Saturday, December 28, 2013

Types of Anemia

Anemia

Anemia may be defined as qualitative or quantitative deficiency of hemoglobin in the blood for the age and sex of the individual. The Normal Hemoglobin level in an adult male is 14 to 18 mg/dl and 12 to 16 for female. When the hemoglobin concentration is below of this level then the person can be called anemic theoretically. Normally the hemoglobin concentration in female body is less than a male body. This is due to the activity of estrogen hormone.
Nail change in Anemia

Classification of Anemia

Morphological classification:

Microcytic hypo chromic anemia:

Causes:
1.       Iron deficiency anemia
2.       Thalassaemia
3.       Sideroblastic anemia
4.       Anemia in chronic disease.

Normocytic normochromic anemia:

Causes:
1.       Aplastic anemia

Thursday, December 26, 2013

Causes of Iron Deficiency Anemia

Iron Deficiency Anemia

This is a condition when the loss of iron or the physiological demand for iron is more than the intake or absorption. In Iron deficiency anemia, the red blood cells become small and hypo chromatic. The major causes of Iron deficiency anemia are the followings:
Iron Deficiency Anemia

Blood loss:

1.       Gastriris
2.       Peptic Ulceration
3.       Gastric malignancy
4.       Carcinoma colon
5.       Inflammatory bowel disease
6.       Diverticulitis
7.       Polyps
8.       Hook worm infestation
9.       Schistosomiasis
10.   Chronic use of NSAIDs or Aspirin

Tuesday, December 24, 2013

Common Causes of Anemia in Bangladesh

Anemia
Bangladesh is a poor country. Most of the people here are deprived of basic needs of life. The number of doctors and the health care centers are insufficient. They cannot take nutritious food for their illiteracy and poverty. For these reasons most of the people in Bangladesh are anemic. More over the chronic disease such as Tuberculosis, SLE, Peptic Ulcer Disease, hook worm infestation are very common. These diseases also play a vital role in the development of anemia. A short example can give you a clear idea about the hematological condition of Bangladeshi people. In Bangladesh a lady with a hemoglobin level of 10mg/dl is considered as free from anemia, where the normal international level is 12 to 16 mg/dl.

Sunday, December 22, 2013

Clinical Feature and the Treatment of Perforated Peptic Ulcer Diseases


Peptic Ulcer disease is a condition when excessive acid pepsin condition makes a foramen (perforation) in the gas containing hollow viscous of the abdomen.

Clinical feature of perforated peptic ulcer disease

1.       History of previous peptic ulcer disease and non steroidal anti inflammatory drug (NSAIDs) intake.
PUD perforation
2.       Abdominal pain; which is sudden in onset, severe in intensity. The distribution of the pain follows the spread of the gastric contents over the peritoneum. Pain initially develops on the upper abdomen and rapidly become generalized. Pain is also being felt on the tip of the shoulder due to the irritation of the diaphragm. The pain is accompanied by shallow respiration due to limitation of the diaphragmatic movement and by shock.
3.       The muscle of the abdomen become board like rigid.
4.       Bowel sounds are not audible.

Friday, December 20, 2013

Indications of Bone Marrow Transplantation

Indications of Bone Marrow Transplantation

Allogeneic bone marrow transplantation is the last line of treatment in some systemic and some Hematological diseases. The indications of allogeneic bone marrow transplantation are the following;

General indications for allogeneic bone marrow
Bone Marrow Transplantation
transplantation:

1.       Neoplastic disorders affecting the totipotent or pluripotent cell component (Such as Leukemia )
2.       Those with a failure of haematopoiesis
3.       A major inherited defect in blood cell production
4.       Inborn errors of metabolism with missing enzymes or cell lines.

Hematological indications for allogeneic bone marrow transplantation:

1.       AML high risk CR1 and CR2
2.       Adult ALL CR1 and CR2

Wednesday, December 18, 2013

What is Hydatid cyst? Investigations and treatment.

Hydatid cyst

Hydatid cyst is a very common cystic disease of liver, in the people of the subcontinent. This disease is most common among the people of India, Bangladesh, Nepal and Myanmar. This is a parasitic disease. And the causative organism is Echinococcus granulosus.
Hydatid cyst

Structure of Hydatid cyst:

The cyst is composed of three layers. They are;
1.       An outer layer derived from the host.
2.       An intermediate laminated layer.
3.       An inner germinal layer.
Feature of the cyst:
1.       They can be single or multiple.
2.       Chronic cysts become calcified.
3.       The cyst may be asymptomatic but may present with abdominal pain or mass.
4.       Rupture or secondary infection of the cyst can occur and a communication with the intrahepatic biliary tree can then result with associated biliary obstruction.

Monday, December 16, 2013

Causes of Dry Tap

Dry Tap

Bone marrow study is an essential investigation to diagnose the blood disease mainly. But this investigation can help to diagnose many other systemic and neurological diseases. To do the bone marrow study first of all the aspiration of the bone marrow is required from the medulary cavity of the bone. In most of the cases wide bore needle is used for this aspiration. But in complicated cases another method named trephine can be used as well. Dry tap is one of the complicated cases where the trephine method is required.


Failure to aspirate any material in the bone marrow aspiration needle is referred as dry tap.

Saturday, December 14, 2013

Acute pancreatitis can bringa muti systemic complication

Acute pancreatitis

Pancreas 
Acute pancreatitis can be defined as an acute inflammation of the tissue of the pancreas. The most common causes of acute pancreatitis are, stone in the common bile duct and excessive alcohol intake. In most of the cases the patient presents with a severe upper abdominal pain which radiates to the back. Skin color change in the flank of the abdomen can also be seen. The mortality rate in severe attack of acute pancreatitis is very high. And the risk of long term complication or other disabilities are very high as well.
Some Common Complications of Acute Pancreatitis:

Systemic complications:

1.       Systemic inflammatory response syndrome (SIRS)
2.       Hypoxia

Wednesday, April 10, 2013

How Normal Menstrual Cycle is Regulated


How Normal Menstrual Cycle is Regulated

How Normal Menstrual Cycle is Regulated

When a woman reaches puberty stage, she encounters different changes in her body. One of them is the monthly period or also known as menstruation. A menstrual cycle is a female reproductive cycle that causes monthly bleeding except during pregnancy. It lasts from menarche (the first menstruation) to menopause.

The normal menstrual cycle has an average age of

Tuesday, April 9, 2013

Side Effects of Oral Combined Pill


Side Effects of Oral Combined Pill


Oral combined pill is one of the artificial methods for reproductive life planning. This is also called the hormonal contraceptive which is as the name implies causing hormones that regulate the normal menstrual cycle to fluctuate. The combined oral contraceptive pill (COCP), often referred to as the birth-control pill or simply as "the Pill", is a birth control method that is composed of varying amounts of synthetic estrogen combined with a small amount of synthetic progesterone. Estrogen is a hormone that suppresses the follicle stimulating hormone (FSH) and luteinizing hormone (LH) thereby suppressing ovulation. Progesterone on the other hand

Monday, April 8, 2013

Hormones that Regulate Menstrual Cycle


Hormones that Regulate Menstrual Cycle


Hormones controlling Menstrual Cycle 
Like any other body processes, hormones are involved at every stage of the menstrual cycle. Hormones work like messengers that travel in the bloodstream to transport signals from one cell to another. During the women’s monthly period, several hormones are responsible for the control of the menstrual cycle. The menstrual cycle in women is a recurring process in which the lining of the uterus is prepared for pregnancy, and if pregnancy does not happen, the lining is shed at menstruation.

There are four essential hormones in control namely the Gonadotropic Hormones

Sunday, April 7, 2013

Complication of BCG vaccine


Complication of BCG vaccine
Complication of BCG vaccine

BCG vaccine is used to prevent tuberculosis related to meningitis as well as disseminated TB in humankind. Although severe cases of complication of BCG vaccine are rare, there are selected cases where acute reactions have been observed.  These cases include a situation where a test was carried out on a patient with erythematous (7-mm) nodule at 4cm – distance from the vaccination site. During this test, histopathologically, a reaction (necrotizing granulomatous) pattern was observed in the dermis.

Saturday, April 6, 2013

Causative organism of tuberculosis and its structure


Causative organism of tuberculosis and its structure
Mycobacterium

Common and lethal in most cases, tuberculosis (TB) is an infectious disease associated with various types of mycobacteria, normally the mycobactrium tuberculosis. It mostly affects the lungs but can spread to other parts of the body. As an airborne disease, it is easily spread through the air especially so when TB victims sneeze, cough or emit respiratory fluids to the air. Most of the TB infections are asymptomatic and latent but it is

Friday, April 5, 2013

Second-line anti tubercular drugs


Second-line anti tubercular drugs

These types of drugs are mostly used as an alternative to the tuberculosis therapy. In most cases, second-line anti-tubercular drugs are preserved for TB victims with special conditions. This is especially when; a patient exhibits resistance to the first-line tubercular drugs (therapy) or cases of MDR-TB (multidrug-resistance) occurring.

Thursday, April 4, 2013

Drugs used to treat TB


Drugs used to treat TB


There are various ways by which TB can be managed. This includes a number of drugs given at different stages of various conditions.

First-line anti-tubercular drugs

Wednesday, April 3, 2013

Diseases caused by herpes virus


Diseases caused by herpes virus
Diseases caused by herpes virus

There are various diseases caused by herpes virus. Genital herpes and sores around the mouth are some of the health conditions one may experience once infected with one type of the herpes virus. Facial sores may also occur in individuals victimized by the herpes virus.

In certain cases, another type 3 three of the virus has been associated with chickenpox as well as shingles in adults. This occurs as a result of the varicella zosta virus. Mononucleosis condition, a highly contagious infection of the herpes virus, is characterized by coughing, sneezing and

Tuesday, April 2, 2013

Types of herpes virus


Types of herpes virus

There are 8 different types of herpes virus known to affect human beings and they are popularly known by numbers from HHV1 to 8.

Types of herpes virus

HHV 1

This is also referred to as herpes simplex virus 1 or HSV1. This is one of the types of herpes virus that can spread to the genital area resulting to genital herpes. This is mainly through genital contact (oral). HHV 1 is highly contagious and can spread through broken skin or mucous membranes when one comes into direct contact with an infected person. This can also spread through sharing of things like utensils, towels from people with active lesions and razors

Monday, April 1, 2013

Structures of herpes virus


Structures of herpes virus


Structures of herpes virus
According to researches, all animal herpes viruses have similar properties. The herpes virus has a double-stranded, DNA genome (linear) which is found within a cage called caspid, an icosahedral protein cage. It is wrapped in a lipid bilayer commonly known as envelope. By means of tegument, the enveloped is attached to the caspid. 

Sunday, March 31, 2013

Treatment of Benign enlargement of prostate


Treatment of Benign enlargement of prostate
Treatment of BEP


Lifestyle: Benign enlargement of prostate victims should reduce the rates at which they take in fluids a few hours to bedtime, reduce the amounts of alcohol and caffeine intakes and observe their voiding time schedules strictly.
Medications: There are two main types of medication that can be used to manage BPH and these include 5α-reductase inhibitors and alpha blockers.
Alpha blockers: These types of medication are the most commonly used as the first therapy in the United States and Europe. These drugs include terazosin, doxazosin, silodosin, tamsulosin and alfuzosin and are believed to

Saturday, March 30, 2013

Morphology of Benign enlargement of prostate


Morphology of Benign enlargement of prostate
Morphology of BEP

Benign enlargement of prostate involves the hyperplasia of the prostatic epithelial and stromal cells which result into the development of large, slightly discrete nodules inside the periurethral area of the prostate.  When these cells are sufficiently enlarged, they force the nodules to exert pressure on the urethral canal causing slight, or at times complete urethra obstruction. This therefore may cause interference to the normal urine flow.

Thursday, March 28, 2013

Risk Factors of Benign Enlargement of Prostate



Risk Factors of Benign Enlargement of Prostate

Risk Factors of Benign Enlargement of Prostate

There are various risk factors involved in the promotion of benign prostrate enlargement. The most common include:
Age: This is a major factor that influences BPH. It is believed that more than a half of men at the age of 60 are at a great risk of contracting BPH while almost 85% of men at the age of 85 are at a greater risk of developing this health condition.

Wednesday, March 27, 2013

When will you take post coital pill?


When will you take post coital pill?

post coital pill
The post coital pill or emergency contraceptive pill (ECP) is approved for over-the-counter use by women over 17 years of age. Younger ones need to contact a health care provider for prescriptions. It is also called the morning-after pill or Plan B One-Step.  It should be taken immediately after an unprotected sex to protect the woman from getting pregnant. Though it works up to 72 hours after sex, it works best within 12 hours of unprotected sex. Emergency contraceptive pills (EPC)

Tuesday, March 26, 2013

Complication of abortion


Complication of abortion

Complication of abortion
Surgical abortion is a safe and legal procedure. Medical abortion has an even lower incidence of complications due to the fact that no anesthesia is used. Women may suffer immediate complications after an elective abortion. The complications of abortion should be explained thoroughly to every woman that will undergo this procedure. These complications can have a major impact on future pregnancies.

Monday, March 25, 2013

Differential diagnosis of white vaginal discharge


Differential diagnosis of white vaginal discharge

white vaginal discharge
Differential diagnosis is the determination of which one of the several diseases with similar symptoms is causing the patient’s condition. Vaginal discharge serves an important role in distinguishing abnormalities in the female reproductive system. Fluids that are produced by the glands in the vagina and cervix help to prevent infection by making it easy for the excretion of dead cells and bacteria.
The color and odor of the vaginal discharge depends on

Sunday, March 24, 2013

Risk factors for the development of cervical carcinoma


Risk factors for the development of cervical carcinoma

cervical carcinoma
The second most common female malignancy in the world is cervical carcinoma. There are approximately 500,000 new cases each year. It is also considered as the third most common cause of female mortality.  Although it is the most preventable type of cancer, about 300,000 women worldwide die because of cervical cancer.
 Cervical cancer risk factor increases the chance of getting the disease but does not guarantee that cervical cancer will develop. Some of the risk factors such as

How will you know you are pregnant?


How will you know you are pregnant?

Are you pregnant?
The early symptoms of pregnancy aren't recognized immediately because it is often like what happens before and during menstruation. Every woman has different pregnancy experience, even from one pregnancy to the next. However, one of the most important pregnancy symptoms is a delayed or missed period.
One of the earliest pregnancy symptoms is spotting. This is due to the implantation of the embryo in the uterine wall 6 to 12 days after conception. Sometimes, this is

Saturday, March 23, 2013

Hormonal methods of contraception


Hormonal methods of contraception

Hormonal methods of contraception
Due to the variety of options available, woman experienced difficulty in which birth control method to use. In order to choose which the best one is, some factors are to consider. Affordability, convenience, efficacy, duration of action, advantages, side effects and protection from sexually transmitted diseases are some of these. Each woman, including their partners can decide which method to use. Hormonal contraception contains estrogen and progesterone, or progesterone only.
Hormonal contraceptives can interfere with the normal monthly cycle when taken correctly. It works by: (1) preventing the lining of the womb from growing to avoid

Friday, March 22, 2013

Barrier methods of contraception


Barrier methods of contraception

Barrier methods of contraception
Barriers are considered to be the oldest form of contraceptives. It prevents the passage of body fluids from a person to another. Aside from being a contraceptive, it is also used to prevent the transmission of STDs including human immunodeficiency virus (HIV). Unlike other methods of birth control, barriers are used only when having sexual intercourse. It has different uses, failure rate and effectiveness.
Condoms are made of latex (rubber), polyurethane (plastic), or sheep intestine. Condoms made of rubber and plastic help to prevent sexually transmitted diseases, while sheep intestine do not. There are two types of condoms: male and female.

Normal Menstrual Cycle


Normal Menstrual Cycle

Normal Menstrual Cycle
A female reproductive cycle or the well-known “menstrual cycle” is an episodic uterine bleeding in response to cyclic hormonal changes. It is also known by the terms menses, menstrual period or period. Each month, one of the ovaries releases an egg, a process called ovulation. This process allows for conception and implantation of new life. If ovulation takes place and the egg isn’t fertilized, the lining of the uterus sheds and flows from the uterus though the cervix and out of the body through the vagina.

Thursday, March 21, 2013

Treatment of gastric outlet obstruction



Treatment of gastric outlet obstruction

Treatment
Treating a patient with gastric outlet obstruction complications depend entirely on the cause. This may require a patient to undergo endoscopic therapy - dilating the blockage using balloons or placing metallic stents that are self expendable, other types of medical therapies and surgery to remove the obstruction.
Although the treatments vary depending on the type of cause, the most commonly used methods are surgery and medication.

Wednesday, March 20, 2013

Sign and symptoms of gastric outlet obstruction



Sign and symptoms of gastric outlet obstruction

gastric outlet obstruction
In gastric outlet obstruction, vomiting has been singled out as the main symptom. This is a health condition that typically occurs after meals where the victim lets out undigested food that has no traces of bile. Historically, weight loss and peptic ulcers have been found to be very common in patients.
In cases where the condition has reached an advanced stage,

Tuesday, March 19, 2013

Risk factors of gastric outlet obstruction

Risk factors of gastric outlet obstruction

Gastric outlet obstruction refers to a medical condition where obstruction occurs at pylorus, a stomach outlet. Victims of this health condition exhibit recurrent vomiting of the food that is accumulated in the stomach which finds it hard to pass through the small intestines because of the obstruction. Naturally, the stomach contracts and expands to allow in the intake of food and secretion respectively.

Monday, March 18, 2013

Complications of Diabetes mellitus



Complications of Diabetes mellitus

Long term complications can result from all types of diabetes. However, this may take long to develop (10 to 20 years) and for those who have not bothered to diagnose the condition before that period, this could be the first symptoms. Long term complications are related to damaged blood vessels.

Sunday, March 17, 2013

Role of food on the development of Diabetes mellitus



Role of food on the development of Diabetes mellitus

Food plays a pivotal role in influencing the development of diabetes mellitus. There are certain foods that are commonly found on the market that may pose a great risk to your health if care is not taken. It is believed that diabetes affects over 23 million people across United States. 8% of the entire population has problems with their pancreas either producing low levels of insulin or the insulin produced is not efficiently utilized to check the blood sugar levels in the body. Therefore, feeding on a health diet can help you take good control of the blood sugar in your body and also help one to improve on eye, endocrine and heart health systems.

Friday, March 15, 2013

Risk factors of Diabetes mellitus



Risk factors of Diabetes mellitus

Risk factors of Diabetes mellitus
Different types of diabetes mellitus have different risk factors. In type 1 of the diabetes mellitus the following factors influence the development of this condition:
·        Hereditary: In a family that one close relative suffers from diabetes, chances of another family member developing the same ranges from 10 to 15 percent.
·        Proteins derived from the cow’s milk: consuming cow’s milk in the early stages of your childhood can expose you to the risk of developing this condition.
·        Childhood or fetal viral infections
·        High blood pressure during the expectancy period ( Preeclampsia) can lead to the baby developing type 1 diabetes.
·        Birth weight that is above 9.9 pounds

Thursday, March 14, 2013

What is Diabetes Mellitus?


What is Diabetes Mellitus?
Diabetes Mellitus

Diabetes mellitus refers to a group of diseases associated with metabolism whereby the victim exhibits a high level of blood sugar. This condition may be triggered by the inability of the pancreas to produce sufficient insulin or when the cells do not show any response to the quantity of the produced insulin.

Wednesday, March 13, 2013

Patent ductus arteriosus



Patent ductus arteriosus

Patent ductus arteriosus

The PDA refers to a congenital heart disorder that occurs when after birth, the neonate’s ductus arteriosus refuses to close. In most cases, there are no signs or early symptoms; however, during the first year, symptoms such as increased breathing rates and low weight gain can be experienced. This may be aggravated with age and if nothing is done to correct the anomaly; it can lead to congestive heart failure. As such, the ductus arteriosus refers to a normal fetal blood vessel that shuts down immediately after birth.

Tuesday, March 12, 2013

Tetralogy of Fallot


Tetralogy of Fallot

Tetralogy of Fallot

This refers to a congenital heart complication involving 4 types of anatomical heart abnormalities. However, only three of these conditions are common. In fact, TOF stands out as the most common cyanotic heart condition and the commonest cause of a condition known as blue baby syndrome.

Sunday, March 10, 2013

Classification of Congenital Heart Disease



Congenital Heart Disease

Classification of Congenital Heart Disease

There exist different classification systems of congenital heart defects. It was in the year 2000 when an international congenital heart naming was founded to offer a generic system of classification. In this case, various congenital defects were discovered and these include:

Saturday, March 9, 2013

Treatment of Deviated nasal septum



Treatment of Deviated nasal septum

Deviated nasal septum
In less severe cases, the symptoms can be managed by simple medications like antihistamines, nasal sprays and decongestants. However, medication is a temporary method of relieving the pain as it does not actually rectify the situation. Nevertheless, medication to the symptoms associated with septal deviation can be done in form of a slight surgery process commonly known as septoplasty.
This surgery procedure is quickly performed –lasting for about an hour and does not involve any kind of cosmetic changes or scars externally. One who has undergone this surgery may take 4 days to completely heal. However, it is important to note that after the surgery, the septal bones do not re-grow. In some cases, the symptoms may reappear but this may be due to a different cause and not anything related to deviation.

Signs and symptoms of Deviated nasal septum



Signs and symptoms of Deviated nasal septum

In septum nasal deviation, the most common symptoms include the sinus infections which lead to sleep apnea, recurrent sneezing, snoring, pains in the face, nose bleeding, breathing difficulties and slight to complete loss of smelling ability. In essence, nasal septum refers to the bone and cartilage separating the nasal cavity into two – hence, the two nostrils. The cartilage on the other hand, is commonly referred to as quadrangular cartilage and the septum bones include vomer, ethmoid perpendicular plate and the maxillary crest. Usually, the septum is located at the centre forming symmetrical nasal passages.

Friday, March 8, 2013

Deviated Nasal Septum (DNS)


Deviated Nasal Septum
This is a nose physical disorder which involves the displacement of the nasal septum

Cause and type of Deviated nasal septum

Deviated Nasal Septum
The causes of nasal deviation septum is mostly caused by physical trauma such as a blow to the nose or it can also occur due to congenital disorder resulting  from a compression of the nose at birth,  before or it can occur during the first month after birth as a neonatal disease regardless of the cause. Among these health conditions, there are those associated with structural deformations commonly referred to as congenital anomalies and they involve damaging of the developing fetus.
Marfan syndrome, Ehlers-Danlos Syndrome and Homocystinuria are some of the connective tissue disorders associated with septum deviation. The congenital disorder may occur as a result of the genetic abnormalities, infection, chromosomal abnormalities, morphogenesis errors and intrauterine environment. However, the gravity of the disorder is mainly dependent on the complex interactions of the pre-natal deficits and the post natal environment. Studies done on animals reveal that the intake of vitamins and increased glucose levels by either the mother or the father shortly before ovulating and conception pose a long term effect on the growth of the fetus;  adolescent and mature stages of the disease. The cause and abnormalities influence the type of congenital disorders and anything that may result to birth defection is called teratogen.

Wednesday, March 6, 2013

TREATMENT OF ENDOMETRIOSIS



TREATMENT OF ENDOMETRIOSIS



TREATMENT OF ENDOMETRIOSIS

Treatment depends on age, severity of symptoms, and severity of disease, as well as whether one plans to have children in the future.  If one has pain or bleeding but are not planning to get pregnant soon, birth control hormones (patch, pills, or ring) or anti-inflammatory (NSAIDs) may be advised to control pain. Birth control hormones are likely to keep endometriosis from getting worse. Also, surgery may be needed if the implants are affecting other organs and this is to remove endometrial growths and scar tissue.  In dealing with infertility, one should consider trying fertility drugs with insemination or in vitro fertilization.

Tuesday, March 5, 2013

ENDOMETRIOSIS

ENDOMETRIOSIS

ENDOMETRIOSIS

In the fast-paced, modern world that we live in today, people are so busy that we sometimes do not notice the changes that our bodies undergo.  Women, especially, must be aware of these developments, since it is the female reproductive organs that go through changes every month.

One of the problems that commonly affect a woman’s reproductive system is endometriosis.

Monday, March 4, 2013

NASAL POLYP

NASAL POLYP

NASAL POLYP
A nasal polyp is an inflammatory condition that is associated with the lining of the paranasal sinuses and the nasal mucosa. Nasal polyps are actually movable grape-like overgrowths that emerge as a result of inflammation of the lining of the nasal lining that project into the centre of the nose. These overgrowths are soft, lack sensation and may go unnoticed for a long time. This condition is inclined to adults. However, when suspected in children below the age of ten, cystic fibrosis is ruled out.

Sunday, March 3, 2013

Management of Meningitis

Management of Meningitis

Management of Meningitis
The management in meningitis resembles that of the management of other infections. If the causative agent is likely to be a bacteria, antibiotics are readily introduced to the patient even before the result of the lumbar puncture this is to decrease any instances of worsening the disease before the results was read.  Drugs that are commonly used are Cefotaxime, Ceftriaxone or  Cloramphenicol, in some instances one of which is combined with another strong drug such as vancomycin or ampicillin. Some practitioners also add steroids as adjuvant treatment due to the relevant decrease of hearing loss in patients on the antibiotic adjunct with steroids, to include that better prognosis is also observed.