World Lung Day 2024

'Clean Air and Healthy Lungs for All ' is the theme for this year on World Lung Day which emphasizes the connection between air quality and lung health.

Lung diseases can be due to various causes, 1) small airway obstruction causing asthma, COPD, bronchiectasis, 2) diseases affecting lung tissue like fibrosis, asbestosis 3) pulmonary vascular disease 4)Malignancy  or cancer  5) infections like viral, bacterial and fungal.

Smoking both active and passive, environmental pollution specifically air pollution, occupational  ( asbestos, woodsmoke, coal dust ,organic dusts like cotton,grain dust , welding fumes, diesel exhaust, wood finishing), bird excreta ,continuous or recurrent respiratory infections affect the lungs.

Air pollution is an important factor, pollutants , smoking ,trigger asthma, occupational asthma due to exposure to chemicals, fungal amylase in wheat flour among bakers. Smoking  asthmatics have more severe form of asthma as smoking interfers with lung function.

Occupational lung diseases  causes various lung pathologies like  lung fibrosis, cancer, COPD ,asthma, bronchitis, asbestosis ( asbestos industry), silicosis ( mining, quarrying, stonecutting, sand blasting, cement manufacturing).

Air pollution both outdoor air pollution  ( sulfur dioxide, Nitrogen dioxide, lead carbon monoxide )and indoor exposure to active & passive smoking ,wood smoke,  charcol  smoke affect lungs causing  various lung diseases and cancer .

About smoking, tobacco contains certain substances which are carcinogens like polycyclic aromatic hydrocarbons and nitrosamines. Use of unfiltered cigarette, pipe will increase the carcinogenic effect ,along with alcohol intake synergistic effect occurs as alcohol increases absorption of carcinogens contained in the tobacco. Duration of smoking, amount of cigarettes daily increase the carcinogenic effect.

Head and neck cancers  ,majority of the patients give history of smoking and alcohol intake.

To conclude let's be aware of the importance of a healthy lung and  take measures to reduce airpollution, more greenery, quit smoking, use safety measures while working in  places  like asbestos, coal, organic dust, chemical factories.

Cleaner air  and healthy lung improves quality of life.

Graves' Disease.....

Thyroid is an endocrine gland and it is situated in front of the neck. It plays a very crucial role in our daily life by releasing thyroid hormones. Thyroid dysfunction  can occur causing excess ( hyper thyroidism high free T3,T4& low TSH ) or deficiency (low Free T3,T4 & high TSH hypothyroidism).

July month is for Graves' Disease  awareness, which is a  condition  with hyperthyroidism and thyrotoxicosis. Thyrotoxicosis is a clinical syndrome due to  overproduction of thyroid hormones.

What is the  mechanism behind Graves' Disease ? ( pathogenesis)

It's an autoimmune condition with presence of IgG autoantibodies against TSH receptor inside the thyroid tissue ,which inturn leads to  stimulation of  thyroid hormone synthesis.Thyroid gland enlarges due to  increased expression of fibroblast growth factor. There is a cross reactivity between thyroid antigens and antigens present in orbit and extra orbital tissue.

Aetiology unknown, run in families, associated with certain genes .Other factors like stress, smoking, steroids, dietary iodine intake, Lithium, female gender. Graves disease also associated with Type 1 diabetes, vitiligo, and other  conditions like Addison's disease.

What are the manifestations or  characteristics ?

Diffuse goitre, eye and skin involvement which are known as opthalmopathy and dermatopathy. More in females, complications more among smokers.

Eye complications in Graves' Disease  manifests as eye swelling, eye irritation, foreign body sensation ,eye watering ,there will be feeling of pressure sensation behind the eyes due to deposition of glycosaminoglycans and lymphocytic infiltration of  orbital and retro orbital tissue. Sometimes corneal ulceration may occur  as complete eye closure may not be possible while sleeping. Double vision, decrease vision, colour vision due to pressure or stretching of optic nerve which is an emergency situation. So many eye signs are there.

Skin manifestations  are raised, edematous, pink nodular lesions  above the shin.

How to diagnose 

Clinical history, symptoms of hyperthyroidism like weight loss, anxiety, irritability, fatigue, breathlessness, heat intolerance, sweating, hairloss, brittle nails, increased appetite, menstrual irregularities  and signs like increased heart rate, tremor, warm moist skin among others.

Lab investigation  

Thyroid function test

Test for antibodies to TSH receptor.

Radiological investigation in case of opthalmopathy ( eye complications)

Management 

Antithyroid medication,  other medications to treat symptoms  due to thyroid hormone excess, Radioiodine treatment   ( not given in pregnancy, lactation, children), follow up needed. TSH level   needs to be checked annually.

Treatment of  orbital complications to be  done. Relapse and Remission can occur in Graves' Disease.

Surgery for those whom Radioiodine is contraindicated, cosmetic, not controlled with antithyroid medication, eye complications, associated carcinoma , compression symptoms in the neck like difficulty in swallowing, breathing difficulties. Patient needs to be euthyroid  before surgery to prevent complications like thyroid storm.

To summarise  dysfunction of thyroid is common, few may be autoimmune. When a patient has thyroid swelling, features of   hyperthyroidism,  they need medical evaluation, follow up. Since smoking is associated with  doubling of complications  in Graves disease , awareness is necessary.

Migraine and it's ENT manifestations

Migraine and it's ENT symptoms, how migraine can be confused with Sinusitis 

June is the month for Migraine and headache awareness .

It is a common cause of headache and neurologic cause of disability.

What is migraine?

It is an episodic or recurrent headache often one sided with characteristic features (attributed to autonomic nervous system) ,like sensitivity to sound, light, movement, and with nausea and vomiting. 

Precipitating and aggravating factors could be bright light, glare, sounds, hunger, stress, food containing tyramine like aged cheese, smoked fish, cured meat, MSG ,physical exertion, atmospheric pressure and temperature changes. Hormonal fluctuations in females during menstruation, lack or excessive sleep, alcohol intake. 

Mechanism 

it's a brain disorder where there is a constant activation of trigeminovascular system causing release of neuropeptide like calcitonin gene related peptide , substance P from peripheral trigeminal nerve endings causing headache (dysfunction of monoaminergic sensory control system located in brainstem and hypothalamus.)

Pulsating headache due to peripheral sensitisation.

Familial mainly in females.

Familial genes identified ( FHM familial hemiplegic migraine).There is involvement of ion channels with alteration in membrane excitability .Mutations involving Ca channels,Na k ATP ase ,sodium channels.

Types of Migraine

Migraine without aura, with aura 

typical aura with and without headache 

 Migraine with brain stem aura

Hemiplegic migraine…familial hemiplegic migraine type 1,2,3

Retinal migraine 

Chronic migraine 

 complications of migraine status migrainous

Coming to the Symptoms

One sided pulsatile or throbbing headache lasting for 2 hrs to 3 days.

Nausea, vomiting, photophobia, phonophobia ,in classic migraine with aura ,light headedness, scalp tenderness, visual disturbances like flickers or flashes, vertigo, numbness, altered consciousness, diarrhoea ,syncope ( fainting attack), seizure,confusion.

Common migraine usually has throbbing headache, nausea with out aura.

Patient may come to ENT for headache, giddiness,vertigo,  some of the patients will have one-sided nasal congestion, nasal discharge, eye watering, eye redness .

Treatment 

Assessment of the extent of disability ( migraine assessment disability score MIDAS)

Migraine due to its tendency to headache it can be controlled by lifestyle adjustment, medication, avoidance of trigger factors.

Healthy lifestyle , with a heathy diet, regular exercise, regular sleep patterns, avoid excess alcohol, caffeine, stress.

Reduce stress by yoga, meditation.

Medical management 

Mild to moderate symptoms simple analgesics like NSAID .

Moderate to severe needs other medications 

Preventive measures 

Life style alterations, nutritional supplements, medications.

Prophylactic medication for those having headache for more than 2 days a week,those with severe attacks,who cannot tolerate medications used to treat acute attacks.

To summarise migraine is a brain disorder and it's included under disability .Need to have a thorough history and examination as certain symptoms can mimic Sinusitis ,not to be confused and should not start antibiotics , straight away.

World Asthma Day..... Allergic rhinitis and Asthma

World Asthma Day is on first Tuesday of  the month of May . This year's theme ( 2024) is "Asthma Education Empowers ",creating awareness and educating people about asthma and how to lead a normal life.

What is allergic rhinitis and Asthma ?

Allergic rhinitis is a noninfectious rhinitis  mediated by Ig E .There will be inflammatory changes in the nasal mucosa due to exposure to inhaled allergens like pollen, dust mite, moulds   to name a few ,which leads to sneezing, itching, nasal discharge ,nasal block , itching of eyes, nose, scalp,ear, eye watering. Genetic factors are  also involved . Certain foods also causes nasal symptoms.

Children has allergic rhinitis  as the most common allergic manifestation, which affects their quality of life.  They should be treated by antiallergens and supportive measures.

Treatment of allergic rhinitis  includes reducing allergen exposure, medical treatment.

Asthma is a chronic inflammatory disorder of the airways  seen both among kids and adults. it is associated with hyper responsiveness of the airway, resulting airway obstruction. Ig E mediated  sensitivity to common allergens which are airborne, smoking, airpollution, stress are the common predisposing factors .

Symptoms of asthma include wheezing, breathing difficulties, coughing and tightness in the chest,occurng at  night or early morning. Presence of family history of asthma or atopic disorder also seen ,but nonatopic form of asthma also seen later in  life .

Treatment should be taken and preventive measures like avoidance of allergens should be done.

Relationship between  Asthma and Allergic rhinitis 

There is occurance of rhinitis in allergic and nonallergic asthma patients. Risk of allergic asthma high in allergic rhinitis patients. Rhinitis increase the risk of asthma in both atopic and nonatopic  individuals. Chronic rhinosinusitis also seen associated with asthma patients. Both asthma and allergic rhinitis has common predisposing factors like allergens which can be pollen, mould, pollutants and various other factors. Rhinoviral infections can cause exacerbation of asthma. Occupational rhinitis due to continuous exposure to certain chemicals or substances can lead on to occupational asthma. Inflammation is an important component seen both in asthma and rhinitis and sometimes nasal polyp also present.

Eosinophilic infiltration of nasal mucosa seen in asthma patients. Treatment for asthma and rhinitis given by  oral inhalers, intranasal sprays along with oral  medications .Sometimes injections may be needed for acute exacerbation of asthma. Immunotherapy  can be given if patient is allergic to a particular allergen.

Quality of life is affected by Asthma and rhinitis and  it causes  significant morbidity .

Those patients with persistent allergic rhinitis need to be evaluated for asthma.

WORLD MALARIA DAY 2024

World Malaria day 2024,  April 25 th.

Accelerate the fight against Malaria for a more equitable world… is the theme of world malaria day 2024.

Know about Malaria, organism, vector  ,symptoms, complications, treatment and prevention.

HOW DOES IT SPREAD

Malaria is transmitted by  female Anopheles mosquito when it takes bloodmeal from  a human infected with  malaria and causative parasite is plasmodium species like falciparum, vivax, ovale, malariae. Falciparum species  are responsible for malarial deaths. Vivax and falciparum species are seen in India.

Mosquito breeds in water tanks, pits, overhead tanks,edge of streams, wells, brackish water, pools, ponds, marshy areas.

When an infected female Anopheles mosquito bites a human, the parasite ( sporozoite form )enters the human blood stream from the mosquito’s salivary gland. It reaches the liver through the blood, where it undergoes  amplification process, then released into blood stream which will invade and multiply inside RBC. Symptoms appear as a result of invasion and destruction of RBC and by host  response.

Malaria endemic countries are Africa,  Asia. Certain countries have eliminated Malaria. It affects both urban and rural areas, multifactorial like inappropriate water storage and disposal, population migration from endemic to nonendemic areas and vive versa.

WHAT ARE THE SYMPTOMS 

 Both adults and children are affected. Endemic area they present with  severe anaemia and cerebral malaria.

Common symptoms are high  fever, which spikes regularly daily, 2 days or 3 days, chills ,rigor, headache , fatigue, loss of appetite, jaundice. Falciparum malaria can  affect brain leading to coma or cerebral malaria ,anaemia, renal failure,lung issues or respiratory distress, hypoglycemia, bleeding from nose, gums, GIT ,seizures, hypovolemia . Classic intermittent fever is usually not seen in children.

ENT manifestations are bleeding from the nose, headache,dizziness, ringing sensation in the ear,hearing loss. 

 WHAT ARE THE COMPLICATIONS ?

It can cause multi-organ  failure. Coma, convulsions, shock, breathing problems or respiratory distress, spontaneous bleeding.

Malaria can undergo relapse also.

HOW TO DIAGNOSE ?

Diagnosis is   history, by peripheral blood smear examination for malarial parasite. Rapid test for antibody, PCR .

TREATMENT 

Treatment by  antimalarial drugs, oral and injections, supportive measures.

Complicated or severe cases by falciparum requires requires immediate attention, hospital admission .

Oral medicine for uncomplicated malaria.

How to prevent Malaria

Use bed nets treated with insecticide especially in endemic areas, kill the vector mosquito ,  find and eliminate the breeding places  ,early or rapid diagnosis and management of the infection, chemo prevention or prophylaxis.

Avoid exposure to mosquito, use insect repellent, use fully covered clothes ,use bednets.

Chemoprophylaxis  should be taken, if travelling to endemic area, pregnant women to be warned about the risks if travelling. Consult a doctor for prophylaxis  before travelling as antimalarial drug resistance also is a problem.Those taking medicines should be advised regarding the side effects  of the medicine and  should inform the doctor if any adverse effects happen.

EARLY CASE DETECTION, PROMPT TREATMENT AND VECTOR CONTROL   PREVENTS SPREAD OF MALARIA.

VOICE AND SOME PROBLEMS WE COME ACROSS

April 16th is celebrated as WORLD VOICE DAY, in order to highlight the importance of voice in our daily lives. 2024 theme is   Resonate Educate Celebrate .Voice is produced by the vibration of vocal cords, as the expired air passes through it. Voice is unique. 

WHAT ARE THE  CAUSES THAT LEADS TO PROBLEMS WITH  THE VOICE  ? 

Structural abnormalities due to any inflammation ( upper respiratory infections,allergies,acid reflux), lesions, neurology or muscular problems can lead on to hoarse or weak voice along with pain or discomfort in the throat. 

Problems can arise due to overuse or abuse of the vocal cords as in professional voice users like teachers or singers ( vocal cord nodules)  and  shifting from high pitch to low pitch as in mimicry . There will be early tiring  of the voice. 

Other problems are due to restricted activity of the vocal cords . 

WHAT ARE THE  SYMPTOMS AND SIGNS ? 

Abnormal vocal cord vibration leads to DYSPHONIA ( impairment of voice) absence of vocal cord vibration results in APHONIA. Vocal cord nodule ( teacher's or singer's nodule) , vocal cord polyp, cyst,  inflammation  due to chronic laryngitis, keratosis, granuloma, papilloma, cancers, cleft , neurological problems  causing vocal cord paralysis ,these are some of the conditions affecting vocal cords. 

WHAT CAN BE DONE? 

Examination of the ENT areas, Endoscopy , Stroboscopy , Radiological evaluation and Biopsy  . 

Treatment depends upon the diagnosis. Voice rest, vocal hygiene, voice therapy, vocal exercises ,laryngeal massages are some of the measures.. Medical management ( for upper respiratory infections, allergic and acid reflux) and in some cases phonosurgery. 

WHAT IS VOCAL HYGIENE ? 

Life style changes and dietary modifications, voice rest, adequate hydration,  to quit smoking and alcohol,  to consume less spicy food, to cut down tea and coffee ,  to have food 3 hours before sleep. 

VOICE IS A PRECIOUS GIFT, DON'T ABUSE OR OVER USE IT. ANY CHANGE IN VOICE WHICH IS LASTING FOR  MORE THAN 3 WEEKS NEEDS ATTENTION. 

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Throat pain causes and infection

Throat  pain is a very distressing symptom especially when you are not able to eat or drink or swallow  saliva. The cause for throat pain can be various like infection, inflammation, ulcers inside the mouth or any lesions.

Infective causes are  viral, bacterial and fungal .Viral pharyngitis  usually accompanied by cold or coryza symptoms, body pain, chills, fever ( always need not be in this order).Those with long standing  tonsillitis issue may come with flare up of tonsillitis or membrane  over the tonsils. Viral pharyngitis need to be treated symptomatically.

Bacterial pharyngitis and tonsillitis usually caused by gram positive cocci  like streptococcus. Antibiotics are needed to control bacterial tonsillitis to prevent abscess formation ( collection of pus).

Fungal Infection  seen more in those with low immunity like Diabetes or those on immunosuppressive medication. 

Other causes are allergic reaction to food or drinks, it can cause  pain , itchy throat, swelling of pharynx especially uvula .

Chronic conditions like acid reflux or Sinusitis with post nasal discharge leads to throat pain which will be of long standing duration.

 Preventive measures 

Viral and bacterial Infection usually spread through nasal or oral route. Those with illness should wear mask while going out . Avoid overcrowded areas as it leads to rapid spread of upper respiratory Infections.

Eat healthy food,  adequate hydration ,maintain oral hygiene.

TREATMENT 

Depends on the findings, comorbidities . Analgesics to relieve the pain, gargling with salt water and betadine. Drink warm fluids. Antibiotics only if symptoms point towards bacterial infection. Don't self medicate, visit a nearby doctor.

Red flag signs 

Any choking sensation or breathing difficulties change in voice ( like hot potato voice) high fever with chills need immediate hospital visit.

If mouth ulcers or blister like lesions are the causes for throat pain, topical  cream   should be added according to the findings.

Eat healthy, adequate hydration, take rest, avoid travelling if you are sick .