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Osteomalacia, or soft bones, often develops because of a lack of vitamin D. It causes severe bone pain and muscle weakness. In Victorian times the condition often affected children and was called rickets, but today osteomalacia usually affects adults, especially the elderly and/or people of South Asian origin.

The causes of adult osteomalacia are varied, but ultimately result in a vitamin D deficiency:

• Insufficient nutritional quantities or faulty metabolism of vitamin D or phosphorus
• Renal tubular acidosis
• Malnutrition during pregnancy
• Malabsorption syndrome
• Hypophosphatemia
• Chronic renal failure
• Tumor-induced osteomalacia
• Long-term anticonvulsant therapy
• Coeliac disease
• Cadmium poisoning, Itai-itai disease

Symptoms of osteomalacia can include:

• pain felt in your bones – usually felt in your legs, groin, knees and feet
• muscle weakness – usually affects your thighs, shoulders and main trunk of your body
• back pain
• pain caused by slight cracks in the bone (partial fractures) – sometimes these cracks can turn into complete breaks (complete fractures)

As the condition gets worse, pain can be felt everywhere and any movement can be painful.

Osteomalacia in adults starts insidiously as aches and pains in the lumbar (lower back) region and thighs, spreading later to the arms and ribs. The pain is symmetrical, non-radiating and is accompanied by sensitivity in the involved bones. Proximal muscles are weak, and there is difficulty in climbing up stairs and getting up from a squatting position.

Due to demineralization bones become less rigid. Physical signs include deformities like triradiate pelvis and lordosis. The patient has a typical "waddling" gait. However, those physical signs may derive from a previous osteomalacial state, since bones do not regain their original shape after they become deformed.

Pathologic fractures due to weight bearing may develop. Most of the time, the only alleged symptom is chronic fatigue, while bone aches are not spontaneous but only revealed by pressure or shocks.

It differs from renal osteodystrophy, where the latter shows hyperphosphatemia.

Patients who have osteomalacia can take vitamin D, calcium, or phosphate supplements, depending on the individual case. For instance, people with intestinal malabsorption (the intestines cannot absorb nutrients or vitamins properly) may need to take larger quantities of vitamin D and calcium.

Other treatments to relieve or correct osteomalacia symptoms may include:

• Wearing braces to reduce or prevent bone irregularities
• Surgery to correct bone deformities (in severe cases)
• Adequate exposure to sunlight

Prostate cancer is one of the 10 most common diseases that afflict man. Unfortunately, men often are not aware of him until the disease is spread and more difficult to treat. This could be due to too many symptoms. At least, there is a way to recognize the symptoms of prostate cancer. Let us look at the following signs and symptoms:

1. Difficult urination

Could be a feeling of wanting to urinate but nothing comes out, stop when you're urinating, there is still a feeling of wanting to urinate or have to travel frequently to the toilet to urinate due out a little bit. This phenomenon is due to enlargement of the prostate gland is around the urinary tract due to a tumor in it so disturbing voiding process. The prostate gland will be greater with age a person. So check with your doctor to distinguish whether only prostate enlargement or cancer.

2. Pain during urination

This problem is also due to prostate tumors that suppress the urinary tract. However, pain can also be a symptom of prostate infection called prostatitis. It could also be a sign of prostate hyperplasia is not cancerous.

3. Bleeding during urination

These symptoms are rare, but should not be ignored. Immediately see a doctor even if only a little blood ejected, or only faint faint pink. Sometimes a urinary tract infection can also cause these symptoms.

4. Hard erection or sustain an erection

Prostate tumors may cause blood flow to the penis which should increase the time of the erection becomes blocked so hard erection. Could also cause an erection can not ejaculate after. But once again, an enlarged prostate may cause these symptoms.

5. Blood in semen

These symptoms, such as blood in the urine, may arise not so clear. Blood in large quantities and not just cause the color changed to pink. Still worth on alert.

6. Difficult defecation and no other gastrointestinal problems

The prostate gland is located below the bladder and in front of the rectum. As a result, when there is impaired intestinal tumors. But remember, difficult defecation Persistent could also lead to an enlarged prostate gland due to pressure on a continuous basis. Difficult defecation and gastrointestinal disorders may also indicate colon cancer.

7. Continuous pain in the lower back, pelvis or upper thighs

Frequently, prostate cancer spreads in these regions, ie at the lower back, pelvis and hip pain that is difficult to explain in this section can be a sign of disturbance

8. Frequent urination at night

If you often wake up at night more than once just to urinate, check immediately to the doctor.

9. Urine dripping or not strong enough

These symptoms similar to urinary incontinence (wetting). Urine can not be held until slowly out and drip. Or if it was not strong enough flow out.

10. The age of 50 and have risk factors

Because it does not cause symptoms, men who have risk factors should be screened routinely. These risk factors include a family member who had cancer, especially if it's the father, obesity / overweight and smoking is a risk factor for prostate cancer.

Nasopharyngeal carcinoma is a rare tumor arising from the epithelium of the nasopharynx.

Nasopharyngeal carcinoma is difficult to detect early. That's probably because the nasopharnyx isn't easy to examine and symptoms of nasopharyngeal carcinoma mimic those of other more common conditions.

Three subtypes of NPC are recognized in the World Health Organisation (WHO) classification [20]:

• type 1: squamous cell carcinoma, typically found in the older adult population

• type 2: non-keratinizing carcinoma

• type 3: undifferentiated carcinoma

Possible noticeable symptoms of nasopharyngeal carcinoma include:

• A lump in your neck caused by a swollen lymph node
• Blood in your saliva
• Bloody discharge from your nose
• Nasal congestion
• Hearing loss
• Frequent ear infections
• Headaches

Staging of Nasophayngeal Carcinoma

Staging of Nasophayngeal Carcinoma is based on clinical and radiologic examination. Most patients present with Stage III or IV disease.

Stage I is a small tumor confined to nasopharynx.

Stage II is a tumor extending in the local area, or that with any evidence of limited neck (nodal) disease.

Stage III is a large tumor with or without neck disease, or a tumor with bilateral neck disease.

Stage IV is a large tumor involving intracranial or infratemporal regions, an extensive neck disease, and/or any distant metastasis.

No sure way exists to prevent nasopharyngeal carcinoma. However, if you're concerned about your risk of nasopharyngeal carcinoma, you may consider avoiding habits that have been associated with the disease. For instance, you may choose to cut back on the amount of salt-cured foods you eat or avoid these foods altogether.

Treatment for nasopharyngeal carcinoma usually involves radiation therapy, chemotherapy or a combination of the two. You can work with your doctor to determine the exact approach depending on your particular situation.

Thyroid storm, also referred to as thyrotoxic crisis, is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones (THs) in individuals with thyrotoxicosis.

Symptoms of Thyroid Storm

• Rapid heart beats (palpitations)
• Greatly increased body temperature
• Chest pain
• Shortness of breath
• Anxiety and irritability
• Disorientation
• Increased sweating
• Weakness
• Heart failure

Diagnosis of Thyroid Storm

The following tests are usually performed to diagnose thyroid storm:

• blood cell count,
• electrolyte levels,
• blood sugar level,
• liver function, and
• thyroid hormone levels.

Investigations of Thyroid Storm

• Investigations for any underlying precipitant - eg, infection screen.
• TFTs: elevated T3 and T4 levels, elevated T3 uptake, suppressed TSH levels.
• Indications of decompensation of homeostasis - eg, renal dysfunction, elevated creatine kinase, electrolyte imbalance (due to dehydration), anaemia, thrombocytopenia, raised white cell count, abnormal LFTs (raised levels of transaminases, lactate dehydrogenase, alkaline phosphatase and bilirubin), hypercalcaemia, hyperglycaemia.
• ECG.
• CXR.
• Arterial blood gases and pH.

Thyroid Storm Self-Care at Home

People experiencing thyroid storm are not able to function normally. Thyroid storm is always a medical emergency. People experiencing symptoms of thyroid storm should be taken to the closest hospital, because thyroid storm is a life-threatening condition.

Glaucoma is an eye disease in which the optic nerve is damaged in a characteristic pattern. This can permanently damage vision in the affected eye(s) and lead to blindness if left untreated.

Glaucoma is a disease that steals the sight of people around the world -- and they typically don't even know they have the disease until it has permanently destroyed at least 40 percent of their vision.

Symptoms of Glaucoma

Glaucoma often is called the "silent thief of sight," because most types typically cause no pain and produce no symptoms until noticeable vision loss occurs.

For this reason, glaucoma often progresses undetected until the optic nerve already has been irreversibly damaged, with varying degrees of permanent vision loss.

But with acute angle-closure glaucoma, symptoms that occur suddenly can include blurry vision, halos around lights, intense eye pain, nausea and vomiting. If you have these symptoms, make sure you see an eye care practitioner or visit the emergency room immediately so steps can be taken to prevent permanent vision loss.

Risk Factors of Glaucoma

• Age over 45 years
• Family history of glaucoma
• Black racial ancestry
• Diabetes
• History of elevated intraocular pressure
• Nearsightedness (high degree of myopia), which is the inability to see distant objects clearly
• History of injury to the eye
• Use of cortisone (steroids), either in the eye or systemically (orally or injected)
• Farsightedness (hyperopia), which is seeing distant objects better than close ones (Farsighted people may have narrow drainage angles, which predispose them to acute [sudden] attacks of angle-closure glaucoma.)

Treatments of Glaucoma

Treatment can involve glaucoma surgery, lasers or medication, depending on the severity. Eye drops with medication aimed at lowering IOP usually are tried first to control glaucoma.

Because glaucoma often is painless, people may become careless about strict use of eye drops that can control eye pressure and help prevent permanent eye damage.

In fact, non-compliance with a program of prescribed glaucoma medication is a major reason for blindness caused by glaucoma.

If you find that the eye drops you are using for glaucoma are uncomfortable or inconvenient, never discontinue them without first consulting your eye doctor about a possible alternative therapy.

Aortic stenosis is the obstruction of blood flow across the aortic valve. The aortic valve has three flaps (cusps). Blood flows through the valve when the left ventricle contracts at the early part of the heartbeat. When the left ventricle relaxes, the aortic valve closes. Then the mitral valve opens to allow more blood into the ventricle ready for the next heartbeat.

The main causes of aortic stenosis include:

• A birth defect of the aortic valve, which normally has three cusps:

• An aortic valve that has only one cusp or is otherwise stenotic from birth
• A bicuspid (two-part) aortic valve with progressive wear and tear

• Progressive calcification of the aortic valve with age (most common in elderly)
• Rarely, scarring of the aortic valve caused by Rheumatic Fever

The classic triad of symptoms in patients with aortic stenosis is as follows :

• Chest pain: Angina pectoris in patients with aortic stenosis is typically precipitated by exertion and relieved by rest
• Heart failure: Symptoms include paroxysmal nocturnal dyspnea, orthopnea, dyspnea on exertion, and shortness of breath
• Syncope: Often occurs upon exertion when systemic vasodilatation in the presence of a fixed forward stroke volume causes the arterial systolic blood pressure to decline

Emergency Care for Aortic Stenosis

A patient presenting with uncontrolled heart failure should be treated supportively with oxygen, cardiac and oximetry monitoring, intravenous access, loop diuretics, nitrates (remembering the potential nitrate sensitivity of patients with aortic stenosis), morphine (as needed and tolerated), and noninvasive or invasive ventilatory support (as indicated). Patients with severe heart failure due to aortic stenosis that is resistant to medical management should be considered for urgent surgery.

Sleep is a routine activity that can rest your mind and soul. But too many of us ignore the hours of sleep. This is due to various factors such as tasks that have been piling up, playing games or browsing the Internet and other activities. Therefore, it is very difficult to get quality sleep for your health. Then, how to get quality sleep ....???

There are so many consequences that can result from reduced hours of sleep you have. Problems with weight, less passionate, troubled heart and body are susceptible to various diseases is the lack of impact of your daily bedtime. Thus the importance of quality sleep tips you should know. Companions, health tips. Here are tips for better sleep quality:

1. Keep doing morning sports activities on a regular basis. This is because, Sports that you do every morning will help you to fall asleep faster at night. So the quality sleep you can get by very easily.

2. Try to create a regular schedule for your sleep every night. By making a night time sleep schedule, then automatically you can get quality sleep easily anyway.

3. Try not to eat foods that are too filling your stomach in while going to sleep. This is because, that too very full stomach will lead to trouble sleeping. A light dinner are strongly advised to make your evening more quality sleep.

4. Try not to carry a cell phone or mobile phone in your bed. So you will not be doing activities like call someone or sms air with someone who can disturb your sleep. So the quality sleep you can easily get away with a cell phone or mobile phone of your bed.

5. Try to turn off your bedroom light before you sleep at night. With the room lights were extinguished will make you sleep more soundly. So the quality sleep you will be able to fulfill.

6. Get to know your habits before bed. So you will be easier to prepare everything to be able to sleep on time and get quality sleep anyway.

7. If you are someone who is always associated with computers, you should turn off your computer when your sleep schedule has arrived. But it is advisable to rest your brain and mind for half an hour before you sleep. So that your mind is more calm and you sleep more soundly and getting quality sleep anyway.

Herpes zoster commonly known as shingles and also known as zona, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe.

Anyone who has recovered from chickenpox may develop shingles, including children. However, shingles most commonly occurs in people 50 years old or older. The risk of getting shingles increases as a person gets older. People who have medical conditions that keep the immune system from working properly, like cancer, leukemia, lymphoma, and human immunodeficiency virus (HIV) infections, or people who receive drugs that weaken the immune system, such as steroids and drugs given after organ transplantation, are also at greater risk to get shingles.

Shingles usually starts as a rash on one side of the face or body. The rash starts as blisters that scab after three to five days. The rash usually clears within two to four weeks.

Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Other symptoms of shingles can include fever, headache, chills, and upset stomach.

Diagnosis of Herpes zoster

The diagnosis of herpes zoster is usually clinical, with laboratory tests reserved for more atypical cases. The ideal specimen is a swab from the base of burst new vesicles in viral transport
medium. This can be processed for direct fluorescent antibody testing (1–2 hour turnaround time), DNA testing by PCR (turnaround time of one day, but more sensitive especially in older lesions) and
viral culture (takes 1–2 weeks and is less sensitive than PCR). Serology for antibodies to varicella zoster virus usually adds little to the diagnosis and may be falsely negative in early
presentation due to waning IgG antibodies below detectable levels.

Pain Management of Herpes zoster

Treating the pain associated with herpes zoster, particularly in the acute stage, is considered an integral component of management and may have benefits in reducing the severity and incidence of
postherpetic neuralgia. This should follow a stepwise approach based on current Australian guidelines.11 These have been summarised in Table 1. Of note, one double-blind randomised controlled trial showed a reduction in incidence of postherpetic neuralgia at six months by about half with early (within 48 hours of rash
onset) commencement of low-dose amitriptyline 25 mg at night (for 90 days) although caution must be used when treating the elderly.12
Pharmacological management of postherpetic neuralgia follows a similar stepwise approach and may additionally involve the use of gabapentin or pregabalin and topical capsaicin. Transcutaneous
electrical nerve stimulation (TENS) may also be useful.

Osteoarthritis is the most common form of arthritis. Osteoarthritis is a joint inflammation that results from cartilage degeneration. It causes pain, swelling, and reduced motion in your joints. It can occur in any joint, but usually it affects your hands, knees, hips or spine.

For many, although by no means everyone, arthritis seems to be an inevitable part of the aging process, and there are no signs of long-lasting cures in the immediate future. On the positive side, advances in both conventional medical treatment and alternative therapies make living with arthritis more bearable.

Risk factors of Osteoarthritis include:

• Older age
• Having family members with OA
• Obesity
• Joint injury or repetitive use (overuse) of joints
• Joint deformity such as unequal leg length, bowlegs or knocked knees.

The main symptoms of osteoarthritis are:

• pain (particularly when you’re moving the joint or at the end of the day)
• stiffness (especially after rest – this usually eases after a minute or so as you get moving)
• crepitus, a creaking, crunching, grinding sensation when you move the joint
• hard swellings (caused by osteophytes)
• soft swellings (caused by extra fluid in the joint)

Other symptoms can include:

• the joint giving way because your muscles have become weak or the joint structure is less stable
• the joint not moving as freely or as far as normal
• the muscles around your joint looking thin or wasted

Cardiogenic shock is a physiologic state in which inadequate tissue perfusion results from cardiac dysfunction, most often systolic. The most common causes are serious heart complications. Many of these occur during or after a heart attack (myocardial infarction).

Cardiogenic shock most commonly occurs as a complication of acute myocardial infarction (MI). It occurs in 7% of patients with ST-segment elevation MI and 3% with non ST-segment elevation MI. It is a medical emergency requiring immediate resuscitation.

Cardiogenic shock can result from the following types of cardiac dysfunction:

• Systolic dysfunction
• Diastolic dysfunction
• Valvular dysfunction
• Cardiac arrhythmias
• Coronary artery disease
• Mechanical complications

Symptoms of Cardiogenic shock

• Chest pain or pressure
• Coma
• Decreased urination
• Fast breathing
• Fast pulse
• Heavy sweating, moist skin
• Lightheadedness
• Loss of alertness and ability to concentrate
• Restlessness, agitation, confusion
• Shortness of breath
• Skin that feels cool to the touch
• Pale skin color or blotchy skin
• Weak (thready) pulse

Prevention of Cardiogenic shock

Early coronary revascularisation in patients post-myocardial infarction (MI) and adequate treatment of patients with structural heart disease may help to prevent cardiogenic shock.
Better treatment of acute coronary syndrome seems to be reducing the rates of cardiogenic shock.

Multiple sclerosis is a chronic disease that attacks the central nervous system, i.e. the brain, spinal cord and optic nerves. In severe cases the patient becomes paralyzed and/or blind, while in milder cases there may be numbness in the limbs.

People with multiple sclerosis (MS) tend to have their first symptoms between the ages of 20 and 40. Usually the symptoms get better, but then come back. Some may come and go, while others linger.

According to the National Health Service, UK, approximately 100,000 people live with multiple sclerosis in Great Britain. Symptoms usually appear initially between 15 and 45 years of age. Women are twice as likely to get MS than men.

11 Common Symptoms of Multiple Sclerosis :

1. Bladder problems: About 8 in 10 people have bladder problems, which can be treated. You may need to pee often, urgently, need to go at night, or have trouble emptying your bladder fully. Bowel problems, especially constipation, are also common.

2. Dizziness: It's common to feel dizzy or lightheaded. You usually won't have vertigo, or the feeling that the room is spinning.

3. Abnormal sensations: People with MS often say they feel a "pins and needles" sensation. They may also have numbness, itching, burning, stabbing, or tearing pains. About half of people with MS have these uncomfortable symptoms. Fortunately, they can be managed or treated.

4. Fatigue: About 8 in 10 people feel very tired. It often comes on in the afternoon and causes weak muscles, slowed thinking, or sleepiness. It's usually not related to the amount of work you do. Some people with MS say they can feel tired even after a good night's sleep.

5. Difficulty walking: MS can cause muscle weakness or spasms, which make it harder to walk. Balance problems, numb feet, and fatigue can also make walking difficult.

6. Sexual difficulties: These include vaginal dryness in women and erection problems in men. Both men and women may be less responsive to touch, have a lower sex drive, or have trouble reaching orgasm.

7. Muscle spasms: They usually affect the leg muscles. For about 40% of people they are an early symptom of MS. In progressive MS, muscle spasms affect about 6 in 10 people. You might feel mild stiffness or strong, painful muscle spasms.

8. Thinking problems: About half of people with MS have trouble concentrating that comes and goes. For most, this means slowed thinking, poor attention, or fuzzy memory. Rarely, people can have severe problems that make it hard to do daily tasks. MS usually does not change your intellect and ability to read and understand conversation.

9. Speech problems: Sometimes MS can cause people to pause a long time in between words and have slurred or nasal speech. Some people also develop swallowing problems in more advanced stages of MS.

10. Vision problems: Problems with your eyes tend to be one of the first symptoms. They usually affect only one eye and go away on their own. Your sight may be blurry, gray, or have a dark spot in the center. You may suddenly have eye pain and temporary vision loss.

11. Tremors: About half of people with MS have tremors. They can be minor shakes or make it hard to manage everyday activities.

Rabies is a viral disease that causes acute encephalitis in warm-blooded animals. The rabies virus travels to the brain by following the peripheral nerves. The incubation period of the disease is usually a few months in humans, depending on the distance the virus must travel to reach the central nervous system. Once the rabies virus reaches the central nervous system and symptoms begin to show, the infection is virtually untreatable and usually fatal within days.

Rabies Symptoms

Rabies symptoms and signs occur after exposure and may consist of some or many of the following: odd behaviors, delirium, combativeness, loss of muscle function, muscle spasms, drooling, convulsions, pain, and other problems.

Although the majority of rabies infections worldwide originate from bites from infected dogs, other animals (for example, bats, foxes, raccoons, coyotes, wolves) may transmit the disease. Saliva from infected animals and bat guano may also transmit the rabies virus to humans under certain conditions.

Rabies Prevention

Prevention of rabies depends on decreasing the disease in the animal kingdom. Avoid contact with wild animals and strays. Have your pets (including cats, dogs, and ferrets) vaccinated against rabies. Keep pets under control and away from wild animals and strays. Call animal-control services to remove stray animals from your neighborhood.

Rabies Diagnostic

Diagnostic tests for rabies exposure usually involve taking tissue samples (often brain tissue) from the potentially rabies-infected animal exposed to the patient and using immunofluorescence or other immunological techniques to detect the virus in the animal tissue.

Gastritis is inflammation of the stomach lining. The main acute causes are excessive alcohol consumption or prolonged use of nonsteroidal anti-inflammatory drugs (also known as NSAIDs) such as aspirin or ibuprofen. In some cases, the stomach lining may be "eaten away," leading to sores (peptic ulcers) in the stomach or first part of the small intestine. Gastritis can occur suddenly (acute gastritis) or gradually (chronic gastritis). In most cases, gastritis does not permanently damage the stomach lining.


In many cases, gastritis has no symptoms. Common symptoms can include:

• Loss of appetite
• Pain in the upper abdomen just under the ribs
• Nausea or indigestion
• Hiccups
• Vomiting
• Blood in the vomit
• Blood in the bowel actions, if the stomach lining has ulcerated (this turns stools black and is called melaena)
• Weight loss.

Diagnosis:

Several tests can be used to make a diagnosis. These include endoscopy of the stomach, where a thin tube with a light and a camera on the end is inserted down your throat into your stomach. This allows the doctor to see into your stomach and take samples (called a biopsy) from the lining if needed. The laboratory tests you may need will depend on the cause of your gastritis. A stool test may be used to check for the presence of blood, or a biopsy may be taken of the tissues of your esophagus or stomach. A breath test may detect H. pylori, or samples from your esophagus or stomach may be taken to look for this bacteria.


Nursing Assessment for Gastritis

• During the gathering health history, the nurse asked about the signs and symptoms in patients.
• Does the patient have heartburn, can not eat, nausea or vomiting?
• Does the patient have symptoms occur at any time, before or after meals, after ingesting spicy foods or irritants or after ingesting certain drugs or alcohol?
• Does the patient have symptoms associated with anxiety, stress, allergies, eating or drinking too much, or eating too fast? how the symptoms disappear?
• Is there a history of previous gastric or stomach surgery?
• Historical diet plus a new type of diet eaten for 72 hours, would help.
• Full history is essential in helping nurses to identify whether excess dietary frivolous known, associated with current symptoms, whether others in the same patient has symptoms, whether the patient vomited blood, and if the elements are known to have ingested causes.

Nursing Diagnosis for Gastritis

Based on all the data assessment, nursing diagnosis is the major include the following:

1. Anxiety related to treatment.
2. Imbalanced Nutrition, Less Than Body Requirements related to inadequate nutrient inputs.
3. Risk for Fluid Volume Deficit related to insufficient fluid intake and excessive fluid loss due to vomiting.
4. Knowledge Deficit: on the management of diet and disease processes.
5. Acute Pain related to gastric mucosal irritation.