Voice of Masum Billah Sunny

GIT - Approach for Constipation

#GIT #Constipation approach :প্রথমে দেখে নেয়া এটা constipation এর criteria fulfill করে কিনা। এটা  হতে পারে functional (80%)→অনেক দিন ধরে সমস্যা। fever,wt loss,anaemia,per rectal bleeding  নাইহতে পারে organic cause(20%) --features of obstruction,wt loss,anaemia,fever,per rectal bleeding থাকতে পারে।  যদি functional হয় হতে পারে ঃ Normal Transit constipation (IBS Type)এদের defecation frequency normal. Dx criteria ↓(নিচে ছবি   দেয়া আছে) Slow Transit constipation (Young aged female, 5- 6 দিন পর পর টয়লেট হয়, টয়লেটের কোন urge থাকে না, hard, dry stool) Pelvic floor dyssynergia(Straining থাকে,persistent urge থাকে, hard pillet shape stool,মাঝে মাঝে   manual evacuation করতে হয়)Functional গুলাকে কিভাবে differentiate করব?1 টা sign আর 1টা symptom Urge  কেমন ঃ Normal transit – normal urgeSlow transit – no urge(almost)Pelvic floor dyssynergia- persistant urge DRE:পেশেন্ট  bear Down করলে anal sphincter paradoxically contract করলে৷৷৷  এটা pelvic floor dyssynergia Secondaary কিছু causes :Hypothyroid, hypercalcemia, DM. Slow transit constipation এর নত feature নিয়ে আসতে পারে।   #Management  IBS type constipation /Slow transit constipation  Non pharmacological: (Common for all)Lifestyl change Regular food habitপর্যাপ্ত পানি,শাক সবজি(20-40g/day) খাবেলাইফ style modifications, Wt loss  করতে হবে।Gastro-colic reflex কে কাজে লাগাবে। খাবারের 20- 30মিনিট পর টয়লেটে বসে থাকবে 5- 10 মিনিট সকালে এবং রাতে( mainly slow transit constipation এ ভাল benifit পাওয়া যায়)  1 মাস পর if Not improved →pharmacoloical treatment  synthetic bulk forming agent[Ispaghula husk(ভুসি)৷  ]কিভাবে খাবেন: এক গ্লাস পানির সাথে 1 sachet ভুসি মিশিয়ে সাথে সাথে খেয়ে ফেলতে হবে।  বেশিক্ষন ভুসি পানির সাথে ভিজিয়ে রেখে খেলে কাজ হবে না তেমন। কারন সে already পানি absorb করে বসে থাকবে gut এ গিয়ে আর পানি absorb করতে পারবে না। →if not improved Osmotic laxative (lactulose)Syp.avolac 6tsf @night or 3/4 tsf tds →If not improved Cl channel activator (lubiprostone)- Gut এ পানি ধরে রাখবে-stool কে soft করবেTab.lubigut 24mcg 1+0+1 →if not improved 5HT4 agonist(Prucalopride) -Colon এর motility বাড়াবেtab.caloprid 1 or 2mg  0+0+1 এই পর্যন্ত এক ই। IBS type /slow transit type এর ক্ষেত্রে।  →if not improved  In IBS variety constipation :Tab.Duloxatine 30-60mg 0+0+1 Abdominal boating থাকলে:Gluten free food(বেকারি খাবে না)Tab.Rifagut 600mg daily -14 days In slow transit constipation :Stimulant drug(Bisacodyl)Tab.Duralax 5mg 0+0+1 এর পর ও ভাল না হলেtab.Neostigmine  এরপরও ভাল না হলে surgery<div class="separator" style="clear: both; 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GIT - Approach for Constipation

#GIT #Constipation approach : প্রথমে দেখে নেয়া এটা constipation এর criteria fulfill করে কিনা। এটা হতে পারে functional (80%) →অনেক দিন ধরে ...

July 28, 2022

ইসলামী বিশ্বকোষ Apk download

<b style="background-color: white; border: 0px; color: red; font-family: inherit; font-size: large; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; overflow-wrap: break-word; padding: 0px; position: relative; vertical-align: baseline;"><a href="https://apkaio.com/download-apk/com.islamboi.rizwan" style="border: 0px; color: #0eb975; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; overflow-wrap: break-word; padding: 0px; position: relative; text-decoration-line: none; vertical-align: baseline;">ইসলামী বিশ্বকোষ ও আল-হাদিস অ্যাপ</a> [Download]<a href="https://m.apkpure.com/%E0%A6%87%E0%A6%B8%E0%A6%B2%E0%A6%BE%E0%A6%AE%E0%A7%80-%E0%A6%AC%E0%A6%BF%E0%A6%B6%E0%A7%8D%E0%A6%AC%E0%A6%95%E0%A7%8B%E0%A6%B7-%E0%A6%93-%E0%A6%86%E0%A6%B2-%E0%A6%B9%E0%A6%BE%E0%A6%A6%E0%A6%BF%E0%A6%B8-al-hadith/com.islamboi.rizwan/download?from=amp_info" style="background-color: white; color: #01b8c0; text-decoration-line: none;"><img alt="ইসলামী বিশ্বকোষ অ্যাপ (Install)" height="320" id="Image2_img" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiv_afE3EqjpAucrjXWq1bIewEsL6UiErEYEQ65FMw4zLOBWxjEOuH2l6FgiFsXt6i3r0LBbEVZeMSxhByeY3AE6guLydfagsgMBxiVTK0rgAXvkOlPZL3hXX4fTcN0gFXkXZhIXMn4swE/w320-h320/PicsArt_03-02-11.16.42.webp" style="border-width: 0px; height: auto; max-width: 100%;" title="ইসলামী বিশ্বকোষ ও আল-হাদিস অ্যাপ [Download] ইসলামী বিশ্বকোষ অ্যাপ (Install)" width="320" /></a> অন্যান্য সার্ভারঃ <ol><li><a href="https://m.apkpure.com/%E0%A6%87%E0%A6%B8%E0%A6%B2%E0%A6%BE%E0%A6%AE%E0%A7%80-%E0%A6%AC%E0%A6%BF%E0%A6%B6%E0%A7%8D%E0%A6%AC%E0%A6%95%E0%A7%8B%E0%A6%B7-%E0%A6%93-%E0%A6%86%E0%A6%B2-%E0%A6%B9%E0%A6%BE%E0%A6%A6%E0%A6%BF%E0%A6%B8-al-hadith/com.islamboi.rizwan/download?from=amp_info">ইসলামী বিশ্বকোষ ও আল হাদিস - APK Pure</a></li><li><a href="https://apkaio.com/download-apk/com.islamboi.rizwan" style="font-style: inherit; font-variant-caps: inherit; font-variant-ligatures: inherit;">ইসলামী বিশ্বকোষ ও আল হাদিস - Apkaio</a> </li><li><a href="https://steprimo.com/download/Y29tLmlzbGFtYm9pLnJpendhbg==/OWIzYWVhYWRhOWJjZTdlZjFjYTVmNmNiNWI1OTEwNGM/" style="font-style: inherit; font-variant-caps: inherit; font-variant-ligatures: inherit;">ইসলামী বিশ্বকোষ ও আল হাদিস - Steprimo.Com</a></li><li><a href="https://xn-------al-hadith-dk2am0s8a51a0da5b5fj7g2atp1a0loaunr50bjc.apk.cafe">ইসলামী বিশ্বকোষ ও আল হাদিস - Apk Cafe</a></li><li><a href="https://www.99images.com/apps/books-reference/com.islamboi.rizwan/download?amp=1">ইসলামী বিশ্বকোষ ও আল হাদিস - 99images</a></li><li><a href="https://apkfun.com/down_%E0%A6%87%E0%A6%B8%E0%A6%B2%E0%A6%BE%E0%A6%AE%E0%A7%80-%E0%A6%AC%E0%A6%BF%E0%A6%B6%E0%A7%8D%E0%A6%AC%E0%A6%95%E0%A7%8B%E0%A6%B7-%E0%A6%93-%E0%A6%86%E0%A6%B2-%E0%A6%B9%E0%A6%BE%E0%A6%A6%E0%A6%BF%E0%A6%B8-Al-Hadith.27741981.html">ইসলামী বিশ্বকোষ ও আল হাদিস - Apkfun</a></li><li><a href="https://www.luckymodapk.com/al-hadith-mod/com.islamboi.rizwan">ইসলামী বিশ্বকোষ ও আল হাদিস - luckymodapk</a></li><li><a href="https://apk.support/old-apk-from-google-play/com.islamboi.rizwan/">ইসলামী বিশ্বকোষ ও আল হাদিস - Apk.Support</a></li><li><a href="https://www.apk4now.com/apk/357167/-----------al-hadith/download">ইসলামী বিশ্বকোষ ও আল হাদিস - Apk4now</a></li><li><a href="https://www.sunni-encyclopedia.com/2022/03/App.html">ইসলামী বিশ্বকোষ ও আল-হাদিস - Encyclopedia</a></li></ol>

ইসলামী বিশ্বকোষ Apk download

ইসলামী বিশ্বকোষ ও আল-হাদিস অ্যাপ [Download] অন্যান্য সার্ভারঃ ইসলামী বিশ্বকোষ ও আল হাদিস - APK Pure ইসলামী বিশ্বকোষ ও আল হাদিস - Apkaio ...

March 19, 2022