November 2019

1.1 PAIN
Pain is the most common symptom of disease. It is an unpleasant sensation or emotional experience
associated with actual or potential tissue damage. Any pain of moderate or higher intensity is
accompanied by anxiety and the urge to escape or terminate the feeling.
Diagnostic criteria
Self-report is the key to pain assessment. In non- or pre verbal children, facial expression is the most valid
indicator of pain; therefore use faces pain scale to assess severity. Pain should be assessed by:
Duration
Severity, e.g. does the patient wake up because of the pain
Site
Character, e.g. stabbing, throbbing, crushing, cramp like
Persistent or intermittent
Relieving or aggravating factors
Accompanying symptoms
Distribution of pain
In children pain can be assessed by Childs’ crying voice, posture, movement and colour
1.1.1 HEADACHE
1.1.1.1 Acute Headache
Diagnostic criteria
Secondary to fever and infection diseases
Secondary to local inflammatory cause
For further actions refer to fever, eye, ear and oral sections.
Pharmacological Treatment
A: Paracetamol oral 1g every 8 hours for at least 3 days
OR
A: Ibuprofen, oral 400mg 8 hourly for at least 3 days
Children A: Paracetamol 15 mg/kg/dose 6 hourly when required to a maximum of 4 doses per
24 hours
If there is no relief to paracetamol give:
A: Ibuprofen oral, 5-10mg/kg/dose 8 hourly
Note: Ibuprofen shall be given with food

Chronic Headache
Diagnostic criteria
Migraine
Cluster headache
Tension headache
Pharmacological Treatment:
Migraine
In acute attack give analgesics:
A: Paracetamol 1g immediately then every 4 hours; maximum dose 4g per day
2
OR
A: 
Acetylsalicylic acid 600mg 6 hourly.
AND
C: 
Metoclopramide (PO) 10mg 8 hourly.
OR
C: Metoclopramide IV 10mg 8hourly
In severe attack give:
C: Ergotamine tartrate 2mg 12 hourly. Not to be repeated at intervals less than 4 days.
For prevention purposes give
:
A: 
Propranolol 40-80mg 12 hourly
OR
A: 
Amitriptyline 10-50mg at night
Cluster and T
ension headache: Give analgesics as in acute headache (section 1.1.1)
1.1.2 CHEST PAIN
Differential diagnoses
Angina
Myocardial infections
Reflux Esophagitis
Lung infection
Pericarditis
Non-Pharmacological and Pharmacological Treatments
Treat as for main disease as indicated in specific chapters.
1.1.3 ABDOMINAL PAIN
1.1.3.1 Upper Abdominal Pain
Differential diagnoses
Pain related to eating food:
Dyspepsia
Gastritis
Pain related to eating food but persisted for more than three months
Peptic ulcers
Acute and recurrent pain in upper quadrant
Gallbladder diseases
Inflammatory bowel syndrome
Chronic pancreatitis
Diabetic autonomic neuropathy
Non-Pharmacological and Pharmacological Treatments
Treat as for main diseases
1.1 3.2 Lower Abdominal Pain
Diagnostic Criteria
Pain associated with diarrhoea or constipations
Intestinal involvement
Helminthes
Colicky pain in abdomen without diarrhoea or constipation

3
Colitis
Pain just before or during menstruation
Dysmenorrhoea
Endometriosis
Pain over lower abdomen and back associated with excessive white discharge in women
Pelvic inflammatory diseases
Pain during urination
Urinary tract infections (UTI)
Non Pharmacological and Pharmacological Treatments
Treat as for main disease as indicated in specific chapters
1.1.4 OTHER PAINS
Other pains may include:
Generalized body ache
Joint pain
Pain due to local infections
Pains due to injury
Eye pains
Ear pains
Non-Pharmacological and Pharmacological Treatments
For generalized pain give analgesics as in section 1.1.1. Advise the patient to rest and make a follow-up.
For joint, infections, injury, eye and ear pains treat as for main disease.
CAUTION: Do not use aspirin for abdominal pain or if a patient is vomiting or has nausea and do not use aspirin in children. Patients
with peptic ulcers should not be given acetic salicylic acid tablet.

Referral:
Refer patients to Regional and Tertiary care for:
Children with moderate and acute severe pain
No response to oral pain control
Uncertain diagnosis
All acute abdominal pain accompanied by vomiting and no passing of stool
Pain requiring definitive treatment for the underlying disease
Pain requiring strong opioids

Imarisha misuli ya uume wako na kupunguza tatizo la kumaliza mapema kwa kutumia mazoezi madogo tu (Improve your Penis function by doing simple exercises)


Kumaliza mapema (Premature ejaculation) wakati wa tendo la ndoa ni tatizo linalowakumba wanaume wengi hivi sasa, Ingawaje dawa za aina mbalimbali zimekua zikitumika kutibu tatizo hili imeonekana kwamba bado tatizo hili linazidi kuongezeka kila kukicha. Tatizo hili limekua likichangiwa na mambo mengi sana, ikiwemo yafuatayo;
  • Mwenendo wa maisha wa hivi sasa yaani watu wengi wanakula vyakula visivyokua na virutubisho kamili.
  • Matatizo ya kiafya ya muhusika
  • Na sababu nyinginezo nyingi
Kama nivyokwishakusema hapo mwanzo kwamba sababu za tatizo hili ziko nyingi sana, hivyo basi inatakiwa tusuruhishe swala hili kwa kutibu mzizi wa tatizo. 

Mbali na sababu za kiafya na zinginezo Mfumo wa uzazi wa mwanamume una misuli ya uume iliyoanzia eneo la mifupa ya kiuno (Pelvic bone), misuli hiyo ndiyo kiini cha tatizo hili (Kumaliza mapema). Nikupe mfano mmoja; Chukua picha ya watu wanaoinua vitu vizito, watu hawa wanaongeza ukubwa wa misuli yao kwa kufanya mazoezi ya viungo. Je, unaweza kuongeza ukubwa na ukakamavu wa misuli kwa kunywa dawa?? Lahasha ni jambo lisilowezekana, bali kwa kufanya mazoezi ya viungo.

Kwa kutumia mfano wa hapo juu nikurudishe kwenye kipengele cha misuli ya uume, Misuli ya uume haina tofauti na misuli mingine ya mwili, mfumo wake ni uleule. Tatizo la wanaume wengi kumaliza mapema inasababishwa na kusinyaa kwa misuli hiyo (Pelvic muscle). Tazama picha hapo chini inayoonyesha misuli hiyo;


Picha: Kwa hisani ya mtandao

Misuli ya uume ikiimalika Mwanaume hamalizi mapema pia anakua na uwezo wa kusimamisha vizuri uume wake na unakua kakamavu sio legevu.

JINSI YA KUITAMBUA MISULI YA UUME (PELVIC FLOOR MUSCLE)
Misuli hii ya uume (Pelvic floor muscle) ipo mwanzoni kabisa mwa shina la misuli ya uume. Namna ya kuitambua misuli hii fanya ifuatavyo;

Nikuulize swali moja kidogoUmeshawahi kubana mkojo?? Pengine upo maeneo ya hafla, darasani, ofisini, mpirani, kwenye gari ama safarini au sehemu ambayo unataka usipitwe na mada inayozungumziwa. Katika mazingira haya watu wengi wanajikuta wakibana mkojo kwa muda Fulani ili wamalizie uhondo wa mada Fulani au tukio fuani pengine yupo safarini na anajitahidi abane mkojo ili akojoe atakapofika.

Au ukiwa unakojoa maeneo Fulani yasiyo rasmi, pengine wakapita maofisa polisi ama migambo unajikuta unakatisha mkojo, Hivyo basi ile hali ya kubana au kukatisha mkojo unatumia misuli hiyo ya uume (Pelvic muscle), ndio breki ya mkojo.

Misuli hii ya uume ipo chini ya maungo ya mapaja katikati ya korodani na sehemu ya haja kubwa, mara nyingi sehemu hii ukiguswa au kutomaswa kwa kidole utaona uume unashtuka. Uuume unashtuka Zaidi ukiwa umesimama. 

Ndio maana wale watu wanaoingiliwa kinyume cha maumbile (Mashoga) wanaharibiwa misuli hii baadae mtu huyu (Shoga) anakuwa hana uwezo wa kusimamisha uume. Hivyo basi misuli hii ina kazi kubwa sana ya kuimarisha ukakamavu wa uume wako.

Hivyo basi misuli hii (Pelvic floor muscle) ndiyo inayotakiwa ifanyiwe mazoezi, sehemu hii ikiwa kakamavu uume unasimama vizuri na utaacha kumaliza mapema (Premature ejaculation).


NAMNA YA KUFANYA MAZOEZI YA MISULI YA UUME (PELVIC FLOOR MUSCLE EXERCISE/KEGEL EXERCISES)
Kama nilivyoeleza mwanzoni kwamba kiini cha mazoezi haya ni misuli ya uume, Hivyo ile hali ya kubana mkojo ndio zoezi lenyewe. Sio kwamba ubane mkojo, Lahasha inatakiwa uwe kama unabana mkojo wakati huna hamu ya kukojoa. Fanya hivyo kwa nguvu kwa sekunde 3 alafu utaachia, pia utafanya tena kwa sekunde 3, Vilevile utaachia tena afu utafanya tena. Unaweza kuendelea hadi sekunde 5, 10 na 30 kadiri utakavyokua unaweza. Fanya zoezi hili wakati wowote uupendao haijalishi uume umelala au umesimama, Pia ukifanya zoezi hili wakati uume wako umesimama itakua bora zaidi na misuri yako itakazika vizuri.

Uendelee na zoezi hilo mara nyingi kadri uwezavyo, ukizoea utaweza kufanya zoezi hili kwa muda mrefu zaidi na sehemu yoyote ukiwa unatembea, ukiwa umekaa, kwenye gari na sehemu yoyote ile. Uzuri wa zoezi hili unaweza kufanya sehemu yoyote pasipo watu kujua.


Natural Vitamins to increase Body Immunity

These 3 Natural Vitamins to increase Body Immunity

There is an old saying in English, whose Hindi translation is like, 'If you eat an apple a day, then stay away from the doctors'. This thing is quite true because apple has many elements that increase your immunity-resistant ability. If your immune system is good, then you survive from all kinds of diseases because most of the diseases in the body cause viruses and bacteria. Your immune system protects you from these bacteria and viruses. There are many such vitamins, which increase your immune system. Let's tell you who are those vitamins and what are those natural sources of vitamins.

Vitamin C

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Vitamin C is also called immunity booster vitamin. Vitamin C deficiency in the body increases the risk of many diseases. Vitamin C is known as bicarbonate acid, which is considered to be the best antioxidant. Glutathione contains vitamins containing substances that protects us from arterial diseases. By taking this, tissue builds in the body better, and the tissue that remains is available to connect with one another. In addition, Vitamin C prevents the destruction of cells.

Natural sources of Vitamin C

Vitamin C is rich in all citrus fruits like lemon, orange, amla, seasonal, grapes, tangrias, strawberries etc. Apart from this, vitamin C is also found in broccoli, capsicum, capsicum, spinach and oceanic diets. In a small lemon, up to 29.1 milligrams, a small orange contains about 51.1 milligrams and vitamin grams up to 445 milligrams in 100 gram pieces.

Vitamin B6

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Vitamin B6 also increases the body's immune system. Vitamin B6 supports biochemical reactions in the body, helping immune systemswork. Vitamin B6 is soluble in water and is beneficial in many diseases related to heart, skin and nervous system. This vitamin also provides relief from depression and lethargy. Vitamin B6 is also very important for the control of hormones in the body. Its deficiency increases the risk of diseases like many types of emotional disorders, heart diseases, kidney disease, multiple sclerosis, anemia, arthritis and influenza.

Natural sources of Vitamin B6

Most vitamins and nutrients meet us through diet. The best source of vitamin B6 is whole grains like wheat, millet, barley, corn, peas, green beans, walnuts etc. In non-vegetarian people this lack of vitamin is seen low because fish, eggs, chicken, mutton etc. are a good source of vitamin B6. Vegetarians can also find these vitamins easily with bananas, soy beans, carrots and green vegetables, besides cereals and dry fruits.

Vitamin E


Vitamins to increase Body Immunity
Vitamin E works like a powerful antioxidant, which enhances the body's ability to fight diseases and infections. Vitamin E is very important to increase the skin low and hair growth. Therefore, dietary vitamins should definitely be consumed.

Natural sources of Vitamin E

Vitamin E is found in vegetable oil. Apart from this, wheat, green greens, gram, barley, dates, rice grams, butter, cream, sugarcane, sprouted grains and fruits are found.
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