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With the passage of time, our lifestyle has changed a lot. Today, most of us lead a busy and hectic life and the more we try to ecel, the more we pose a danger to our health. Of all the organs, our heart is most severely affected by the stress. Regular exercise can guarantee safety for the heart. There is no better way to improve the efficiency of the heart than exercise. Remember the following facts :

• Heart is like a muscle that works better when it is in shape.
• Exercise makes it stronger, helping it to pump more blood.
• A healthy heart can pump a large amount of blood with fewer heart-beats than an unhealthy heart does.
• During exercise, blood is pumped at a much faster rate - as much as 20 times the normal volume of blood.
• Cardiovascular or aerobic exercises target the large muscles of the body and create an increased demand for oxygen.
• Exercise - such as walking, cycling, jogging and swimming - improves the circulatory and pulmonary systems.
• Five to six days a week, we must think of 20-60 minutes of continuous activity of an intensity of 55% to 90% of maximum heart rate.
• Those who have undergone a bypass surgery or angioplasty, can simply start by walking. They can, however, increase it gradually.
• Heart rate must be monitored when one indulges in exercise, to keep track of its prescribed limit.
• For specific exercise recommendations a physician should be consulted.

Mouth nourishes a population of commensal microorganisms which is normally controlled by the reasonable standard of oral hygiene. If it is neglected bacterial population may proliferate and this causes stomatitis. Stomatitis may occur when resistance to commensal population is lowered by disease, particularly in immune-compromised host. Stomatitis can also be due to nutritional deficiencies or some other factors.

Ulcerative Stamatitis (vincent’s infection):- It occurs mainly in adults with malnutrition and poor dental hygiene. Ulcers with ragged necrotic margins occur particularly on gums. It may involve palate, lips or inner aspects of cheeks. Ulcers are covered by grey slough surrounded by erythematous margin. The stained smear shows several spirochaetes and fusiform bacilli. Those organisms are present in small number in normal commensal population of mouth and condition may be regarded as endogenous infection because of impairment of the host resistance. That condition is infectious, so that patient’s food vessels and the cutlery should be sterilized. This is treated with metronidazole (200mg 8hourly for 4 days) or penicillin.

Viral Infections: - Herpes Simplex type 1 may cause recurrent problems of the herpes Labialis in normal individuals. It may cause much more severe stomatitis in AIDS.

Candidosis:- Fungus ‘candida albicans’ is normal commensal in mouth. It may proliferate to cause thrush in babies, in aged and especially in debilitated patients. The thrush is common in those receiving prolonged treatment with oral antibiotics and in patients who are immuno suppressed by the corticosteroids or AIDS. White patches appear on tongue and buccal mucosa also may enlarge. There is a little surrounding inflammation. During severe infection the pharynx and the oesophagus may be affected causing dysphagia.

Stomatitis due to deficiency of nutritional factors: - It may arise directly from insufficient intake or indirectly as the result of impaired absorption of vitamins, particularly niacin, folic acid, riboflavin and vitamin B. When this deficiency is acute and severe the tongue is red, raw and also painful because of atrophy of papillae. Tongue appears to be moist and unduly clean when the deficiency is less severe and chronic. The angular stomatitis sometimes accompanies glossitis particularly in case of gross iron deficiency. During severe vitamin C deficiency gums become swollen and spongy.

Aphthous Ulceration: - It is a common recurrent condition of the unknown aetiology characterized by painful superficial ulcers in mouth. Lesion begins as indurated erythematous area in one day or so by ulceration. Ulcers are often multiple and also remain painful for about one week before healing commences. They can recur every few weeks. The emotional stress may also precipitate an attack. In many women ulcers tend to recur in the cyclical fashion during premenstrual phase. When most of the patients are healthy, severe chronic aphthous ulceration can be found in association with Crohn’s disease, ulcerative colitis, coeliac disease and Behcet’s syndrome.

Hydrocortisone hemisuccinate lozenges (2.5mg, 8 hourly) can be effective at early stage of the lesions. The pain may be reduced with tropical anesthetics. The secondary infection can be controlled with tetracycline mouth washer. Suspension of sucralfate can be tried for healing.

Other forms of stomatitis: - Allergic reaction to the chemicals in some toothpaste, destures, foodstuffs and many drugs, particularly antibiotics, may cause stomatitis. Blue-black punctuate line may be visible where gum margins adjoin teeth in lead poisoning. Skin diseases like lichen planus, pemphigus and erythema multiforme involve mouth often before being visible on the skin. The stomatitis may also be the manifestation of blood dyscrasias.

Pancreas Division (Dominal Dorsal Duct Syndrome): - This problem occurs in up to 10% of the whole population. It results from dorsal and ventral pancreas to unite. Consequently most of the pancreas is drained through accessory papilla that is proximal to papilla of Vater. These types of patients are more prone to pancreatitis for condition appears to be associated with stenosis of opening of one or other papilla.
Diagnosis in made via endoscopic retrograde cholangiopancreatography (ERCP).

Annular Pancreas: - Ventral pancreas surrounds the second part of duodenum and it is frequently associated with other congenital defects such as mal-rotation of intestine, artesian and cardiac defects. Pancreas may constrict duodenum causing obstruction soon after the birth or in adult life. This may predispose to duodenal ulcer and acute pancreatitis. Diagnosis is made by barium studies and treatment is surgical bypass of constriction.

Ectopic Pancreatic Tissue: - It may occur in gastric antrum or duodenum and it takes the form of smooth nodule. It is normally asymptomatic and it does not require any treatment. If it is found coincidentally during surgery, the nodule is excised for it is subject to same conditions including carcinoma, as the pancreas itself.

Pathology: - The pathological findings and clinical features result from obstruction by abnormal viscid secretion of the ducts in salivary glands, digestive and biliary tracts and pancreas causing atrophy
Clinical Features: - The exocrine insufficiency leading to steatorrhoea and diarrhea is almost universal in childhood. If patient survives to adulthood, malabsortion tends to be less troublesome. The intestinal obstruction, commonly called “meconium ileus equivalent”, may occur in the children and in the adults, caused by inspissated food and secretions. Rectal prolapse is frequent in children because of the large bulky stools and frequent coughing. The recurrent episodes of the acute pancreatitis may also occur. The incidence of the diabetes mellitus increases with the age. Chronic pancreatitis may supervene. The disease of liver or biliary tract may occur.
Investigation: - The gastrointestinal problems are investigated according to suspected problems. There may be disorder in the gut epithelium and pancreas. 80% of the patients with cystic fibrosis have both pulmonary disease and pancreatic disease. But 15% patients have lung sepsis with clearly normal pancreatic function.

Management: - Optimal treatment in adolescent and adult depends on a team approach to the complicated respiratory, nutritional and hepatobiliary problems. Many treatment centers have established special clinics for such kind of patients with specialist care. Read more…

Dyspnoea or breathlessness can be defined as the unpleasant subjective awareness of sensation of breathing. It is the common symptom of the cardiac disease and the respiratory disease. In physiological terms, the patients usually perceive discomfort either from the increased ventilatory rate or drive, that can be provoked by the variety of factors or from a disease that causes enough reduction of ventilatory capacity. Other factors, including stimulations of J receptor leading to the amplification of ventilatory response in asthma or restrictive disorders, can also contribute.

It is obvious that diseases having dyspnoea may have a multifacteral etiology e.g., acute respiratory infections can stimulate respiratory rate as a result of fever, hypoxaemia and in serious cases, by acidoemia or hypercapnia. They can also reduce ventilatory capacity by increasing the bronchial resistance and also by restricting the ventilation because of pleural pain.

Different diagnosis in Patients with chronic Exertional Dyspnoea: -

Chronic obstructive pulmonary disease (COPD): -Very often there is a history of exertional dyspnoea over many years or months, with steady chronic decline exercise capacity. Chronic persistence cough and the daily production of sputum is the common rule and they can be a history of recurrent acute exacerbations of bronchitis. Wheezing on exercise can be prominent. In the late disease, especially if corpulmonale develops, orthopnoea, nocturnal breathlessness and ankle swelling many also supervene.

On Investigation, cyanosis may be at rest or on the trivial exertion, together with the expiratory wheeze, pursing of lips and intercostals indrawing, Antero-posterior diameter of chest may be increased and they may also be a reduced crico-sternal distance with ‘tracheal tug’ on inspiration. Chest radiograph shows signs of hyperinflation and bullae, arterial blood gases may expose hypoxaemia, hypercapnia and the raised plasma bicarbonate. There will often be the severe obstructive defeat on the spirometry which may or may not improve after the inhaled bronchodilators.

Heart Disease: - Sometime it is difficult to differentiate dyspnoea due to the heart disease. History of cough, wheezing and the nocturnal breathlessness may also occur in the cardiac failure as well as chronic obstructive pulmonary disease. History of angina or hypertension can be useful in implicating the cardiac cause. On investigation an increase in the heart size as judged by a displaced apex beat, the raised JVP and the cardiac murmurs may implicate cardiac disease. Chest radiograph and the ECG may provide the evidence of left ventricular or the arterial enlargement. Read more…

Scientists have found a vital information about Insulin, the essence of life force. Presence of less insulin, the glucose-regulating hormone, in brain may be the cause for long life. This tremendous information is reported in the journal “Science” by a group of researchers headed by Dr. Morris White, a Howard Hughes Institute investigator at Children’s Hospital in Boston, USA. The group picked up mutant mice that over-ate, became fat and got symptoms of diabetes but yet lived 18% longer than their normal lab nice. The secret behind this is that these mice lacked a key gene that affects insulin. This new information raises question about how desirable it is to use insulin for treating type-2 diabetes. It is known to the Doctors that people doing exercise regularly live longer on average. The researchers also know that putting animals on a strict diet makes them live longer, though this has not been shown to work in human beings. So, Dr. Morris White’s group wanted to see if the two effects were linked. They had looked at Insulin because both fasting and exercise make cells more insulin-sensitive, meaning they respond more effectively to the effects of insulin.

The group made effort to look at the entire insulin pathway-a series of actions in the cell that control the body’s use of insulin. The team investigated mice that had no working copies of one of the genes involved in this pathway, called insulin receptor substrate 2 or Irs2. The group found that mice with no copies of Irs2 got defective brains and also diabetes. But mice having one working copy lived 18% longer than normal lab mice even if they could shorten their lives being overweight and having higher insulin levels in their blood. Read more…