerves, function properly. Electrolyte replacement is also commonly done through an IV.

What is Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. Usually hypertension is defined as blood pressure above 140/90, and is considered severe if the pressure is above 180/120.High blood pressure typically does not cause symptoms. Over time, if untreated, it can cause health conditions, such as heart disease and stroke.

Causes

The causes of Hypertension are unknown in 95% of patients. In 5% of cases, some specific conditions can be responsible for the high blood pressure, such as kidney disease, atherosclerosis and hormonal imbalance. There are also several risk factors that may increase your chances of developing hypertension including diabetes, obesity as well as a strong family history of the disease.

Symptoms

Hypertension usually does not lead to any symptoms, but in the long term it can damage various organs and lead to the following:

• Headache and giddiness (in severe cases)
• Heart attack
• Heart failure
• Kidney disease
• Stroke

Treatment in General Medicine

Your doctor will evaluate your condition and discuss with you the range of treatment options available. These include a combination of:

• lifestyle changes to improve your general health:
• Eating a healthy diet (limit your intake of salt, cholesterol, and all fat types, and increase fibre intake)
• Exercise regularly
• Limit your alcohol consumption
• Maintain a healthy weight
• Quit smoking
• monitoring of blood pressure at home
• visiting your doctor for regular check-ups to better manage your condition and avoid any potential complications

Antihypertensive medications may also be prescribed, and these need to be taken regularly and permanently.

• Beta-blockers: Beta-blockers make your heart beat slower and with less force. This reduces the amount of blood pumped through your arteries with each beat, which lowers blood pressure. It also blocks certain hormones in your body that can raise your blood pressure.
• Diuretics: High sodium levels and excess fluid in your body can increase blood pressure. Diuretics, also called water pills, help your kidneys remove excess sodium from your body. As the sodium leaves, extra fluid in your bloodstream moves into your urine, it helps lower your blood pressure.
• ACE inhibitors: Angiotensin is a chemical that causes blood vessels and artery walls to tighten and narrow. ACE (angiotensin converting enzyme) inhibitors prevent the body from producing as much of this chemical. This helps blood vessels relax and reduces blood pressure.
• Angiotensin II receptor blockers (ARBs): While ACE inhibitors aim to stop the creation of angiotensin, ARBs block angiotensin from binding with receptors. Without the chemical, blood vessels won’t tighten. That helps relax vessels and lower blood pressure.
• Calcium channel blockers: These medications block some of the calcium from entering the cardiac muscles of your heart. This leads to less forceful heartbeats and a lower blood pressure. These medicines also work in the blood vessels, causing them to relax and further lowering blood pressure.
• Alpha-2 agonists: This type of medication changes the nerve impulses that cause blood vessels to tighten. This helps blood vessels to relax, which reduces blood pressure.

What is Deep vein thrombosis?

Deep vein thrombosis (DVT) is a serious condition that occurs when a blood clot forms in a vein located deep inside your body. A blood clot is a clump of blood that’s turned to a solid state. Deep vein blood clots typically form in your thigh or lower leg, but they can also develop in other areas of your body This condition is serious because blood clots can loosen and lodge in the lungs.

Cause

DVT is caused by a blood clot. The clot blocks a vein, preventing blood from properly circulating in your body. Clotting may occur for several reasons. These include:

• Damage to a blood vessel’s wall can narrow or block blood flow. A blood clot may form as a result.
• Blood vessels can be damaged during surgery, which can lead to the development of a blood clot. Bed rest with little to no movement after surgery may also increase your risk for developing a blood clot.
• Reduced mobility or inactivity. When you sit frequently, blood can collect in your legs, especially the lower parts. If you’re unable to move for extended periods of time, the blood flow in your legs can slow down. This can cause a clot to develop.
• Certain medications. Some medications increase the chances your blood will form a clot.

Symptoms

Symptoms of DVT only occur in about half of the people who have this condition. Common symptoms include:

• Swelling in your foot, ankle, or leg, usually on one side
• Cramping pain in your affected leg that usually begins in your calf
• Severe, unexplained pain in your foot and ankle
• An area of skin that feels warmer than the skin on the surrounding areas
• Skin over the affected area turning pale or a reddish or bluish color

People with an upper extremity DVT, or a blood clot in the arm, may also not experience symptoms. If they do, common symptoms include:

• Neck pain
• Shoulder pain
• Swelling in the arm or hand
• Blue-tinted skin color
• Pain that moves from the arm to the forearm
• Weakness in the hand

People may not find out that they have deep vein thrombosis until they’ve gone through emergency treatment for a pulmonary embolism (blood clot in the lung).

A pulmonary embolism can happen when a DVT clot has moved from the arm or leg into the lung. When an artery in the lung becomes blocked, it’s a life-threatening condition and requires emergency care.

Treatment in General Medicine

DVT is a serious medical condition. Tell your doctor right away if you think you’re experiencing symptoms of DVT or go to the closest emergency room. A healthcare provider can check out your symptoms.

DVT treatments focus on keeping the clot from growing. In addition, treatment may help prevent a pulmonary embolism and lower your risk of having more clots.

Medication

Your doctor might prescribe medications that thin your blood, like heparin, warfarin, enoxaparin, or fondaparinux. This makes it harder for your blood to clot. It also keeps existing clots as small as possible and decreases the chance that you’ll develop more clots.

If blood thinners don’t work, or if you have a severe case of DVT, your doctor might use thrombolytic drugs. People with upper extremity DVT may also benefit from this medication.

Thrombolytic drugs work by breaking up clots. You’ll receive these intravenously. Read more about these drugs and how they can help prevent and destroy blood clots.

Compression stockings

If you’re at high risk for DVT, wearing compression stockings can prevent swelling and might lower your chance of developing clots.

Compression stockings reach just below your knee or right above it. Your doctor may recommend you wear these every day.

Filters

You might need to have a filter put inside the large abdominal vein called the vena cava if you aren’t able to take blood thinners. This form of treatment helps prevent pulmonary embolisms by stopping clots from entering your lungs.

But filters do have risks. If they’re left in for too long, they can actually cause DVT. Filters should be used for a short-term period, until the risk of thromboembolism is reduced and blood thinning medications can be used.

DVT surgery

Your doctor may suggest surgery to remove a DVT clot in your arm or leg. This is typically only recommended in the case of very large blood clots or clots that are causing serious issues, like tissue damage.

During a surgical thrombectomy, or surgery to remove a blood clot, your surgeon will make an incision into a blood vessel. They’ll locate and remove the clot. Then, they’ll repair the blood vessel and tissue.

In some cases, they may use a small inflating balloon to keep the blood vessel open while they remove the clot. When the clot is found and removed, the balloon is removed with it.

Surgery isn’t without risks, so many doctors will only use this treatment in severe cases. Risks include infection, damage to the blood vessel, and excess bleeding.

DVT exercise

The longer you sit, the greater your risk of developing a blood clot. If you have to be seated for long periods, there are exercises you can do while sitting to keep your legs moving and help circulate blood.

Knee pulls

Bend your leg, and raise your knee toward your chest. Wrap your knee with your arms for a greater stretch. Hold this position for several seconds, then do the same exercise on the other side. Repeat these stretches several times.

Foot pumps

Place your feet flat on the floor. Keeping the balls of your feet on the floor, raise your heels. Hold for a few seconds, then lower the heels. Raise the balls of your feet off the floor, keeping your heels in place. Hold for a few seconds, then lower the balls of your feet.

Repeat these pumps several times.

Ankle circles

Lift both feet off the floor. Draw circles with your toes in one direction for a few seconds. Switch directions, and draw circles for a few seconds. Repeat this exercise several times.

DVT home remedies

Once a DVT blood clot is diagnosed, your doctor will likely prescribe a medication to help thin the blood or break up the clot. You can combine the prescribed medication with the following home remedies to prevent other complications and reduce the risk of future blood clots.

Move more

Take walks daily to improve blood flow. Shorter, frequent walks are better than one longer walk.

Keep your leg or arm elevated

This is especially important for legs. Blood can pool if your feet are on the ground all day. Use a stool or chair to keep your legs elevated and close to level with your hips.

What is Electrolyte Imbalance?

Electrolyte imbalance is commonly caused by loss of body fluids through prolonged vomiting, diarrhea, sweating or high fever. Examples of electrolytes are sodium, chloride, magnesium, potassium and calcium. Electrolyte imbalance causes a variety of symptoms that can be severe.

Types of electrolyte disorders

Elevated levels of an electrolyte are indicated with the prefix “hyper-.” Depleted levels of an electrolyte are indicated with “hypo-.”

Conditions caused by electrolyte level imbalances include:

• potassium: hyperkalemia and hypokalemia
• sodium: hypernatremia and hyponatremia
• calcium: hypercalcemia and hypocalcemia
• chloride: hyperchloremia and hypochloremia
• magnesium: hypermagnesemia and hypomagnesemia
• phosphate: hyperphosphatemia or hypophosphatemia

Potassium

Potassium is particularly important for regulating heart function. It also helps maintain healthy nerves and muscles.

Hyperkalemia may develop due to high levels of potassium. This condition can be fatal if left undiagnosed and untreated. It’s typically triggered by:

• severe dehydration
• kidney failure
• severe acidosis, including diabetic ketoacidosis
• certain medications, including some blood pressure medications and diuretics
• adrenal insufficiency, which is when your cortisol levels are too low

Hypokalemia occurs when potassium levels are too low. This often happens as a result of:

• eating disorders
• severe vomiting or diarrhea
• dehydration
• certain medications, including laxatives, diuretics, and corticosteroids

Sodium

Sodium is necessary for the body to maintain fluid balance and is critical for normal body function. It also helps to regulate nerve function and muscle contraction.

Hypernatremia occurs when there’s too much sodium in the blood. Abnormally high levels of sodium may be caused by:

• Inadequate water consumption
• Severe dehydration
• Excessive loss of bodily fluids as a result of prolonged vomiting, diarrhea, sweating, or respiratory illness
• Certain medications, including corticosteroids

Hyponatremia develops when there’s too little sodium. Common causes of low sodium levels include:

• Excessive fluid loss through the skin from sweating or burns
• Vomiting or diarrhea
• Poor nutrition
• Alcohol use disorder
• Overhydration
• Thyroid, hypothalamic, or adrenal disorders
• Liver, heart, or kidney failure
• Certain medications, including diuretics and seizure medications
• Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

Calcium

Calcium is a vital mineral that your body uses to stabilize blood pressure and control skeletal muscle contraction. It’s also used to build strong bones and teeth.

Hypercalcemia occurs when you have too much calcium in the blood. This is usually caused by:

• kidney disease
• thyroid disorders, including hyperparathyroidism
• lung diseases, such as tuberculosis or sarcoidosis
• certain types of cancer, including lung and breast cancers
• excessive use of antacids and calcium or vitamin D supplements
• medications such as lithium, theophylline, or certain water pills

Hypocalcemia occurs due to a lack of adequate calcium in the bloodstream. Causes can include:

• kidney failure
• hypoparathyroidism
• vitamin D deficiency
• pancreatitis
• prostate cancer
• malabsorption
• certain medications, including heparin, osteoporosis drugs, and antiepileptic drugs

Treating electrolyte disorders in General Medicine

Treatment varies depending on the type of electrolyte disorder and on the underlying condition that’s causing it.

In general, certain treatments are used to restore the proper balance of minerals in the body. These include:

Intravenous (IV) fluids

Intravenous (IV) fluids, typically sodium chloride, can help rehydrate the body. This treatment is commonly used in cases of dehydration resulting from vomiting or diarrhea. Electrolyte supplements can be added to IV fluids to correct deficiencies.

Certain IV medications

IV medications can help your body restore electrolyte balance quickly. They can also protect you from negative effects while you’re being treated by another method.

The medication you receive will depend on the electrolyte disorder you have. Medications that may be administered include calcium gluconate, magnesium chloride, and potassium chloride.

Oral medications and supplements

Oral medications and supplements are often used to correct chronic mineral abnormalities in your body. This is more common in if you’ve been diagnosed with ongoing kidney disease.

Depending on your electrolyte disorder, you may receive medications or supplements such as:

• calcium (gluconate, carbonate, citrate, or lactate
• magnesium oxide
• potassium chloride
• phosphate binders, which include sevelamer hydrochloride (Renagel), lanthanum (Fosrenol), and calcium-based treatments such as calcium carbonate

They can help replace depleted electrolytes on a short- or long-term basis, depending on the underlying cause of your disorder. Once the imbalance has been corrected, your doctor will treat the underlying cause.

Although some of the supplements can be purchased over the counter, most people with electrolyte disorders get a prescription for supplements from their doctor.

Hemodialysis

Hemodialysis is a type of dialysis that uses a machine to remove waste from your blood.

Hemodialysis can be used when an electrolyte disorder is caused by sudden kidney damage and other treatments aren’t working. Your doctor may also decide on hemodialysis treatment if the electrolyte problem has become life-threatening.

What is Meningitis?

Meningitis is an inflammation (swelling) of the protective membranes covering the brain and spinal cord. A bacterial/viral or fungal infection of the fluid surrounding the brain and spinal cord usually causes the swelling.

Symptoms

In adults, viral meningitis may cause:

• headaches
• fever
• stiff neck
• seizures
• sensitivity to bright light
• sleepiness
• lethargy
• nausea and vomiting
• decreased appetite

Bacterial meningitis symptoms

Bacterial meningitis symptoms develop suddenly. They may include:

• altered mental status
• nausea
• vomiting
• sensitivity to light
• irritability
• headache
• fever
• chills
• stiff neck
• purple areas of skin that resemble bruises
• sleepiness
• lethargy

Seek immediate medical attention if you experience these symptoms. Bacterial and viral meningitis can be deadly. There’s no way to know if you have bacterial or viral meningitis just by judging how you feel. Your doctor will need to perform various tests to determine which type you have.

Fungal meningitis symptoms

Symptoms of fungal meningitis resemble the other types of this infection. These may include:

• nausea
• vomiting
• sensitivity to light
• fever
• headache
• confusion or disorientation

Types and Causes of Meningitis

Each type of meningitis has a slightly different cause, but each ultimately acts in the same way: A bacterium, fungus, virus, or parasite spreads through the bloodstream until it reaches the brain, or spinal cord. There, it sets up in the lining or fluids around these vital body parts and starts developing into a more advanced infection.

Non-infectious meningitis is the result of a physical injury or other condition; it doesn’t involve an infection.

Viral meningitis is the most common type of meningitis. Viruses in the Enterovirus category cause 85 percent of cases. They include:

• Coxsackievirus A
• Coxsackievirus B
• Echoviruses

Viruses in the Enterovirus category cause about 10 to 15 million infectionsTrusted Source per year, but only a small percentage of people who get infected will develop meningitis.

Other viruses can cause meningitis. These include:

• West Nile virus
• Influenza
• Mumps
• HIV
• Measles
• Herpes viruses
• Coltivirus, which causes Colorado tick fever

Viral meningitis typically goes away without treatment. However, some causes do need to be treated.

Bacterial meningitis

Bacterial meningitis is contagious and caused by infection from certain bacteria. It’s fatal if left untreated. Between 5 to 40 percentTrusted Source of children and 20 to 50 percentTrusted Source of adults with this condition die. This is true even with proper treatment.

The most common types of bacteria that cause bacterial meningitis are:

• Streptococcus pneumoniae, which is typically found in the respiratory tract, sinuses, and nasal cavity and can cause what’s called “pneumococcal meningitis”
• Neisseria meningitidis, which is spread through saliva and other respiratory fluids and causes what’s called “meningococcal meningitis”
• Haemophilus influenza, which can cause not only meningitis but infection of the blood, inflammation of the windpipe, cellulitis, and infectious arthritis
• Listeria monocytogenes, which are foodborne bacteria
• Staphylococcus aureus, which is typically found on the skin and in the respiratory tract, and causes “staphylococcal meningitis”

Fungal meningitis

Fungal meningitis is a rare type of meningitis. It’s caused by a fungus that infects your body and then spreads from your bloodstream to your brain or spinal cord.

People with a weakened immune system are more likely to develop fungal meningitis. This includes people with cancer or HIV.

The most common funguses related to fungal meningitis include:

• Cryptococcus, which is inhaled from dirt or soil that is contaminated with bird droppings
• Blastomyces, another type of fungus found in soil, particularly in the Midwestern United States
• Histoplasma, which is found in environments that are heavily contaminated with bat and bird droppings, especially in the Midwestern States near the Ohio and Mississippi Rivers
• Coccidioides, which is found in soil in specific areas of the U.S. Southwest and South and Central America

Parasitic meningitis

This type of meningitis is less common than viral or bacterial meningitis, and it’s caused by parasites that are found in dirt, feces, and on some animals and food, like snails, raw fish, poultry, or produce.

One type of parasitic meningitis is rarer than others. It’s called eosinophilic meningitis (EM). Three main parasites are responsible for EM. These include:

• Angiostrongylus cantonensis
• Baylisascaris procyonis
• Gnathostoma spinigerum

Parasitic meningitis is not passed from person to person. Instead, these parasites infect an animal or hide out on food that a human then eats. If the parasite or parasite eggs are infectious when they’re ingested, an infection may occur.

One very rare type of parasitic meningitis, amebic meningitis, is a life-threatening type of infection. This type is caused when one of several types of ameba enters the body through the nose while you swim in contaminated lakes, rivers, or ponds. The parasite can destroy brain tissue and may eventually cause hallucinations, seizures, and other serious symptoms. The most commonly recognized species is Naegleria fowleri.

Non-infectious meningitis

Non-infectious meningitis is not an infection. Instead, it is a type of meningitis that’s caused by other medical conditions or treatments. These include:

• lupus
• a head injury
• brain surgery
• cancer
• certain medications

Prevention in General Medicine

There is a vaccine for several types of bacterial meningitis. Meningococcal meningitis, caused by Neisseria meningitidis, is one version for which vaccines are available. While viral meningitis is more common, bacterial meningitis can be more dangerous if it’s not diagnosed and treated quickly.

For that reason, the two primary vaccines for meningitis are for bacterial causes. The first vaccine, the meningococcal conjugate vaccine, features a vaccine that targets four of the most common types of bacterial serotypes. It lasts longer and offers greater protection, especially if you maintain booster shots.

The second vaccine, MenB, targets one specific strain, and its protection window is much shorter. Only certain populations are recommended to get this vaccine

Who should be vaccinated against meningococcal meningitis?

These five groups are considered at risk and should get a meningitis vaccine:

• college freshmen who live in dorms and haven’t been vaccinated
• adolescents who are 11 to 12 years old
• people traveling to countries where meningococcal disease is common
• children ages 2 or older who don’t have a spleen or who have a compromised immune system

Teenagers should protect themselves by getting a meningitis vaccine.

Treatment in General Medicine

Your treatment is determined by the cause of your meningitis.

Bacterial meningitis requires immediate hospitalization. Early diagnosis and treatment will prevent brain damage and death. Bacterial meningitis is treated with intravenous antibiotics. There’s no specific antibiotic for bacterial meningitis. It depends on the bacteria involved.

Fungal meningitis is treated with antifungal agents.

Parasitic meningitis may either involve treating just the symptoms or attempting to treat the infection directly. Depending on the cause, this type may get better without antibiotic treatment. If it worsens, however, your doctor may try to treat the infection itself.

Viral meningitis may resolve on its own, but some causes of viral meningitis will be treated with intravenous antiviral medications.

Treatment in General Medicine

Your treatment is determined by the cause of your meningitis.

Bacterial meningitis requires immediate hospitalization. Early diagnosis and treatment will prevent brain damage and death. Bacterial meningitis is treated with intravenous antibiotics. There’s no specific antibiotic for bacterial meningitis. It depends on the bacteria involved.

Fungal meningitis is treated with antifungal agents.

Parasitic meningitis may either involve treating just the symptoms or attempting to treat the infection directly. Depending on the cause, this type may get better without antibiotic treatment. If it worsens, however, your doctor may try to treat the infection itself.

Viral meningitis may resolve on its own, but some causes of viral meningitis will be treated with intravenous antiviral medications.

Complications

These complications are typically associated with meningitis:

• seizures
• hearing loss
• vision loss
• memory problems
• arthritis
• migraine headaches
• brain damage
• hydrocephalus
• a subdural empyema

What is Congestive Heart Failure?

Congestive heart failure (CHF) is a chronic progressive condition that affects the pumping power of your heart muscles. While often referred to simply as “heart failure,” CHF specifically refers to the stage in which heart muscle is too weak or when another health problem prevents it from circulating blood efficiently.

The most common type of HF is left-sided HF. The left side of the heart must work harder to move the same volume of blood around the body. This may cause a fluid buildup in the lungs and make breathing difficult as it progresses.

These fluids give congestive heart failure its name.

There are two kinds of left-sided HF:

• Systolic heart failure: The left ventricle cannot contract normally, limiting the heart’s pumping ability.
• Diastolic heart failure: The muscle in the left ventricle stiffens. If the muscle cannot relax, the pressure in the ventricle increases, causing symptoms.

Right-sided HF is less common. It occurs when the right ventricle cannot pump blood to the lungs. This can lead to blood backing up in the blood vessels, which may cause fluid retention in the lower legs and arms, abdomen, and other organs.

A person can have left-sided and right-sided HF at the same time. However, HF usually begins on the left side and can affect the right side if a person does not receive effective treatment.

Prevention

Lifestyle strategies can reduce the risk of developing HF and can also slow its progress.

To prevent or slow the progression of HF, people should take the following steps:

• Maintain a healthy body weight: Exercise regularly:  150 minutes of moderate-intensity exercise every week.
• Manage stress: Meditation, therapy, and relaxation techniques can help
• Eat a heart-healthy diet: Daily food intake should be low in trans fats, rich in whole grains, and low in sodium and cholesterol. . However, individuals should check with their doctor what their sodium and fluid intake should be.
• Monitor blood pressure regularly
• Vaccinations: Be sure to stay on top of vaccinations for influenza and pneumococcal pneumonia.
• Treat and manage risk factors such as hypertension, smoking, alcohol, drugs, diabetes

People who already have HF should take the following steps to prevent further progression:

• avoid alcohol
• limit caffeine and other stimulants
• get adequate rest
• track changes in their symptoms and exercise capacity
• monitor daily weights
• check blood pressure and heart rate at home

Without treatment, HF can be fatal. Even with adequate treatment, HF may get worse over time, triggering dysfunction of other organs throughout the body.

Causes

HF is more likely to occur in people with other conditions or lifestyle factors that weaken the heart.

Risk factors for HF include:

• congenital heart anomalies
• high blood pressure or cholesterol
• obesity
• asthma
• chronic obstructive pulmonary disease (COPD) and coronary heart disease
• cardiovascular conditions, such as valvular heart disease
• heart infection
• reduced kidney function
• a history of heart attacks
• irregular heart rhythms or arrhythmias
• abuse of alcohol or illicit drugs
• smoking
• older age

Symptoms

People with a history of cardiovascular health issues or several risk factors for HF should seek immediate care if they experience symptoms of HF.

The most common symptoms of HF are:

• Shortness of breath or difficulty breathing: People with HF may also struggle to breathe when lying down, with activity or at rest due to fluid accumulation in the lungs.
• A persistent, unexplained cough: Some people experience wheezing and pink, or blood-stained mucus.
• Swelling in the legs, ankles, abdomen, or hands: The swelling may get worse as the day goes on or after exercise.
• Weight gain: Rapid weight gain may be a sign of congestive heart failure.
• Feeling tired: Even well-rested people can experience fatigue.
• Changes in thinking and memory: Electrolyte imbalances due to HF can impair a person’s ability to think clearly.
• Nausea: A reduced appetite can accompany this.
• A rapid heart rate: This occurs because the heart is unable to pump blood with a regular rhythm.
• Light-headedness, dizziness, or passing out: This might also include tingling or numbness in the extremities due to an inadequate blood supply.

Diagnosis

A doctor or cardiologist will perform a physical exam. This involves listening to the heart, checking for fluid retention, and looking at the veins in the neck to see if there is extra fluid present in the heart. They may order other diagnostic tests, including:

• Electrocardiogram: This records the heart’s electrical rhythm.
• Echocardiogram: This is an ultrasound test that can help a doctor determine if a person has a leaky heart valve, a heart muscle that is not squeezing or relaxing properly.
• Stress tests: These tests show how the heart performs under different levels of cardiac stress, such as during exercise. Sometimes, they involve using medications that stimulate the heart to beat faster and harder or cause the blood vessels to relax.
• Blood tests: A doctor may request these to check for infections, assess kidney function, and levels of brain natriuretic peptide (BNP). BNP is a “stretch” hormone that indicates stretching or increased pressure that occurs with HF.
• MRI: This can provide high-resolution images of the heart and can assess for structural changes and scarring.
• Cardiac catheterization: This can help a doctor identify blockages in the arteries, one of the most common causes of HF. A doctor may check blood flow and pressure levels in the ventricles at the same time.

Treatment in General Medicine

Several types of medication can reduce the health impact of heart failure.

Different medications can help symptoms of and prognosis in HF. These include:

• Blood thinners: These reduce the risk of blood clots, which might break loose and travel to the body, heart, lungs, or brain. Blood thinners carry risks, such as increased bleeding.
• Angiotensin receptor-neprilysin inhibitors: These help reduce the risk of mortality and decrease congestion in the heart.
• ACE inhibitors: These relax the blood vessels and help reduce the impact of heart failure.
• Angiotensin receptor blockers: These work to reduce tension in the blood vessels.
• Anti-platelet drugs: Doctors prescribe these to stop blood clots because they prevent platelets in the blood from sticking together.
• Beta-blockers: These drugs lower the heart rate, the force of the heartbeat, and blood pressure, helping to “rest” the heart.
• Sino-atrial node modulators: These can help further reduce the heart rate in people who are already taking beta-blockers.
• Statins: People use these to reduce levels of low-density lipoprotein (LDL), or “bad” cholesterol and increase high-density lipoprotein (HDL), or “good” cholesterol levels.
• Diuretics: These help the body excrete excess fluid in the urine and remove it from the heart and lungs. They also reduce swelling and prevent shortness of breath.
• Vasodilators: These reduce the amount of oxygen that the heart needs to dilate. They can also ease chest pain.

People with advanced HF might need more intensive treatment. Medical procedures that may help include the following:

Implantable devices

People with advanced HF might need more intensive treatment. A surgeon might implant a medical device, such as:

• An implantable defibrillator: These can prevent arrhythmias.
• A pacemaker: These address electrical problems in the heart to help the ventricles contract more regularly.
• Cardiac resynchronization therapy: This helps to regulate heart rhythm and reduce arrhythmia symptoms.
• A left ventricular assist device (LVAD): This supports the pumping ability of a heart when it cannot do this efficiently on its own. People once used LVADs on a short-term basis but can now use them as part of long-term treatment.

Other procedures

A doctor may recommend some other procedures for treating HF, including:

• Percutaneous coronary intervention to open a blocked artery: The doctor may place a stent to help keep the vessel open.
• Coronary artery bypass surgery: This reroutes some of the blood vessels so the blood can travel to supply oxygen to the heart while avoiding diseased or blocked blood vessels.
• Valve replacement or repair surgery: A doctor can replace or repair an inefficient or diseased valve with a mechanical valve or one developed from living tissue.
• Heart transplant: This may be the only remaining option if other treatments are not effective.

What Is Pneumonia?

It is an infection of the lungs with a range of possible causes. It can be a serious and life-threatening disease. It normally starts with a bacterial, viral, or fungal infection. The lungs become inflamed, and the tiny air sacs, or alveoli, inside the lungs fill up with fluid. Pneumonia blocks the normal exchange of gas inside the lungs, which leads to low levels of the oxygen in the blood and poor removal of carbon dioxide from the body. The severity of pneumonia ranges from mild to life threatening.

Causes

Pneumonia can affect anyone at any age and it can usually be triggered by a cold or a bout of flu.

• People who have a weakened immune system due to AIDS or cancer, are also at high risk of developing pneumonia.
• Various micro-organisms including bacteria, viruses, fungi and parasites can cause pneumonia.
• Young children are considered most prone to pneumonia, as well as the elderly, who may suffer from chronic illnesses like chronic obstructive pulmonary disease (COPD), diabetes and congestive heart failure.

Symptoms

Symptoms associated with pneumonia differ considerably depending on the cause and the health condition of the patient. These may include:

• Blue tinge to skin, lips, tongue and fingertips due to lack of oxygen
• Breathing difficulty and wheezing
• Chest pain when breathing and coughing
• Coughing
• Fever and chills
• Greenish or yellowish sputum (phlegm)

Treatment in General Medicine

Treatment of pneumonia depends on what triggered the infection. Your doctor will evaluate your condition and suggest the appropriate treatments for you. These may include:

• Antibiotics to treat bacterial pneumonia
• Antiviral medication to treat viral pneumonia
• Hospitalisation may be required for severe cases of pneumonia to receive intravenous antibiotics and oxygen supply
• Medication to ease pneumonia symptoms including cough, fever, chest pains and muscle aches (given together with suggested antibiotics and antiviral medication)
• Plenty of bed rest, a healthy diet and lots of fluid may be enough to treat mild viral pneumonia

What is Bronchial Asthma?

It is a medical condition which causes the airway path of the lungs to swell and narrow. Due to this swelling, the air path produces excess mucus making it hard to breathe, which results in coughing, short breath, and wheezing. The disease is chronic and interferes with daily working

Cause

No single cause has been identified for asthma. Instead, researchers believe that the breathing condition is caused by a variety of factors. These factors include:

• If a parent has asthma, you’re more likely to develop it.
• History of viral infections. People with a history of viral infections during childhood are more likely to develop the condition.
• Hygiene hypothesis. This hypothesis proposes that babies aren’t exposed to enough bacteria in their early months and years. Therefore, their immune systems don’t become strong enough to fight off asthma and other conditions.
• Early allergen exposure. Frequent contact with possible allergens and irritants may increase your risk for developing asthma.

Triggers of Bronchial asthma – Bronchial asthma triggers may include: Smoking and secondhand smoke. Infections such as colds, flu, or pneumonia. Allergens such as food, pollen, mold, dust mites, and pet dander.

Symptoms

• Coughing, especially at night, when laughing, or during exercise
• wheezing, a squealing or whistling sound made when breathing
• tightness in the chest
• shortness of breath
• Fatigue

Treatment in General Medicine

Treatment consists of self-care and bronchodilators

Asthma can usually be managed with rescue inhalers to treat symptoms (salbutamol) and controller inhalers that prevent symptoms (steroids). Severe cases may require longer-acting inhalers that keep the airways open (formoterol, salmeterol, tiotropium), as well as inhalant steroids.

Medications

• Bronchodilator – Helps open the airways of the lungs to make breathing easier.
• Steroid – Modifies or simulates hormone effects, often to reduce inflammation or for tissue growth and repair.
• Anti-inflammatory – Prevents or counteracts swelling (inflammation) in joints and tissues.
• Self-care – Quitting smoking
• Supportive care – Oxygen therapy
• Specialists – Pulmonologist, Paediatrician, Primary Care Provider (PCP) and Respiratory Therapist

Asthma home remedies

• Coffee – A chemical in caffeine acts similarly to the asthma drug theophylline.
• Essential oils – Inhaling eucalyptus essential oil may ease breathing difficulties brought on by asthma. However, for some individuals, inhaling essential oils may make asthma worse. Strong smells and chemicals can trigger asthma or worsen symptoms.
• Mustard oil – This fatty oil, made from pressed mustard seeds, can be massaged into the skin to help open airways. Shop for mustard oil.

What is Hepatitis?

Hepatitis refers to the swelling of the liver. It can be caused by viral infections, chemicals, drug abuse, some medications and immune disorders. There are several forms of viral hepatitis including hepatitis A, B and C, which are caused by hepatitis A, B, and C viruses, respectively.

Each type of viral hepatitis is spread by different methods and needs different treatment.

Hepatitis A virus infection causes acute inflammation (swelling) of the liver and is a self-limiting disease with symptoms lasting for several weeks before the individual can recover completely. It leads to lifelong immunity.

Hepatitis B infection is the most common infection of the liver. The majority of infected individuals recover from acute hepatitis B infections and become immune to it. However some people can develop a long-term hepatitis B infection, which leads to serious complications including chronic hepatitis, liver cirrhosis (scarring of the liver), liver failure and liver cancer. Hepatitis B is endemic in Singapore and around 4% of the population are hepatitis B carriers.

Hepatitis C infection is responsible for the development of chronic liver disease worldwide. Most infected people can’t get rid of the virus, and thus the virus causes ongoing damage to the liver over the years. Similar to hepatitis B, hepatitis C can lead to chronic hepatitis, cirrhosis, liver failure and liver cancer.

Causes

Hepatitis A virus is transmitted through:

• Blood contact, drug use and sexual contact with infected persons
• Consuming shellfish from water contaminated with sewage
• Direct contact with food, drinks or objects contaminated with the faeces of an infected individual
• The “faecal-oral” route in areas of poor hygiene and overcrowding

Hepatitis B virus is mainly found in the blood, and it can also be found in semen and vaginal secretions. Hepatitis B can be acquired through:

• Infected expecting mothers can transmit the infection to their newborn during childbirth
• Other activities that involve contaminated blood entering the bloodstream of a susceptible individual
• Sharing contaminated injections among drug users
• Unsafe sexual contact with an infected person

Hepatitis C virus is mainly found in the blood and is transmitted when the blood of an infected person enters the bloodstream of a susceptible person, like drug users sharing contaminated needles.

Symptoms

Some hepatitis patients are asymptomatic. However, the general symptoms may include any of the following:

• Abdominal pain or discomfort
• Dark urine
• Decreased appetite
• Fever
• Jaundice (yellowish skin and eyes)
• Tiredness
• Nausea and dizziness
• Oedema (swelling due to fluid build-up)
• Painful joints
• Pale stools

Treatment in General Medicine

Hepatitis A

There is no specific treatment for hepatitis A but there are treatment measures that help improve your condition:

• Avoid drinking alcohol
• Getting plenty of bed rest
• Increasing fluid intake
• Practicing good personal hygiene to prevent faecal-oral transmission to other individuals
• Taking prescribed medication if your symptoms worsen

Hepatitis B

Treatment of hepatitis B depends on the symptoms and stage of your disease and includes:

• Anti-viral medication to stop the virus from replicating
• Medication to ease symptoms

Hepatitis C

Treatment of hepatitis C aims to delay its complications, and these include:

• Anti-viral medication to stop the virus from replicating
• Avoid drinking alcohol as it can increase the liver damage
• Regular screening for liver cancer for hepatitis C carriers, especially those who have liver cirrhosis (scarring of the liver)

Complications

• Liver cancer
• Liver cirrhosis
• Liver failure
• Early death

What is UTI?

A urinary tract infection (UTI) is an infection of any part of the urinary system. The urinary system consists of the kidneys, bladder, ureters and urethra. A urinary tract infection (UTI) is an infection of any part of the urinary system. UTIs usually affect first the bladder or the urethra, and if not treated they can then spread to the ureters and the kidneys.

The types of UTIs include:

• Bladder infections (cystitis)
• Kidney infections (pyelonephritis)
• Urethra infections (urethritis)

Causes

Urine is usually sterile, which means it does not have any bacteria, viruses or fungi present.

A UTI can occur when a microorganism enters the urinary system through the urethra. Most infections are caused by Escherichia coli (E. coli), which is a digestive tract bacterium that lives in the colon, and spreads to the urethra from the anus.

Other microorganisms, including chlamydia and mycoplasma, can cause UTIs in men and women, but these UTIs are usually restricted to the urethra and the reproductive system.

Other causes that increase the risk of UTIs include:

• People with diabetes have more sugar in the urine, they are more prone for UTI.
• Men with an enlarged prostate are unable to empty their bladder completely.

Symptoms

UTI symptoms vary depending on the type of the infection and a person’s age. Some may not have any symptoms at all. When symptoms are present, they can include any of the following:

• Back pain
• Blood in the urine
• Cloudy urine
• Fever and chills
• Frequent and urgent need to urinate
• Incontinence (inability to control urination)
• Malaise (feeling generally unwell)
• Nausea and vomiting
• Pain in the abdomen or above the pubic bone
• Pain in the ribs
• Painful and burning sensation during urination

Treatment in General Medicine

• An appropriate antibiotic course is usually enough to treat simple UTIs. The choice and duration of antibiotic treatment depends on medical history and the type of bacteria involved.
• Preventive measures, especially in women with recurrent infections, can be taken to reduce the risk of developing UTIs. These include:
  1. Drinking plenty of water
  2. Not holding the bladder for long, and urinating when needed
  3. Urinating immediately after sexual intercourse