Doctor’s blog

Gout is a metabolic disorder which cause increased uric acid level in blood and deposition of uric acid crystals (monosodium urate or MSU) in various joints of the body. As the main reason of gout is increased uric acid level in blood and uric acid is produced from purine rich diet, the role of diet in causation of gout as well as in management of gout is extremely important.

Historically gout was known as the “disease of Kings” or “rich man’s disease” as it was more common among affluent class of the society. But these days it is not uncommon to see patients of gout from poor and lower middleclass also. Gout is no more a disease of rich men and it can be seen among all the classes of the society.

As gout is due to increased uric acid level in blood and uric acid is produced from diet which contains high purine, it is only prudent to avoid purine rich diet completely or if it can not be avoided completely, the amount of intake of purine rich diet should be reduced as much as possible.

To avoid or reduce intake of purine rich diet it is important to have knowledge about the foods which contain high purine and food items with low purine content. The idea is to reduce purine rich food intake and increase low purine food intake which will hopefully reduce uric acid level in blood in combination with medication for gout.

Some of food items with high purine content and should be avoided:

• Meat (any type of meat, red or white meat), fish, poultry, sea foods especially shellfish such as crab, oyster, scallop, shrimp, lobster, and crayfish etc.
• Liver, kidney, brain, meat extracts, meat gravies etc.
• Fast growing vegetables such as asparagus, spinach, mushrooms, cauliflower, pulses (such as lentils, peas etc.).

Some low purine foods and to be taken liberally:

• Cheese and other dairy products, tart cherries, celery extracts (including celery seeds) etc.
• Fresh fruits and vegetables are low in purine content.
• Dietary supplements and carbonated beverages.

Some food items may not have high purine but can aggravate gout and may increase uric acid level indirectly also should be avoided such as alcoholic beverages.

Moderate intake of fruits and vegetables with high purine content is not associated with increased risk of gout nor they precipitate gout and can be consumed safely. There is no data suggests moderate intake of high purine fruits and vegetables is harmful in gout.

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If you start blogging or decide to start a website (or a network of websites), you should think about buying web hosting from a good and trustworthy web hosting provider which allow multiple domain hosting. By choosing a web hosting provider you can save a good amount of money and also get your desired web hosting.

Gout is a metabolic disorder which commonly affects postmenopausal women and men of middle age to older age group. The metabolic disorder results in increase in uric acid level in blood (serum) and hyperuricemia (increased uric acid excretion in urine). Increased uric acid level in serum can result in deposition of uric acid crystals (monosodium urate or MSU crystals) in the joints, especially in the smaller joints such as joints of toes (interphalangeal joints and metatarsophalangeal joints of toes, especially big toes) and fingers (interphalangeal joints and metacarpophalangeal joints of fingers) which are known as “tophi”. There is also risk for deposition of monosodium urate crystals in kidney interstitium or uric acid nephrolithiasis.

What are the clinical features of gout?

Common clinical manifestations of gout are arthritis (usually involving single joint, most commonly the metatarsophalangeal joint of big toe, initially and become multi joints later on) and the first attack of acute arthritis is generally severe and painful swelling of the affected joint commonly at night which wakes up the patient. The initial attack subsides within 3-10 days even without treatment and later become intermittent with remissions and exacerbations.

How gout is diagnosed?

Clinical picture is strongly suggestive of gout and the diagnosis of gout is confirmed by needle aspiration of acutely or chronically involved joints or MSU deposits. Sometimes MSU crystals may also be demonstrated in the aspirates from inflamed joints.

Serum uric acid level may be high, normal or low during acute attacks of gout, although the serum uric acid level is generally elevated in gout and estimation of serum uric acid level can be used to decide and guide the course of the therapy.

Treatment of gout:

The mainstay of treatment of acute gout is use of NSAIDs (such as indomethacin, piroxicam etc.), colchicine, or glucocorticoids. Once the acute condition subsides the mainstay of treatment is hypouricemic agent allopurinol (a xanthine oxidase inhibitor drug) at the dose of 100-300 mg per day initially and may need up to 800 mg per day.

The contact lenses are being used for a long time now and the purpose of use of contact lens also slowly changing to various reasons. Initially contact lenses were used for corrective purpose only, i.e. for correction refractive errors of the eye (the commonest eye problems are refractive errors) such as presbyopia, astigmatism, myopia etc. but now a days contact lenses are also used for cosmetic purpose (to change the look or change the color of the eyes) and for therapeutic purpose (to deliver a drug locally to cornea only or for protecting cornea after eye surgery). Although still the main use of contact lens is correction of refractive errors.

As the main purpose of using contact lens is corrective purpose and contact lenses has to be used for long period of time or throughout the day it is wise to use daily disposable contact lenses, as use of washable or reusable contact lens may increase the risk of infection of the eye. The availability of soft daily disposable contact lenses has made the choice easier for the use of daily disposable contact lenses. The only disadvantage of daily disposable contact lens is the cost, which may be higher than reusable contact lenses. But the cost of disposable contact lenses at present is reasonable and most of the people who decide to use contact lens instead of using glasses can afford to use daily disposable contact lenses.

If you are user of contact lens, especially if you are using contact lenses for correction of your refractive errors, you should use disposable contact lenses and rest in peace that the risk of infection due to use of contact lens is negligible with daily disposable contact lenses.

If you are using contact lens for cosmetic purpose also you should go for disposable contact lens. You can use disposable contact lens of different color for changing the color of your eye and your eyes will also be safe from infection.

Contact lens is a type of lens which is placed over the cornea of the eye for correction of refractive errors of the eye, for treatment purpose (e.g. to deliver medication over a period of time and for sustained release of drug; it is than called therapeutic contact lens), or for cosmetic purpose such as changing look and color of the eyes. By far the commonest use of contact lens or simply contacts is for correction of refractive errors of the eyes such as myopia, astigmatism, presbyopia etc.

Contact lens serves the same purpose as served by glasses (spectacles) which is correction of refractive errors of eye (which cause vision problem), but may serve other purpose too such as cosmetic purpose and in treatments, to deliver a particular drug at predetermined rate or dose.

Contact lenses can be of single vision type where only one focal point is present or a contact lens may have two focal points (bifocal contact lenses) and contact lenses can also be multifocal or with more than one focal point.

Presbyopia is a problem of eye where accommodation becomes problematic. Accommodation of eye is ability of focusing of the eye from far to near and from near to far very rapidly e.g. if you are watching a far away object and need to see an object very close to you, if your accommodation capacity of eye is normal you should be able to see it without any problem. But if you are suffering from presbyopia you may need some time to focus on the object close to you. The same is true for focusing on far away object suddenly while seeing a near object.

Presbyopia is generally treated using multifocal contact lenses. As the manufacturing process of multifocal contact lens is complicated the price of multifocal contact lenses may be higher than single focus of bifocal contact lenses. The technique of fitting multifocal lens may also be more complicated than single focus contact lens.

Varicose veins in rectum are called hemorrhoids. When a vein becomes elongated and tortuous it is said to have become varicose. The common anatomical sites where veins can become varicose are rectum, leg, abdomen, esophagus, scrotum and many other sites of the body. If you are suffering from hemorrhoids, it may become embarrassing at times and also troublesome, especially in long standing hemorrhoids.

Symptoms of hemorrhoids include bleeding (fresh) per anum, pain, itching, in severe and late cases prolapse of the varicose veins. Due to regular bleeding anemia may become evident, especially on long standing cases and if other cofactors for anemia exist, such as worm infestation, other bleeding sites in the gastrointestinal tract, poor dietary intake of iron etc.

Hemorrhoids should be treated promptly and appropriately upon diagnosis. It is difficult so say which the best hemorrhoid treatment method is. Generally the mode of treatment depends on many factors such as the type of treatment a patient wants, the age of the patient, treatment facilities available locally, the affordability of the patient, expertise of the treating physician etc.

Many patients choose to get hemorrhoids home treatment, at the comfort of home, especially if the hemorrhoids is not giving much trouble and at the initial stage of disease when it can be managed medically or at least it is possible to prevent further progression of the hemorrhoids. There are several methods which can help relieve symptoms and also prevent further progression of hemorrhoids, such as establishing normal and healthy bowel habits, use of non prescription pain relievers and other NSAIDs (non steroidal anti inflammatory drugs such as ibuprofen), application of ice locally several times a day etc. Normal and healthy bowel habit can be established by taking plenty of fiber rich foods such as fresh fruits and vegetables and whole cereals instead of taking refined and fast food.