Tuberous Sclerosis is a genetic disease, forms benign tumor in the brain and other vital organs of the body such as heart, kidney, lungs, eyes, skin etc. Tuberous Sclerosis mainly affects the central nervous system.

Tuberous Sclerosis is manifested by seizures, convulsions, behavioural problems, mental retardation, skin disorders, pulmonary and renal disorders, etc. Tuberous Sclerosis may be present at birth but the symptoms are seen during growing period of the child. The gyri, foldings of brain becomes thick and firm in the TSC affected  individual.

Causes of Tuberous Sclerosis:-

Genetic cause is the main cause of tuberous Sclerosis. Inheritance of autosomal dominant genes, causes Tuberous Sclerosis.

SIGNS AND SYMPTOMS:-

* Learning difficulties are the main symptoms of tuberous sclerosis, found in 50 % totally affected.
* Less intelligent quotient, ( IQ ), when large part of brain is involved.
* Autism is seen in nearly 25 % of Tuberous Sclerosis affected.
* Behavioural problems,
* Difficulty in adjustment to environment,
* Aggression,  OCD, etc.

The Tuberous Sclerosis individual Will have the symptoms of renal, pulmonary or integumentary system on the basis of tumors presence on those organs.

Diagnosis of Tuberous sclerosis:-

* Family history helps in diagnosing tuberous Sclerosis, as it helps in knowing any history of Genetic cause.
* Woods Lamp is used to visualise the skin, mouth, etc..
* CT scan, MRI scans provides clear image of the affected part.
* Ultrasound Scan is used to find tumors in the kidneys,
* Echo cardiogram, Fundoscopy, are the diagnostic tests performed for Tuberous Sclerosis.

When the thyroid secretes low thyroid hormone is called as under active thyroid or hypothyroidism . Thyroid is one of the important endocrine gland situated in the neck region  in front of the trachea joins to larynx. Thyroid measures 4cm height and 3 cm width. Thyroid secretes the hormones called T4- thyroxine and T3 – triiodothyronine. These thyroid hormones have very important vital functions in the body. Low thyroid levels should be treated to prevent metabolic disorders.

Control of body metabolism is the main function of thyroid gland. The thyroid hormones are less secreted when thyroid becomes under active and is a thyroid disease. Under active thyroid leads to hypothyroidism. Body metabolism is altered with under active thyroid gland. Thyroid function is to regulate body metabolism, and the change in body metabolism causes altered vital signs. Thyroid weight gain is common with under active thyroid or hyperthyroidism.

Thyroid stimulating hormone (TSH) : Controls the production of thyroid hormone. Pituitary gland secretes and controls the release of thyroid stimulating hormone.

Causes of under active thyroid:-

Iodine insufficiency : Iodine is the major element needed to secrete thyroid hormone in the body. Iodine deficiency in diet causes under active thyroid. Iodine supplementation with Salt helps in preventing Iodine deficiency.

Autoimmune thyroiditis : Autoimmune disorder destroys the thyroid and leads to less secretion of thyroid hormones.

* Anti thyroid drugs and radio iodide therapy causes under active thyroid.
* Congenital hypothyroidism, babies have at the time of birth.
* Older people are more prone to have under active thyroid.
* Women are more affected than males.
* thyroid tumor, or thyroid cancer,
* Autoimmune disorder also causes Hypothyroidism.
* Certain medications such as  lithium carbonate and amiodarone causes under active thyroid.

Symptoms of Under active thyroid:-

Symptoms of under active thyroid develops gradually and may vary from mild to severe.

* Tiredness and feeling sleepy,
* Cold body temperature,
* Dry and pale skin,
* Thin and coarse hair and brittle nails,
* Mental depression,
* Weight gaining,
* Muscle weakness and reduced movements,
* Hoarse and croaky voice,
* Decreased memory power,
* Constipation is associated with under active thyroid,
* Problems related to fertility,
* Irregular menstrual periods, and
* Slow heart rate

Treatment of Under active thyroid or Hypothyroidism:-

Thyroxine replacement  and levothyroxine in tablet form is the main treatment for Hypothyroidism. Lower dose is started first and dose of medication is gradually increased later. Blood test have very significant value in fixing the dose for an individual with under active thyroid or Hypothyroidism. Side-effects are less with levothyroxine and symptoms such as anxiety and weight loss are seen on prolonged replacement of levothyroxine hormone. Periodical medical check up is suggested for patients with under active thyroid or Hypothyroidism. Normal thyroid levels are shown in the healthy individual.

Definition:-

The condition in which acidity of body fluids and tissues is abnormally high is known  acidosis.
Description:-

Due to imbalance in the acid and alkali maintenance, because of body mechanism failure leads to acidosis. When acid base balance is altered leads to acidosis.

Acidosis commonly found in the blood plasma, when PH of blood goes below 7.35  leads to acidity. Cellular metabolic activity and PH of the body fluid determines the acidity.

Respiratory acidosis and Metabolic acidosis are the two main type of acidosis. Kidney and lungs maintains the acid base balance in the body.

Causes of Acidosis:-
When the acid level goes up and base or bicarbonate comes down , leads to acidosis. Kidney and lungs maintain the acid base level in the body. when kidney or lung becomes unable to maintain acid base balance leads to Acidosis.

Types of Acidosis :-

1. Respiratory acidosis is caused when the carbon dioxide level increases in the blood, is mainly due to decreased breathing.

2. Metabolic acidosis is of different types, such as

a. Diabetic acidosis : is also called as ketoacidosis, caused when ketone bodies increases during uncontrolled diabetes.

b. Hyperchloremic acidosis : caused when sodium bicarbonate is lost in the body, in conditions such as severe diarrhoea.

c. Lactic acidosis : is caused when lactic acid level is increased in the body.  Lactic acidosis is caused in conditions such as

* liver failure,
* low blood sugar,
* alcoholism,
* medications such as salicylates,
* cancer,
* excess tiredness, or exercises
* seizures etc.

Kidney diseases and dehydration also can cause acidosis.

Diagnosis of acidosis:-

Arterial blood gas analysis is main confirmation test for acidosis.

Treatment of acidosis:-

Treatment includes maintaining acid base balance with medications  and fluids. Oxygen supplementation is indicated in some conditions. Treating the cause of acidosis is important.

Typhoid fever  is the enteric infection caused by the bacteria, Salmonella enterica serovar Typhi. vaccination typhoid prevents typhoid.Typhoid  fever is common worldwide and is also caused as Enteric fever or bilious fever.

Transmission of bacteria salmonella typhi occures through the ingestion of food and water contaminated with fecal matter of infected person. After entering the body, salmonella typhi perforates the intestinal wall and is phagocyted by macrophages. This makes salmonella typhi to become resistant to body immune power. Then the organism spreads to different parts of the body through lymphatic system. Salmonella typhi is a gram negative organism grows best at 37 degree celsius temperature.

Causes of Typhoid fever:-

• Anybody can be infected with typhoid fever, but the travellers visits the infected places are at risk. People live slum and unsanitary environment get typhoid fever easily.
• Ingestion of contaminated food and water with infected fecal material, causes typhoid fever. After entering intestine, salmonella typhi spreads to blood stream and establishes infection.
• Salmonella typhi infects the gallbladder directly after entering the blood stream.
• Living with typhoid carriers, also cause typhoid fever.
• People who travel  in trains, refugees, may get typhoid fever.
• Poor environmental sanitation also leads to Typhoid fever.
• Eating road side selling foods, contaminated by flies, causes typhoid fever.

Symptoms of Typhoid fever:-

Typhoid symptoms are observed after two or three weeks the bacteria enters the body. Even though Typhoid is not a fatal disease, if not treated may lead to Death.

* Fever : is the main symptom of Typhoid. Fever up to 104 degree F, along with heavy sweating.
* Headache : severe headache is common with typhoid fever.
* Rose coloured spots on the trunk,
* Diarrhea, ( non bloody),
* Gastroenteritis,
* Bradycardia,
* Malaise,
* Epitaxis,
* Eosinopenia,
* lymphocytosis,
* General discomfort,
* uneasiness,
* loss of appetite,,
* weight loss,
* chills,
* delirium,
* confusion, hallucination,
* typhoid more than two weeks can cause

Diagnosis of  Typhoid fever:-

• Blood test : WIDAL test  is the common test performed to diagnose Typhoid fever. In the first week, widal test will be negative and later test becomes positive.  WIDAL test is the specific test for salmonella antibodies against antigens O- somatic and H- flagellar.
• Bone marrow culture,
• Stool test for Salmonella typhi,
• Blood Platelet count,
• ELISA test, for Vi antigen in urine, etc

Treatment of Typhoid fever:-
Typhoid fever is a bacterial infection, need to be treated with antibiotics.

* The antibiotics used to treat Typhoid are
* Ampicillin,
* Chloramphenicol,
* trimethoprim- sulfamethaxazole,
* Ciprofloxacin etc..

The duration of typhoid infection continues up to 3 weeks, if not treated. If not treated Typhoid becomes Fatal.

Abrasions:-

Abrasions are the damaged caused to the superficial layer of the skin. Abrasions commonly the sports injuries, occur due to fall on hard surface.  Because of fall the friction occurs between the skin and hard surface.  So the athletes are at high risk of falls and they will get abrasions.  Abrasion removes the superficial layer of the skin called epidermis, which provides elasticity to the skin.

An abrasions may cause very less bleeding or causes no bleeding.   Abrasion may be caused falls while bicycle riding even bike riding falls.

Treatment of Abrasions:-

Cleaning the wound with water and soap is the first step of treating abrasions.  Mild antibiotics can be applied on the abrasions.  The abrasion is cleaned with hydrogen peroxide, and covered with antibiotic ointment.  A dry bandage is applied with comfortable tightness.

Abrasion treating machine is also used to treat abrasions.  If abrasions are severe meet the physician to get treatment.

Prevention of abrasions:-

Wearing protective pads to the proned areas such as knee, elbow, helps in preventing abrasions in the athletes. Care to be taken to avoid falls, and first aid kit is beneficial to treat abrasions

Gastritis:-

Stomach is  a J  shaped organ present in the abdominal region. Stomach stores and digests the food received through esophagus. The stomach has different types of cells which helps in digestion. Hydrochloric acid is the main juice secreted from the specialized cells.  Gastritis may be Acute or Chronic.

Definition:-

Inflammation of gastric mucosa or stomach is known as Gastritis. The inflammation is caused due to white blood cells accumulated to the gastric acid injured site of stomach.

Causes of Gastritis:-

Helicobacter pylori :- Is a bacteria present in the gastric mucosa and is doesn’t infect the gastric mucosa. When the gastric layer is  damaged by excess gastric gastric secretion, helicobacter pylori infects the deep layers of gastric mucosa and leads to Gastritis.

Prolonged NSAIDS use:- Are the Non steroidal anti inflammatory drugs, used to relive pain, especially in arthritis. Aspirin and the NSAIDS bind to prostaglandins and helps in relieving pain. On prolonged use, these NSAIDS and Aspirin uses the prostaglandins which covers the gastric mucosa, the destruction of protective layer of gastric mucosa causes Gastritis.

Auto immune disorder and Pernicious Anaemia also causes Gastritis.

Alcohol :- Prolonged Alcohol consumption, causes Gastritis, as the chemicals in the alcohol destroys the gastric mucosa by secreting excess hydrochloric acid. Occasional alcohol doesn’t cause Gastritis, but chronic alcohol consumption leads to gastritis.

Gastritis also developed after major surgery, burns, prolonged medications use, injury to stomach, severe stress, etc..

* Chronic bile reflex also leads to Gastritis.
* Excess caffeine consumption,
* Cigarette smoking,
* Fungal infection of gastric mucosa,
* Parasitic infection,
* Gastric allergens
* Tuberculosis, syphilis and other infections,
* Radiation treatment for cancer,
* Endoscopy and other gastrointestinal procedures,
* Potassium supplements,
* Iron tablets,
* Chronic vomiting,
* Are the different causes of gastritis.

Symptoms of Gastritis:-

* Abdominal discomfort, in the upper part of stomach,
* Gastric hemorrhage, Malena,
* Excess gastric acid production,
* Loss of appetite,
* Belching,
* Nausea,
* vomiting,
* Stomach burning,
* Fever may occur.

Diagnosis of Gastritis:-

Barium meal, and gastroscopy are the common diagnostic tests performed to diagnose Gastritis.

History collection from the patient is more beneficial. History such as taking any medications, consuming alcohol, smoking, any surgeries, stressful situations, any other chronic illness helps in diagnosing Gastritis.

* Biopsy,
* stool antigen test,
* Specific antibody test in the blood,

Are the other diagnostic test to diagnose Gastritis.

Treatment of Gastritis:-

Removing the cause or treating the causative factor of gastritis is a treatment option. To treat infection, antimicrobials are used and to treat Helicobacter pylori infection, Triple therapy is used. Triple therapy is the combination of two antibiotics and proton pump inhibitor. PPI, Clarithromycin, Amoxicillin are the right combinations.

* Avoiding alcohol,
* leaving smoking habit,
* Avoiding excess caffeine,
* Relieving stress.

Sources of Vitamin k :-

The richest sources of vitamin K are

* broccoli,
* Brussels sprouts
* cabbage,
* cauliflower,
* kale,
* spinach
* soyabean,

Other sources of Vitamin K are

* cow’s milk,
* greens ,
* olive oil,
* onions, etc…

Blood Cell:-

As one of the important body fluid, blood is a fluid connective tissue present in the circulatory system. the presence hemoglobin gives red color to blood.
blood made up of fluid component plasmas 55%, and formed elements -

* Erythrocytes or RBC

* Leukosis or WBC

* Platelets and thrombocytes.

The PH of blood is 7.35 -7.42, the specific gravity is 1055 to 1060.

Functions of blood:-

1. Transport of oxygen from lungs to tissue site. and carrying carbon dioxide from tissues to lungs.

2. Supply of various nutrients to tissues. carrying of waste material s for excretion.

3. Transport of hormones, vitamins, drugs and chemicals.

4. Maintains acid- base balance.

5. Regulation of body temperature.

6. The immune system of blood protects against infection.

7. Helps in clotting of blood.

The total volume of blood is around 5 lit in an average adult male.

Plasma:-

Plasma is the fluid portion of blood. Its normal volume is 3500 ml. it is mainly composed of water.

Other substances:-

Inorganic substances : Sodium, potassium, calcium ions and copper.

organic substances: Proteins, lipids, glucose, urea and creatinine.

Serum is plasma without clotting factors.

Plasma Proteins:-

They are the proteins present in the plasma. Most of the plasma proteins are synthesized in the liver.

important plasma proteins are:

* Albumin
* Globulin
* Fibrinogen
* Prothrombin

Albumin: it has molecular weight of 66,000. it is produced in liver. Plasma half life of albumin is 19 days. it maintains the colloidal atmospheric pressure. it helps in transport of bilirubin, hormones and drugs.

Globulin: it helps in the transportation of proteins and immunoglobulin. it consists of:-
1. Alpha globulin
2. beta globulin
3. Gama globulin.

Fibrinogen: It helps in blood coagulation. Total proteins in the plasma are:-
albumin 6-8gms/dl
globulin 4.5-5.5 gm/dl
fibrinogen 0.2-0.4gms/dl
prothrombin 0.1gm/dl
albumin globulin ratio 1:7:1

Prothrombin:  Prothrombin is inactive precursor of thrombin. Its concentration in plasma is 15 mg/dl. It is formed in the liver with the help of vitamin k.

Functions of plasma protein:-

* It maintains colloidal osmotic pressure.
* They are responsible for maintenance of viscosity of blood.
* They acts as buffer to regulate PH.
* They act as protein reserve.
* Gama globulin provide immunity.
* They are responsible for blood clotting.
* These proteins help in transport of hormones, drugs and metabolites.

Erythrocytes:

* erythrocytes or red blood cells are abundantly present in blood. These cells don’t have nucleus, mitochondria or ribosomes.
* the coloring pigment present in blood is hemoglobin in jelly form. These are biconcave in shape as it helps in easily pass through the narrow capillaries. They are flexible in nature.
* mean red cell diameter is 7.2 micron.
* thickness is 2.2 at the periphery and 1 micron at the center.
* normal life span of RBC is 120 days.

Normal count:
Males- 5 to 5.5 million cells/ cu mm
Females-4.5 to 5 million cells/cu mm.
Infants- 6-7 million cells/ cu mm.

Functions of RBC:-

* The hemoglobin present in blood helps in
* transport of oxygen
* transport of carbon dioxide.
* regulation of acid base balance.

Erythropoiesis: Is the process of formation of red blood cell. Erythropoiesis starts in the third week of intrauterine life in the mesoderm of yolk sac.
From the third month of intrauterine life it is in the liver and spleen. After 5th month of intrauterine life fetal bone marrow starts producing red cells.

Bone marrow is of two types.
1]  Red bone marrow
2]  Yellow bone marrow.

Red bone marrow produces RBC. During birth it is present in all the bones. In case of adults it is present in the flat bones like cranial bones, vertebrae, pelvic bones, ribs, sternum, upper end of long bones like femur and humorous.

The yellow bone marrow is mainly made up of adipose tissue.

Fate of RBC:-

The old and fragile RBC are phagocytized by reticuloendothelial system. In the reticuloendothelial cells they are broken down and HB is released. Subsequently HB is broken-down into haem and globulin. The Iron liberated is used again for synthesis of new HB. The remaining portion of haem called biliverdin. It is reduced to bilirubin in the liver and secreted through bile.

Polycythemia:

This is a condition where RBC count is increased above 8 million cells/cu mm.

Haemoglobin:

Hemoglobin is a conjugated protein present in the RBC. It forms 95% of the dry weight of RBC. Hemoglobin is a globular molecule made up of subunits. It is  involved in transport of carbon dioxide. It acts as a buffer.

ESR:

It is the rate at which red blood cells settle down. It is the measure of supernatant plasma separated out at the end of one hour when a column of blood is kept disturbed. The normal value in males – 0 to 5 mm at the end of an hour. In females – o -8 mm / hr.

ESR is increased in pregnancy and menstruation. it is increased in infections like tuberculosis rheumatoid arthritis, malignancy and anemic.

Bronchitis:-

Is defined as the inflammation of the bronchi, or its branches, including trachea in the infants. it is the lower respiratory tract infection.

The causative factors may be the infection by the viruses such as adenovirus, parainfluenza, and influenza virus, rhinovirus, mycoplasma pneumonia.

Exposure to the air pollution pollens, allergies is also the triggering factors in the young children. Genetic factor plays a major role in the cause of bronchitis.

In case of young children, due to inflammation there is an increased secretion of mucus. This obstructs the airway. As there is no cartilaginous support, the constriction of bronchioles takes place.

symptoms of bronchitis:-

-upper respiratory tract infection for 1 to 4 days,such as common cold and sinusitis, sore throat, nasal congestion, etc.

-due to inflammation fever with chills is present.

-dry cough in early onset turns to productive later.

-cough may persist more than two weeks

-rapid and shallow respiration.

-nasal flaring and retractions.

Treatment of bronchitis:-

-No antibiotics are given to the children.

-Provide nutrition rich diet.

-Stabilize the child.

-Rest helps in improving the condition.

For adults:

• antibiotics are given.

• Expectorants are given in case of excess mucus production.