Peripheral neuropathy (PN) : Peripheral neuropathy (PN) is damage or disease affecting nerves, which may affect sensation, movement, gland or organ function, and other aspects of health, depending on the type of nerve affected. Common causes include systemic diseases (such as diabetes or leprosy), vitamin deficiency, medication (e.g., chemotherapy), traumatic injury, excessive alcohol consumption, immune system disease, or infection, or it may be inherited.
Commonly used treatments include using a tricyclic antidepressant (amitriptyline) and antiepileptic therapies such as gabapentin , Pregabalin and sodium valproate. Duloxetine, a serotonin-norepinephrine reuptake inhibitor, is also being used to reduce neuropathic pain.
Anemia : Anemia is the most common disorder of the blood. Anemia is a medical condition in which a decrease in number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood. Anemic men hemoglobin level is less than 13.5 gram/100 and for a anemic women hemoglobin level is less than 12.0 gram/100 ml. Anemia is caused by either a decrease in production of red blood cells or hemoglobin, or an increase in loss or destruction of red blood cells. Some patients with anemia have no symptoms. Others may feel tired, easily fatigued, appear pale, a feeling of heart racing, short of breath, and/or worsening of heart problems. Anemia can be detected by a simple blood test called a complete blood cell count (CBC). The treatment of the anemia varies greatly and very much depends on the particular cause.
Treatment – Treatment of anemia is done by
1. Oral iron
2. Injectable iron
3. Blood transfusions
4. Human Erythropoietin Injection
Systemic sclerosis : Systemic sclerosis (SSc) is a systemic connective tissue disease. Characteristics of systemic sclerosis include essential vasomotor disturbances; fibrosis; subsequent atrophy of the skin, subcutaneous tissue, muscles, and internal organs (eg, alimentary tract, lungs, heart, kidney, CNS); and immunologic disturbances accompany these findings. Raynaud phenomenon is usually the first symptom of systemic sclerosis. Patients experience episodes of vasospasm , which causes blood vessels in the fingers and toes to constrict. As less blood is reaching these extremities the skin changes colour to white and the fingers and toes may feel cold and numb. As they warm up, they go blue and then red before returning to normal again.
Other skin changes include:
? Itchy skin
? Thickening of the skin of the fingers, then atrophy (thinned) and sclerosis (scarring). The fingers become spindle-shaped (sclerodactyly) from resorption of the fingertips.
? Fragile nails become smaller with ragged cuticles
? Taut, shiny skin that may have dark or pale patches (hyperpigmentation or hypopigmentation). The tight skin may affect most parts of the body, including the face, resulting in loss of expression and difficulty opening the mouth properly.
? Visibly dilated blood vessels (telangiectases) appear on the fingers, palms, face, lips, tongue and chest.
? Calcinosis (calcium deposits) develops in the skin, particularly the fingers, hands and other bony areas. These can breakdown and discharge chalky material.
? Ulcers may follow minor injuries over the joints, or on the tips of fingers and toes where the circulation is poor. Ulceration can lead to dry gangrene and eventual loss of the tips of the fingers (like frost bite).
? Ulcers may also arise over calcinosis and on the lower legs.
? Sicca symptoms (dry eyes, dry mouth) and Sjogren syndrome
There is no cure for systemic sclerosis and treatment is aimed at controlling symptoms and preventing complications. Because the symptoms of systemic sclerosis are so diverse a team of medical specialists is usually necessary. It is absolutely essential to discontinue smoking.
The mainstay of treatment is with immune modulating agents, including:
? Oral corticosteroids
? Azathioprine
? Cyclophosphamide
? Methotrexate
? Mycophenolate
? Ciclosporin