Thread: Medical Questions with Answers!!

Q. One of my friends talks and laughs while sleeping. Sometimes, he hits the bed with his hands and legs. What is the cause and treatment for this?

A. These are called parasomnias - sleep talking is a very common parasomnia occurring more commonly in kids. In addition, it is possible that he might have other parasomnias (e.g., REM behaviour disorder) as well if he moves his extremities a lot. Some of the parasomnias can lead to an injury to the individual or the bed partner depending on the severity. Please consider evaluation by a physician specialising in sleep disorders if there is any history of injury to him or his bed partner. Also, take adequate precautions, such as bed padding, making sure sharp objects / weapons are inaccessible to the individual during these episodes; make sure doors and windows are locked, etc.

Q. Two months back, a lymphnode appeared on the left side of my neck. A month back, several other lymphnodes appeared on the right side of my neck. The doctor has confirmed TB. I am also having some pain on the right side of my chest with very less cough for 20 days. For the last 15 days, I do not have any fever, but there is a pain in the chest. The skin test for TB was positive, with a diameter of 20 mm. What type of TB am I suffering from? Do I have TB of the lungs? If I do not cough much, can it spread? Is there a particular diet I should follow?

A. Based on the details submitted by you, it does seem that you have TB lymphadenitis with or without TB of the lungs. An X-ray of the chest following a detailed physical examination by your doctor shall tell you whether the lungs are involved or not. A sputum for AFB (acid fast bacilli) smear and culture (ideally on three consecutive days, if the initial smears are negative) shall tell us whether your TB is infectious or not. Irrespective of the results, please maintain good cough etiquette and hygiene by covering your mouth with a handkerchief when you cough. Usually, TB first affects the lungs and is then spread to other parts of the body.

Regarding your food intake, you should take a nutritious balanced diet high in proteins. There is no restriction regarding any food item

Q. My 50-year-old mother has been diagnosed with cataract. Now she has started complaining about difficulties in her daily routine like walking, seeing things and performing her daily essential work. As she is hypertensive, I am worried about her surgery. How should we go about the surgery? How much will the surgery cost? Will she be hospitalised after the surgery? After how long will she be able to see things properly? Should both her eyes be operated simulatneously?

A. Cataract is only treatable by surgery. So far, no medicine has proved to be effective for this.

Surgery for cataract is very easy and painless nowadays. It will involve going to the hospital for only a few hours, and if all goes well, vision should improve in one day. She will need to use some drops for 2-4 weeks after that. Ater she gets new glasses, vision should be perfect, even better than before.

One eye is usually operated at a time. The second eye can be operated after a few days. Both eyes are normally not operated together to avoid any complications and infection.

See your eye specialist who will advise you and also let you know the cost. Cost varies a lot from about Rs 5000 to Rs 50,000 depending on the specialist and the hospital.

Q. My five-year-old daughter has delayed milestones - rolled at six months, sat at one year, walked at 1.3 years and talked at 3.6 months. We took her to NIMHANS, Bangalore where she was diagnosed with ESD(expression speech delay) with adequate comprehension. Her IQ is 109. We are giving her speech therapy and she is attending a Montessori school. She still cannot talk clearly and can handle only Malayalam. The school authorities feel that she mingles with other children, but she is reluctant to learn new things. According to them her maths skills are excellent; however, her imitation skills are limited. What aspects should we keep in mind while choosing a school for her? What kind of support can we give to help her bloom fully?

A. The school should be a relatively small one, where children are allowed the freedom to be themselves. Perhaps a Monetssori school will best fit this description, though many of them use the Montessori system only in the preschool years.

You should keep giving her warm support at her level and not be impatient with her if others her age have more advanced abilities. Having a kind teacher will be a requirement, but I do not see that parents have a choice in such matters. Maybe letting her spend one more year in a Montessori system would be a good idea. Talk to her teachers and decide.

Get her interesting games that she can engage in as well as music and art materials at home. Spend time with her talking to her and listening to her. Avoid the generally noisy and confusing TV. She can grow up to be like other children if she is given tender loving care now.

Q. My son, three years old, was having fever for 2 days with a temperature of 102 even after taking paracetamol and Cefixime. The doctor has asked to do Widal test, which was found to have a titre of 1:80. The doctor said that our son has high typhoid and was admitted in the hospital and was given IV Ciprofloxacin for 2 days, three times a day. After the second dose, there was no fever. He was discharged and asked to take Chloramphenicol for 5 days. He is not having vomiting or diarrhoea. He was also vaccinated for typhoid at 2 years of age. My doubt is if this is typhoid or viral fever because many say that typhoid cannot be detected on the second day of fever itself and there may be false positives because of vaccination? Is this true?

A. It is highly unlikely that a diagnosis of typhoid (enteric fever) or any other salmonellosis can be made solely on the basis of a Widal test done on day 2 of a fever in a vaccinated child, and should ideally be based on the isolation of the organisms either from the blood (in the early stage), urine or faeces (later on in the illness).

We must remember the limitations of Widal test, which is a serological test, and many times shows false positives. The interpretation of Widal test is affected by the frequency of distribution of Salmonella agglutinins (O & H) in the population. There is a certain proportion of the population whose sera will give antibodies capable of reacting to a variable titre in Widal test due partly to the occurrence of latent or after an infection with members of the enteric group like salmonella or other groups with antigenic factors similar to that used as antigen in the test. When we say diagnostic titre, we actually mean significant or suggestive. In Indian population where typhoid is endemic, single titres of only more than 1 in 200 are considered significant.

The agglutinins take time to appear and will usually not show a rise in titre over the baseline before a week; therefore paired sera are usually required to interpret the Widal test.

H agglutinins may persist for years after immunisation, therefore detection of agglutinins is of limited significance in the vaccinated patients with fever. An anamnestic reaction during the course of a fever not due to typhoid can often be misleading. For a vaccinated patient, the O agglutinin levels are better. They can also be elevated following immunisation but do not persist. A high O and a low H titre would suggest an active infection. A low O and a high H suggests an anamnestic reaction. The level of antibodies bear no constant relationship to the severity of the disease and relapses are equally common in those with high or low titre.

The early treatment of cases of typhoid fever with antibacterials has a profound effect on antibody response and consequently the Widal test. If agglutinins have not appeared when treatment is begun, they may not do so subsequently. If they are already present, no further rise may be expected. Treatment later in the disease has little or no effect in the agglutinin response.

In conclusion, Widal test is an old simple test but one needs knowledge in laboratory medicine for this test to be useful as devised. It is only an aid to the diagnosis of typhoid and paratyphoid fevers. A good medical history, proper timing of sampling, and keeping in mind that the diagnosis is aided by a significant rise in titre rather than one single sample is more helpful.

Q. I am 34 years old, diagnosed with cholesterol deposits in my right eye. What is the cause of it and is this an early warning of cholesterol deposits in blood vessels or heart attack?

A. Yes, this means that you have more cholesterol in your blood, which has caused this deposit in your eye. This is called hyperlipidaemia. This is partly genetic and partly your life style with food and exercises etc.

Even new born babies can have too much cholesterol in their blood. There are medications in addition to your life style change, which can reduce your cholesterol levels and thereby prevent subsequent damage to your system. Even if and when you have cholesterol deposits in your blood vessels, this treatment by statins can help to reduce it but treatment has to be taken for the rest of your life.

Q. I am a teacher and facing a problem with a student of mine who is in class 5 (11 years old). He is good at learning but is unable to write properly. To some extent I feel the problem is that he lives in a joint family where his other 3 cousins are of the same age and good in studies. I know he is being demoralised at home but how to boost him is a big issue for me. How should I make this boy good in both writing and studies?

A. Some children do have a problem with writing. In some cases it is related to dyslexia (difficulty in reading) and is called dysgraphia (difficulty in writing). There is not much you can do about the home setting and competitive cousins and uncles! You can only reduce the child’s anxiety by assuring him that he is good and by giving him time to write. The confidence you have in him is the best tonic.

Q. I am 30 years old. My left elbow dislocated 2 months back when I fell down. The doctor corrected this at the hospital and plastered my elbow for a month. After that it took 15-20 days to recover. Now, I feel pain while lifting heavy weight, although I avoid it as much possible. What physiotherapy should I do for full recovery. Normally, I don't have any pain or any other problems.

A. After a dislocation of the elbow it is very difficult to predict how much time it will take to return to normalcy. You are lucky that your elbow has become mobile in such a short time. You need to continue range of movement of exercises till such time your muscle strength returns to normal. While doing exercises, do not use too much of force. Frequency of the range of movement is more important than force of range of movement. If you can have access to physiotherapy unit it is better to supervise exercise for about two weeks and then continue on your own. You need to do flexion extension exercises of the elbow (maximum bending and straightening exercises of elbow) and pronation and supination exercises of the elbow (in, which the forearm is rotated in and out).

Can a failed kidney function be improved?


Q. If someones kidney function declines due to some reason (infection, diabetes etc), can it be improved with the help of medicines? Is there a mathematical correlation between GFR and creatinine?

A. Yes, if kidney function is lost acutely, say due to infection it can recover once the infection is treated. There are many mathematical formulae to calculate GFR from serum creatinine.

Q. Is it a necessary for a TB patient to get cough?

A. Although Tuberculosis (TB) and other lung infections are common throughout the developing world, they are not among the most common causes of chronic cough. Any acute or chronic infection that involves the sinuses, upper airways, lower airways, and lungs may lead to acute or chronic cough. It may also be due to allergies or air pollution. However, cough is one of the most common symptom of active TB affecting the lungs, but may be absent in cases of extrapulmonary TB (TB affecting organs other than lungs). Classically, the cough in TB lasts for more than three weeks, and may start as a dry irritating cough, which may be no different from that suffered in any chest infection. The cough of tuberculosis will continue for weeks or months getting progressively worse. After a while profuse amounts of sputum or phlegm may be brought up from the chest with each cough. If a blood vessel is damaged blood may be coughed up and this is known as haemoptysis. The cough of severe tuberculosis may be uncontrollable causing the patient to have spasms of wracking continuous coughing. Sometimes the patient will complain of pains in the chest which will be made worse by coughing. In severe cases, where much of the lung has been destroyed, breathlessness may occur