Mezology...

Motivation to lose weight and exercise

2013-08-21T12:26:00.000-07:00

http://www.sxc.hu/photo/1098575

Sometimes, the hardest part is to find motivation to exercise and lose weight. You need motivation to START exercising and working out and to commit to it. Here are some tips that will help you to motivate yourself for exercise:

Start with something you like, something you can enjoy. If you like to exercise in the open air, the gym or at home, just get started where ever place you like.
The most important tip of all is to set a goal and make it reasonable, be realistic. working out for half an hour daily is a very good start. Don't expect to find yourself able to exercise for a hour and half or even an hour at first, it is hard to go from zero to maximum speed.

So start slowly and gradually increase the duration and the severity of the exercise, your body accommodates better to gradual exercising.

Why do you want to exercise? It is a good idea to write down the benefits of exercise and the reasons why you really want to start working out as soon as possible. It has to a conscious decision in which you really believe.
There is always time to exercise. No matter how full your day is, you can find time. It is okay to break up your exercise into smaller sessions, 2 or 3 sessions, each lasting about 10-20 minutes. See? Not that hard.
Exercise can be boring sometimes. You don't have to do one type of exercises. You can do various forms like cardio, strengthing, yoga and aerobics. Walk, run, get on a treadmill, do whatever you wanna do.
Speaking of boredom, make exercise as fun and enjoyable as possible. Listen to your favorite music, choose a place you love, watch TV while exercising, exercise with a friend, etc.
Always remind yourself of the benefits of exercise and why you should keep doing it. Re-motivate and refresh yourself. You want to be healthier, happier, you don't want to be short of breath when you climb the stairs, you want to be able to play with your friends/kids/mates, you want to wear nice clothes, you want to feel better!
Reward yourself! After you've set up your goal (your realistic goal!) and made it possible, reward yourself every month or every once in a while. You can do this weekly or even daily. Maybe you should yourself something you really wanted or have a nice dinner in a nice place for every week you complete without skipping an exercise session.
Don't give up. Always remind yourself of the benefits and the rewards. Never expect extra-ordinary results. Never compare yourself to others. Don't let anything distract you or deter you.
Make it safe and convenient. From the start, choose exercises that match your health status and never try something that is beyond your abilities and make it the right way. If you feel tired or exhausted, skip a day and get some rest.

I hope these tips were helpful, if you have any more tips on motivation to exercise feel free to share them in the comments box below.

Why do our legs swell in a plane?

2011-11-12T10:22:00.000-08:00

Why do our legs swell in a plane? Who do my feet swell during a flight?

Many of us have notice that after a long flight, or after travelling for hours in a train or a bus, our feet and lower legs swell and become painfull. This is a normal phenomenon.

It can also occur after prolonged periods of standing. This condition is called : dependant edema. The pressure (the hydrostatic pressure) becomes high in the legs after standing for a long time or in an airplane by the effect of gravity. So fluids are shifted outside the blood vessels to the tissues producing this swelling (oedema). The swelling may press on nerve endings producing pain.

It's called dependant because it depends on the position and gravity. So if you stand for along time it collects in your feet. In patients who are bed-ridden it may accumulate around the sacrum and in the back.

This is normal in the situations mentioned above and in pregnancy, it's also more common in old age. But in some diseases, dependant edema is a sign of the disease, as in liver failure and heart failure. If the edema is only in one leg, it's suggestive of deep vein thrombosis.

Related:

Foot, leg, and ankle swelling.

Depression medication: notes on drugs and herbal treatments

2011-11-05T11:06:00.000-07:00

These are just some notes for medical students to revise what they know about depression treatments and medications as well as it may be helpful to others. Only take depression medications that are prescribed by a health professional for you in the recommended doses. This article is for educational use only and not a substitute to medical advice.

The first line drug treatment for depression and Selective Serotonin Reuptake Inhibitors (SSRIs) such as Citalopram and Fluxetine. They are associated with less side effects and better results in mild to moderate depression.
Antidepression drugs should be continued for at least 6 months after improvement/remission of symptoms. In some cases, treatment might need to be taken for 2 years or even more according to the condition of the patient and the doctor's clinical judgement (e.g. if a patient have history of severe depression or still have residual symptoms).
It is important to tell the patient that SSRIs and most anti-depression medications doesn't cause addiction.
Antidepression medication should be stopped and tapered gradually over a period of about 4 weeks. Sudden stoppage may result in "withdrawal syndrome". Withdrawal symptoms are more with drugs with a short half life such as Paroxetine. Fluxetine, on the other hand is one of the least SSRI associated with withdrawal symptom.
Mirtazapine is a presynaptic alpha 2 blocker that can be used if SSRIs are contraindicated or not tolerated.
If there is no response to SSRIs, Venlafaxine can be tried. Venlafaxine is an SNRI but it shouldn't be given to hypertensive or cardiac patients.
For patients with a recent myocardial infarction or unstable angina, Sertraline is the safest drug. Venlafaxine and Tricyclic Antidepressants (TCAs) are contraindicated (except Lofepramine).
MAO inhibitors (e.g. Phenelezine) are rarely used nowadays. They can cause severe hypertension if the patient eats Tyraine rich food or takes a sympathomimetic (as in cold medicines).
St. John's wort is one of the herbal remedies for depression that was proven to benefit patients but dosage and concentrations differ with each preparation. I can interact with some drugs and it also induces the liver enzymes leading to diminished effects of some drugs such as Estrogen containing contraceptive pills, anticonvulsants, HIV drugs and anticoagulants.
Depression medication and drugs should be associated with psychological interventions such as computer guided CBT, self help and other measures as well as advising the patient about the importance of socializing, exercise, meditation and good sleep.

More on that topic here: NICE guidance on depression in adults.
Related:
Signs of depression in children.

What is the normal blood pressure for adults?

2011-10-04T02:59:00.000-07:00

What is the normal blood pressure for adults? There is no single definite answer to this question but rather guidelines suggest normal ranges of blood pressure for different age groups.

Medical guidelines recommend these ranges and values above which treatment is needed. Here are the latest normal values in adult men and women:

The normal Blood pressure is somewhere between 120/75 mmHg and 129/84 mmHg. Readings between 130/85 and 139/89 are considered high normal.

Diagnosing Hypertension in adults: (latest guidelines untill August 2011 according to NICE)

Mild hypertension or stage 1 hypertension is when the clinic blood pressure is 140/90 or above. At this stage patients are eligible for treatment if they have other diseases such as diabetes or renal disease or have increased risk of cardiovascular diseases (assessed by the doctor).

Stage 2 is 160/100 or more and all patients at this stage should receive treatment.

Stage 3 is when systolic blood pressure is 180 mmHg or higher or diastolic is 110 mmHg or higher.

Note that it is normal for the values to be high during and after exercise. The target pressure is less than 140/90 mmHg or lower than 150/90 mmHg in people older than 80 years old. In people with diabetes the target value is less than 130/80.

USA medical electives for international medical students

2011-01-24T09:38:00.000-08:00

I tried to collect some of the available information about medical electives in the U.S.A for international medical students. Medical electives are important to many students worldwide, it is a strength point in your CV and is specially important to those looking to take the USMLE and work in the USA.

Try to contact the mentioned universities by any means and it is better to call them to get a fast response.

State Univ. of NY Downstate Medical Center
Location: NY
Processing fee: $175
Tuition fee: $0
Contact person: Ms. Sandra Mingo smingo@downstate.edu, visitstudent@downstate.edu

The Cleveland Clinic
Location: Cleveland, Ohio
Processing fee: $0
Tuition fee: $0
Contact person: Patricia Gasser, gasserp@ccf.org , (216)445-7435 or (800)745-7438

Others: You have to be in final year of study and show proof of passing USMLE Step 1 score.

Brown University
Location: Providence, Rhode Island
Processing fee: 50
Tuition fee: 2873
Link: http://bms.brown.edu/students/guide_vist_stu.html
Contact person: Linda Bozzario,401-863-2293

Georgetown University
Telephone Number: +1 202 687 1154

University of Pennsylvania School of Medicine

Telephone Number: +1 215 898 8034

Fax Number: +1 215 898 0833

Columbia Presbyterian Medical Center
710 West 168th Street, New York, NY 10032

Welcome to Mezology

2010-11-23T11:50:00.000-08:00

On this blog I will try to explain the concepts of health and disease for anyone as well as for medical students. Weekly "lessons" or tutorials will be added for medical students aiming to help them understand a subject better or some important medical skills.
Please share us with your opinion and questions.

Stomach ulcer causes and prevention

2010-09-27T19:12:00.000-07:00

Stomach ulcers (peptic ulcers) has many causes that can be prevented in most of the cases. However, there might not be one single definite cause but instead, a group of causes and risk factors share together in the formation of gastric and duodenal ulcers either through increasing the gastric acid secretion or by damaging the mucosa of the stomach. Here are some of the causes of stomach ulcers (peptic ulcers include gastric and duodenal ulcers, the mechanism is different in each type):

Diet can have a very important role in formation of stomach ulcers specially irritant foods such as spices, spirits and alcohol. Coffee, tea and cola also can weaken the protective layer on the gastric mucosa and delay the healing of ulcers.

It is important for every ulcer patient to avoid these types of food (in addition to the medication), this is a major part of the treatment plan.
Deficiency of vitamin A and C is another factor that delays the healing of the ulcer.
Some drug are known to have a damaging effect on the epithelium lining the stomach such as Aspirin and other NSAIDs (Non Steroidal Ant-iinflammatory Drugs) and can also worsen the ulcer and cause more complications such as perforation.
Smoking has also an irritating effect as it leads to reflux of bile into the stomach.
Genetic predisposition also plays a role as peptic ulcers are common in some families.
Stress and psychological disturbances are important in the process of ulcer formation specially in personality type-A persons. Vagal stimulation in over-stressed person causes an increase of gastric acid secretion favoring ulcer formation.
It is also said that stomach ulcers are more likely to occur in blood group "O" individuals and those with family history of peptic ulcers.

Stomach ulcers prevention:

As you can see, most of the causes are easily preventable if you can change your dietary habits and pay more attention to you eat. Avoid eating so much irritant foods (spicy food, alcohol, etc) and the drugs known to cause peptic ulcers. It is also better to divide your meals into 3-4 small meals if you are having symptoms of indigestion and fullness. Also, don't forget to avoid unnecessary stress and learn how to relax and cope better with life stresses and troubles.

© All Rights Reserved.
Photo by Mezo.

Treatment of a ruptured spleen: Splenic trauma and conservative managment

2010-06-25T10:42:00.000-07:00

Hello my fellow medical students and everyone reading this post. Today we will talk about the treatment of splenic traumas (rupture spleen) and what are the possible approaches to manage this condition. The spleen is the most common organ to be injured and until 1971, splenic traumas were treated surgically by splenectomy. After 1971, surgeons have researched the condition more and more and since then there has been an increasing trend towards conservative management and spleen salvage, specially in children, more on this later.

First let's see how such case is presented, what are the symptoms and signs of ruptured spleen?
It differs according to the severity of the damage. The classical cases will present with signs and symptoms of internal hemorrhage :

A history of trauma to the left upper abdomen.
Severe pain that maybe referred to the left shoulder.
Rapid weak pulse, hypotension and collapse, pallor and subnormal temperature.
Abdominal examination may reveal a wound, bruises, tenderness and guarding, shifting dullness and Cullen's sign. The last two signs results from the free blood in the peritoneum.

Another presentation in case of a very severe trauma leading to deep tears may lead to fatal hemorrhage and shock with rapid death. Sometimes, the effect is delayed and the symptoms appear 10-14 days after the trauma when a subcapsular hematoma rupture or a blood clot gets dislodged.

Diagnosis of a ruptured spleen:

Mainly using imaging studies:

-FAST (Focused Abdominal Sonographic Technique) to detect the free fluid in the abdomen.
-CT (helical CT with contrast) shows the injury, a blush of blood and it can determine the grade of the injury.
-MRI can also be used.
-DPL can be performed to determine wether the fluid in the peritone is blood or not, FAST is now used instead as it is less invasive.

Treatment of splenic trauma:
Due to the immunologic functions of the spleen, the philosophy nowadays is to try to save the spleen, specially in children as long as the patient is haemodynamically stable.

If the patient is in shock or haemodynamically unstable, immediate resuscitaion must be performed followed rapidly by exploratory laparotomy through a midline incision with partial or total splenectomy.

If the case is hemodynamically stable or not a serious emergency, the surgeon should try to preserve spleen by performing splenorrhaphy, splenic mesh wrap or embolisation of the splenic artery by interventional radiology.

After the operation, children should be vaccinated against Pneumococcus ,Haemophilus and Meningococcus as pert of post-operative management.

What can cause a deficiency in vitamin k?

2010-05-09T15:43:00.000-07:00

Vitamin K deficiency

Causes:

Deficiency of vitamin K can be caused by the decreased intake of vitamin K in diet in people who don't eat enough green vegetables. Some diseases and conditions can cause this deficiency: e.g. malabsorption syndrome, liver diseases and diseases that cause obtructive jaundice.
Some medications also can be the cause such as oral anticoagulants, barbiturates, salicylates and taking broad spectrum antibiotics for extended periods of time, as these will kill all the bacteria in the gastrointestinal tract, some of these bacteria are sources of vitamin k in the body.

Symptoms & Signs:

The liver needs vitamin k in order to produce coagulation factors: 2,7,9 and 10. These factors are essential for stopping of bleeding and without them the patient shows manifestations such as:

Petichae: purple spots in the skin due to bleeding from small blood vessels.
Bleeding in response to trivial traums.
Ecchymosis and hematomas.
Gum bleeding.
Bleeding into a joint cavity (hemarthrosis).
May cause inability to stop a massive haemorrhage in severe cases.

Diagnosis & Treatment of vitamin K deficiency:

Blood tests will show normal platelet count and bleeding time with elevation of both prothrombin time and partial thromboplasin time. A factor assay will show low levels of the aforementioned clotting factors. The condition is treated with vitamin k injections or it can be taken orally depending on the severity of the condition.

Benefits of eating apple and drinking apple juice

2009-12-09T12:34:00.000-08:00

Here are some of the benefits of eating apple, some of them are known to many and some are not:

Some habits and foods can cause discoloration of teeth and bad breath odour. Apple, carrots and cucumber are known to whiten the teeth and also refresh the mouth helping get rid of bad mouth odour.
Parsley is also known to have a similar effect.

It contains vitamin C as well as other anti-oxidant substances that are very beneficial for your body and immunity.

Apple contains many other vitamins and minerals which are good to your general health.

Apple and fruit juice contain vitamins but are less beneficial to your body as it contain no fibers and of course more sugar in it, so if you are considering weight loss, avoid drinking too much of them.

Apple contains fibers which are good for your digestive system. Fibers in fruits and vegetables such as apple and carrots also gives a sensation of satiety and fullnes and hence used as a weight loss technique in many diet systems.

Apple cider vinegar is said to prevent the formation of kidney stones.

Apple can lower serum cholesterol levels.

Studies have showed that apples may have a good anti-cancer, effect, too! (for more info check this article at BBC news.

So, apple contain vitamins, minerals, anti-oxidants, water, minerals and low calories; and these are just some of the benefits of eating apple.

Photo credits.

How to read a chest X Ray: The easiest way to read a CXR

2009-09-20T06:51:00.000-07:00

These are just some simple tips for medical students on reading chest X Ray. Of course, if want to give a full comment about an X-ray you will have to comment on the quality of the film, postioning, the view(PA, AP or lateral), wether it's an inspiratory or expiratory film, etc.

But in this article I'll only mention hwo you can reach a clinical diagnosis for an X-ray and what are the basics you need for a chest X-ray interpretation and to identify some of the common chest lesions in radiology. Most of the CXR you will see are just plan x rays.

As a rule : Air in X-rays appears black while tissues appears whitish/greyish (hyperdense) the harder the tissue (such as bone) the more dense (white) it appears. The main structures in a CXR are the: lung parynchema, trachea, diaphragm, hear, bones and mediastinal shadows.
To make this as simple as possible let's divide lesions into groups:

I)White opacities:

A-Homogenous: a homogenous or a continuous opacity (whitish) may refer to a consolidation or a fluid and it's not well defined. If the costophrenic angle is obliterated and the shadow is rising to the axilla, that's a typical pleural effusion.

Opacities inside the lung parynchema (with a free angle) is more propably lobar pneumonia.

Lobar pneumonia in the upper zone

There are many features to differentiate types of pneumonia but you can learn about this later, remember that T.B. shadows are most common in the upper lung zones

Pleural Effusion

B-Heterogenous opacities:
Usually, if these opacities are multiple, rounded with well defined borders (nodules or masses) they are malignant (cannon ball metastasis).
Bronchopneumonia also shows a heterogenous opacitiy but it's bilateral, patchy, scattered and not well defined.
Miliary T.B. Shadows will appear like small numerous fine dots.

II)Black opacities: (air):

emphysema

(pneumothorax)

(hydropneumothorax)

III)Cavities:

lung abscess

Of course, there are many other aspects to consider but this is just a short introduction for beginners to summarize things up.
Also, remember the famous mnemonic about the items you should look at in a CXR :
A: Airways
B: Bones
C: Cardiac shadow
D: Diaphragm
E: Empty spaces
F: Fields of the lung
G: Hilar regions

You can also search for another approach to classify chest X rays the way you like, i tried to demonestrate the easiest way for me, others may like to classify the lesions to (alverolar, interstitial, pleural, etc), use the most memorable and systematic method and stick to it.

Acute glomerulonephritis in children

2009-06-22T07:17:00.000-07:00

Acute glomerulonephritis is a common disease in children and it is one of the diseases that are presented commonly with hematuria which means red urine (blood in urine).

Hematuria is the commonest presentation but not the only one. There are many other causes for hematuria in children that has to be differentiated from the topic of this article which is : Acute Post Streptococcal Glomerulonephritis in children which occurs after a streptococcal throat infection (sore throat with exudates or pus,congested throat, enlarged lymph nodes in the neck and may be a membrane on the tonsills).

Characters of post streptococcal glomerulonephritis : (the typical presentation):

History of strptococcal throat infection within the past 5 days to weeks (a latent period as immune reaction takes time to occur) or laboratory evidence of the infection if history is not available.
No history of previous renal disease.
No family history of renal diseases.
Red urine described as smoky coca-cola like colour (hematuria). This is also associated with oliguria (reduced amount of urine)
Hypertension occurs in 70% of cases and it rises all of a sudden and may also suddenly drop back to normal and so on. Hypertension needs early managment and proper treatment and it's the cause of most the complications associated with the disease.
Edema. It starts in the eyes as puffy eye lids in the morning (puffy eyes) and it may progress to edema of the limbs but most of the time edema is not marked.
Complications include hypertensive encephalopathy, heart failure and elecvtrolyte disturbances.

95% of the cases recover completely and the disease never recurs in the same child. Only a little proportion of the cases develope renal failure or chronicity.

Investigations:
-Urine examination shows:

RBCs casts.
Distorted shape of RBCs in urine (more than 5/HPF).

-Blood examination shows the following:

Elevated ESR and CRP.
Low levels of C3 and C4.
Normocytic normochromic anemia.

-Impaired glomerular function of the kidney.

Biopsy is insicated in resistant cases or in cases with atypical presentation (absence of the laboratory signs or clinical manifestations e.g.(normal C3 levels, history of renal disease, severe proteinuria in the nephrotic range)
Also, investigations should be done to exclude other causes of hematuria such as:

ANA to exclude SLE.
Ultrasound to exclude renal stones.
Urine analysis and hearing tests with family history taking to exclude Alport syndrome.

Treatment of Acute Glomerulonephritis in children :

Hospital admission to monitor blood pressure changes.
Salt and fluid restriction if needed (in marked edema, oliguria and H.F.)
Antibiotic therapy to eradicate infection (long acting Penicillin, one dose intramuscular, dose is calculated according to the age).
Treatment of hypertension using diuretics, ACE inhibitors and calcium channel blockers. Other complications such as renal failure, heart failure and electrolytes disturbances should be treated immediately.
Follow up according to the doctor's instructions.

image source:
http://www.flickr.com/photos/spigoo/65405098/

When do babies walk ?

2009-05-22T01:44:00.000-07:00

Watching your baby grow healthy and appropriately is very interesting for all parents no matter how many times they experienced it. When do babies walk ? At what age should you expect your baby to walk?

The growth rate of babies is very rapid in early life, and as their systems become more mature, their physical abilities together with learning and social skills develope in a fast pattern.

Also, keep in mind that there are personal variations between kids according to genetic, environmental, emotional and nutritional factors.

The very early movement of your baby will be raising his head off the bed if you lay him on his belly, this happens at 1 month, and at the age of three months he will be able to support his neck while being held from the arms.

Later on, you will notice that you can help him/her sit with your support and he will be pushing his feet towards the ground if you hold him erect (but he still can't stand, of course), then he may also be able to roll in bed from side to side.

So, at what age do babies walk?

He usually will start crawling at the age of 9 months, one month later he may be able to stand but with support. He begins exploring everything during his crawling and can hold objects and puts them in his mouth.

At the age of 1 year he can stand by himself without support and throw objects. Also, there are 6-9 teeth now by the end of the first year.

Between the age of 18 to 20months (a year and a half) he can finally WALK without support. :)

Later on he may be able to climb the stairs but still in a childish manner. Most kids can run at the age of two years.

Babies may also be able to hold a pencil and just do scriblles on the wall at 14 months. But drawing meaningful things such as a circle begins at the age of three years. Doctors say that a baby may be able to draw a rectangle at the age of 4 and a half years, and finally a triangle at 5 years!

Image credits:
Photo by nyki_m

Related: How Can I help baby walk

Quarantinable Diseases

2009-05-18T02:52:00.000-07:00

Quarantine:
To isolate well-appearing persons coming from and area that is endemic with one of the quarantinable diseases or who got in contact with a case ifected with a quarantinable disease for as long as the incubatory period of this disease to ensure the protection of other people.

What are the quarantinable dieseases?

Cholera
Yellow fever.
Plague.
SARS, avian and swine flue.
Anthrax.

Measures done for these diseases:
Travellers to and from endemic areas should receive vaccines and have valid vaccine certificates.
Some countries should monitor travellers in special occasions (such as pilgrims in Saudi Arabia).

Also cargo ships and airplanes coming from some countries in Latin America, Asia and Africa have to be deratted with gases and given deratting certificate which is valid for a specified period.

Anti mosqueto measures and anti rats in air crafts and sea ports have to be taken as well as monitoring imported monkeys from some countries (for the fear of yellow fever)

International vaccine certificates for cholera and plague are valid for 6 months while that of yellow fever for 10 years.

Thyroid Examination

2009-05-04T15:51:00.000-07:00

Hi! Here are some little notes on the local examination of the thyroid gland. Like examination of other body organs the steps are:

Inspection:
You cave to comment on the shape of any swelling that is visible, whether it moves up and down with deglutition or not (ask the patient to swallow). Also notice any visible pulsations.
Palpation: (Anterior and posterior approaches)
You can apply both approaches or one of them. Comment on these items for any present swelling:
Site, size, shape, consistency, tenderness, pulsations and thrills and wether you can identify the lower border or not.

Thyroid examination video

Another video on thyroid palpation
Percussion:
Percussion of the manubrium sterni to detect if there's a retrosternal extension.
Auscultation:
For arterial bruit.

Also, the thyroid gland or thyrotoxicosis examination should evaluate other signs such as the skin (hottness, sweating, etc) and of course the famous toxic eye signs (lid lag, Mobius sign, and Stellvag sign and others).

New colon stem cell marker discovered

2009-04-12T05:40:00.000-07:00

Researchers at the Helen F. Graham Cancer Center of the Christiana Care Health System have dicovered a new marker for the stem cells of the colon. The enzyme is shared by both malignant and normal colonic stem cells and can help in understanding the developement of cancer and how to treat it.

The enzyme (called ALDH1 = Aldehyde dehydrogenase 1) is also one of the markers of leukemia and breast cancers, but it's also specific to coon stem cells. Isolaction and identification of the malignant stem cell is an important step in studying the process of carcinogenesis.

Source of article : Bio-medicine.org

Related sites:

Christian care

What is a colon cleanse?

Sphygmo-thermal dissociation or relative bradycardia

2009-04-06T05:39:00.000-07:00

Normally, during fever the heart rate is accelerated by 10 beats/minute for every 1 ℃ rise in patient's temperature. But in relative bradycardia, there's fever with normal heart rate, or in other words the heart rate is not proportionate to the high temperature.

It's not below 60 beats/minute, but it's relatively slow for the fever degree.

The expected pulse rate can be calculated using the following formula:
Heart rate = (10 * (temperature in °F)) – 910

Causes of sphygmo-thermal dissociation (also known as relative bradycardia or pulse-temperature deficit):

1)Fevers:

Influenza.
Typhoid fever.
Dengue fever.
Legionnare's disease.
Leptospirosis.
Mumps.
Atypical pneumonia.
Q fever.
Yellow fever.
Malaria.
Viral hepatitis.
Factitious fever.

2)Causes related to inhibition of the vasomotor center by a rapid elevation of the intra-cranial tension:

Brain abscess.
Infection such as meningitis.
Brain tumors.
Pontine haemorrhage.

3)Other causes:

Beta blockers.
Malignant lymphoma.
Drug induced fever.

Ascites :Causes,pathophysiology and prognosis

2009-04-02T11:20:00.000-07:00

This post is also for medical students, I'll try to explain the pathophysiology of ascites in liver failure and portal hypertension, and other causes of ascites.

In liver cell failure, the liver is cirrhotic and cells are damaged so the liver can't form enouh albumin cirrhosis will also lead to obstruction in the liver sinusoids , so :

Pathophysiology of ascites
in liver failure can be summed up in :

Hypoalbuminemia:
Ascites developes when serum albumin drops below 3 gm %.
Portal hypertension:
Together with lowered albumin level , portal hypertension localizes the transudate to the area of drainage of the portal vein producing ascites.
Lymphatic extravasation:
Lymphatics dilate in cases of post-sinusoidal obstruction leading to extravasation of lymph into the peritonium. Also known as "lymphorrhea".
The hypoperfusion of liver cells leads to increased production of ADH and alsosterone by the kidneys resulting in salt and water retention, thus aggravating ascites.
In T.B peritonitis or if SBP develope, ascites becomes more and more resistant to diuretics and other means of treatment.

Causes of ascites:

1-Portal hypertension: as in liver failure, portal vein obstrucion/compression, IVC obstruction, etc.

2-Generalized hypoalbuminemia: as in nephrotic syndrome.

3-Exudation: as in:

Tuberculous peritonitis.
Malignant ascites : with malignant cells in ascitic fluid and rapid ascites formation.
pseudomucinous and pseudomyxomaperitonii.

4-Chylous ascites: this is caused by obstruction of the thoracic duct, in this case, the ascitic fluid is milky white, stains orange with Sudan III and rich in fats.

5-Haemorrhagic ascites: in blood diseases and some malignancies.

6-Ovarian fibroma wit ascites (Meig's syndrome).

Bad prognostic criteria of ascites:
It's really important to treat the actual cause of ascites to get results. In many hepatic patients, alcohol restriction, diuretics and tapping of ascites are very effective. Prognosis depends mainly on the cause of ascites.

Development of hepatic encephalopathy.
Prothrombin time more than 6 seconds.
Malignant ascites has a very poor prognosis.
Ascites resistant to treatment (maybe due to wrong diagnosis or patient non compliance or failure of treatment of the cause.

I hope that this helped a little in understanding the pathophysiology and causes of ascites. There are new theories that develope every while about how ascites occurs but I tried to cover the main causes and the most popular mechanisms.

Feedback is always appreciated.

Why constipation occurs?

2009-04-01T06:56:00.000-07:00

This is supposed to be for medical students as an attempt to explain the mechanism of constipation in a simple way.

Constipation is diagnosed when the amount of bowel is small and the consistensy is hard or if no defecation occurs for 48 hours or more apart from the patient's habits.

Charcol test is negative in constipation if no black stool passes for 48 hours.

Mechanism of normal defecation:

1- Propulsion : from the caecum to the sigmoid part of the caecum.
2- Expulsion :the distended rectum initiates defecation and produces the urge to defecate. Then the intra-abdomina pressure is increased by straining with relaxation of the anal sphincter.

Causes of constipation:

Insufficient fibers intake in diet.
Dehydration.
IBS.
Laxatives over-use.
Dehydration due to vomiting.Obstructed colon.
Paralytic ileus.
Weakened pelvic floor muscles by repeated pregnancies.
Dyschezia: neglection of the urge to defecate.
Anal sphincter dysfunction.

Mild constipation cases can be treated with a laxative. In some diseases the underlying disease must be treated and diet should be changed. In chronic constipation it may be more effective to perform a colonic cleanse.

Related links:
-What is a colon cleanse ?

Symptoms of Salmonella poisoning

2009-03-25T12:09:00.000-07:00

Typhoid worldwide. Image from Wikipedia

The symptoms of Salmonella food poisoning appear after a few hours of ingestion of contaminated food (any type of food specially undercooked eggs, meat, chicken, milk and other dairy products and unclean vegetables and fruits.)

We have to remember that this is different from Typhoid fever. While Salmonella food poisoning is caused by the organism : Salmonella Typhimurium, Typhoid fever is caused by Salmonella Typhi.
They also differ in the symptoms and incubatory period of the organisms.

The clinical picture (symptoms) of Salmonella food poisoning are :

Vomiting.
Fever.
Diarrhea.
Colic.
Rash and headache in some cases.

It's diagnosed by stool and vomitus analysis where the organism can be found.

Treatment:
The infection is treated by antibiotics such as ciprofloxacin (3rd generation qiunolones) or chloramphenicol.
Dehydration may develope due to vomiting and diarrhea, in this case fliud replacement is indicated.

***

Typhoid fever symptoms:
The incubatory period for Salmonella Typhi is from one to two weeks. The course of the disease passes by 4 stages in 4 weeks:

The 1st week:
- Increasing fever (a step-ladder form) untill 40℃ (104 °F). This stage of the disease is characterised by what is called (relative bradycardia or Sphygmo-thermal dissociation). This means that the pulse rate remains low inspite of the high temperature. In other fevers, the pulse should increase by 10 with every 1 ℃ elevation of temperature.
- Severe headache.
- Constipation.
- Sore throat and bleeding nose sometimes.
- Bronchitis and lung rhonchi can be heard.
- Splenomegally.
- Excess sweating in sudoral type of typhoid fever.
- Rose spot rash n some cases.
The 2nd week:
Symptoms get worse and the heart rate is accelerated (fever continues) spleen is more enlarged and diarrhea developes (or constipation sometimes).
Deliruims and sometimes nervousness are frequent.
The 3rd week:
Recovery with treatment. The following complications may occur in untreated cases:
- Intestinal perforation and haemorrhage.
- Encephalitis and meningitis.
- Loss of consciousness and twithces. (Typhoid State) which is characterized by delirium).
- Endocarditis and osteitis.
The 4th week:
Complete cure. Relapses may occur.

Typhoid fever is Diagnosed by:

-Positive Widal test in the 2nd week with antiO and antiH antibodies.
-Leucopenia with relative lymphocytosis.
-Stool culture in the 2n week.

Tratment of typhoid fever:

Complete rest and easily digested food intake.
Antibiotics as Ciprofloxacin, Ampicillin, Chloramphenicol and Amoxicillin.
Antipyretics, analgesics.
Treatment of complications.

In addition to the mentioned symptoms of Salmonella, a reactive reaction in the joints may develope in some cases (Reiter's syndrome). It's also called reactive arthritis with joins pain and inflammation.

How Can I Lose Weight ? (The easy way)

2009-01-24T15:15:00.001-08:00

The best effective weight loss plan: Eat what you want and lose weight!

We all had "losing weight" on the top of our new year resolutions list. The problem is that we start a diet or start excercising with good motivation and great hopes (sometimes unrealistic) and then it fades away with time.

You have to consider the time factor and reality, you didn't gain weight overnight. Decide to change your eating habits and lifestyle not only for a short time but fot the rest of your life. Fitness should be a part of your life. Also, don't cut all your calories at once so suddenly. Expect some setbacks and weakness moments you have and plan on losing weight on a long term basis and to live a healthier life. An option that has been proven to help in losing weight also is weight loss hypnosis which really helps in motivating yourself to lose weight.

Motivate yourself to excercise :

Choose a sport/activity you love. Any kind of sport, running or even walking.
Find someone to excercise with, someone you are comfortable with and who will encourage you.
Don't be hard on yourself. warm up and increase the excercise level gradually.
It will improve your health, burn fats and make you feel & look better.

More on : Motivation to exercise and lose weight.

Eat what you want! :

Starving yourself will only increase your hunger and will make you always thinking about food. And I don't mean to say that diets don't help. But it's not that easy for someone to sudenly deprive himself from calories and expect to lose weight quickly. The easy way to lose weight without having to restrict and cut all calories can be what's called : Fat binders.

They are natural and proved to help people lose weight effectively. Fat binders "bind" with the fat you eat making the fat molecules bigger and unabsorbable/indigestable. They will protect your body from excess fats and get rid of it for you!

They are natural products and medically proven to help people lose weight. One famous fat binder that has no known side effects is called : Proactol.

Wether you choose to reduce your daily fat & calories intake OR to use fat binders and eat normally, you should give your body sometime untill you see results. You can combine both methods (following a diet and using fat binders when you want to eat as you like or when you can't commit to the diet program.

Excercise is essential in all cases.

I wish best of the luck in the new year.
Best regards,
Mezo

You can also check this site for more weight loss tips : How to lose weight.
Also check this: Benefits of Acai Berry products

Tips for hypertensive patients

2009-01-24T01:05:00.000-08:00

Important facts:

Hypertension can be asymptomatic (the patient doesn't suffer from symptoms) and may be detected by a regular blood pressure measurment. It may be presented by headache in the morning (in the back of the head), vertigo (sense of rotation), tinnitus and epistaxis.

Tinnitus= Sense of hearing noise [Perception of sound that doesn't exist]. Epistaxis=Bleeding from the nose.
In hypertensive women, the combination of oral contraceptives (birth control pills) and cigarette smoking is very dangerous.
The rise of blood pressure to 140/90 or more is considered hypertension. In diabetic patients the number is about 130/85.
Alcohol consumption contributes to systemic hypertension in about 10% of cases. Hypertension risk factors include: alcohol, smoking, old age, stressful work and inheritance (having hypertensive relevants/parents).
Some medications as Nasal decongestants used in cold can be risky for hypertensive patients.

Complications of hypertension:

The risk of stroke is increased to 4-6 times with hypertension.
Hypertension is the most common couse of intracerebral hemorrhage (hemorrhagic stroke).
It can affect your ability to think or remember, sometimes.
Hypertension has a bad effect on your heart, brain, eyes, and kidneys.
Hypertension can be controlled if you follow your doctor's instructions and guidelines and take your medication.

Treatment of hypertension:

It's essential to determine the type of hypertension with your doctor to know the best treatment plan for your case.
Physical rest is essential and will help decrease the work of the heart and reduce your blood pressure.
Mental rest. Just like physical rest, avoiding stress is part of the treatment to lower your blood pressure.
Learn to breath slowly, to meditate and relax to relief yourself from the stress. Get enough rest and sleep.
Pregnant and Diabetic patients should follow the doctor's instructions exactly and shouldn't take any medications before consulting their doctor.
Reduce your total caloric intake, restrict salt in your diet as you can and be careful with your daily sodium intake. A special high blood pressure diet should be considered, containing low fat, calories and sodium.
Excercise & weight reduction will help you reduce your blood pressure, your heart rate but avoid vigorous or strenuous muscular excercise. Choose an activity you love, warm up and increase the excercise level gradually.
Wait 1-2 hours after meals before excercise.
Stop excercise if you feel any pain, weakness or giddiness. Stage 3 hypertension should be treated with medications forst before excercise!
Weight loss can be the missing link in hypertension treatment sometimes.

You can practice brisk walking for 30-45 minutes for three times weekly.
Stop smoking! Stop drinking alcohol!

So to summarize it up, the most important general mesures (non pharmacological) to reduce blood pressure are : Rest, Sress reduction, Weight reduction, Excercise and Stopping smoking and alcohol.

National Geographic News: Even bottled water isn't healthy!

2009-01-20T17:21:00.000-08:00

National Geographic News website published this photo of a man carrying empty bottles to be recycled in a factory. Bottled water has now become as unhealthy as tap water and much more expensive.

The cost of bottled water production, packaging and transportation is even more than gasoline!

A new report warns that people's thirst for bottled water is producing unnecessary garbage and consuming vast quantities of energy, even in areas where perfectly good drinking water is available on tap.

The report, released earlier this month by the Earth Policy Institute (EPI), says global consumption of bottled water doubled between 1999 and 2004, reaching 41 billion gallons (154 billion liters) annually.

Bottled water is often no healthier than tap water, but it can be 10,000 times more expensive, says Emily Arnold, a researcher with the Washington D.C.-based nonprofit.

How to cure flu and cold?

2009-01-10T05:49:00.000-08:00

It's winter and everybody has to experience common cold and get the flu, which can be a very annoying thing for alot of people while others just handle it as a small matter that goes away by itself.

Symptoms and signs of a cold:

The flu virus causes the following :

Fever.

Malaise, fatigue and headache and feeling of bone pain.

Running nose, sneezing and nasal congestion/obstruction.

After a few days it may be complicated by secondary bacterial infection causing:

The mucous (phlegm) color turns yellow, yellowish-green.

Enlarged tonsils.

Very sore throat and pharingitis.

Sinusitis (headache over nasal sinuses specially in the morning, mucoid or purulent secretions).
The infection can also spread to the larynx, pharynx and bronchi causing laryngitis, pharingitis and bronchitis.

General measures of treatment :

Rest. It's important to have adequate rest and sleep to strengthen your body as there's no way to kill the virus , so it's essential to have some rest and avoid cold air draughts. All you can do against the virus is to support and help your body to fight, reduce the symptoms and feel better, treat the bacterial infection (if occured) and wait until the symptoms subside.
The flu (alone) is a self-limited disease, the associated bacterial infection will need antibiotics (keep reading!).

Drink enough fluids.

Warm tea or chicken soap can help soothe your throat, also inhaling the steam can reduce the nasal congestion. Lozengens can help prevent and cure sore throat.

In case of a fever, sponge the body with lukewarm water (forehead, face and extremeties).Avoid very cold compresses/fomentations. Don't wrap yourself in so many blankets, don't close all the windows! Let some fresh air come into the room but avoid direct air draughts.

Avoid sneezing and coughing in your hands (use a tissue), and wash them if you do. Avoid touching your eyes and other people with your contaminated hands as it may transmit the infection to your eyes or to others.

Eat plenty of fruits and vegetables. It's said that vitamin C can help shorten the duration of the disease. Nutrition is important during disease, Vitamins, zinc and copper are essential for your body.

Stop smoking and avoid exposure to smoke and pollution, it's very irritating for your nasal mucosa. Alcohol and smoking also reduce your immunity in different ways.

Medication and treatments of cold:

Antibiotics can be used to treat the bacterial infection. Remember that antibiotics can't kill viruses , as we said the flu is caused by a virus, so antibiotics should be used only when secondary bacterial infection occur in association with the flu. (and they are often associated!). But if the symptoms are mild fever, chilling and sneezing , antibiotics aren't necessary.

However some doctors prescribe antibiotics always as a prophylaxis against bacterial infection if the symptoms are severe and bacterial infection is most likely going to occur.

Analgesics and antipyretics:Aspirin, Paracetamol (eg. Advil, Tylenol and Panadol) and others are used to reduce fever, reduce the nasal congestion and relief the headache and bone ache. You can read this post for information on analgesics, aspirin and which pain killer you should use.

Most today's analgesics contain Paracetamol(or Ibuprofen) and Pseudoephiderine.
Paracetamol is the substance responsible for reducing the pain and fever while pseudoephiderine [a decongestant] can help decrease the congestion and rhinitis (running nose).
Some drugs contain paracetamol only, or paracetamol and caffiene as it can help the effect of paracetamol. Some drugs contain pseudoephiderine only such as nasal decongestants.

Decongestant nasal drops or Gel are used to relief the nasal obstruction/congestion but only used 2-3 times per day as their overuse causes rebound congestion.

Oral lozengens can help it treating and preventing pharyngitis and sore throat.

There's alot of controversy about Antihistaminics. They may have the ability to reduce the allergic symptoms (rhinitis and sneezing) but they also have side effects like arrhythmia and drying of the mucous (making it harder to be expelled/expectorated).

Cough sedatives can be used if severe cough develops. Read more about Bronchitis:Causes,symptoms and treatment.

Children and hypertensive patients, patients receiving other medications should consult a doctor about which drugs they should take to cure a cold.
Never use adults' drugs with children even with smaller doses.
Some drugs are dangerous for cardiac and hypertensive patients (as decongestants and antihistaminics).

Your Guide to Healthy Cooking

2008-12-31T03:14:00.000-08:00

A healthy meal should be both delicious and have a high nutritional value. Make sure to have all nutrients you need and eliminate unnecessary calories. Low salt and cholesterol levels should be considered with special conditions such as heart diseases.

Don't cut vegetables and fruits into very small pieces so you can maximaly benefit of their nutritional value.

Boil the water before putting vegetables into it.

While roasting, grilling and broiling, put a rack so the fat drips down and the meat doesn't swim in it's own fat.

It's better to use poly-unsaturated oil instead of butter.

Don't over grill meat untill it turns black! this black color is harmful hydrocarbons and heterocyclic amines which are carcinogenic.

As before, cut off those charred ends of meat, don't eat them.

Clean your grill well.

Wash vegetables and fruits carefully.

Try fat-free dairy instead of whole milk and full cream.

Use unsaturated fat eg. olive oil. Your body needs some fats but satuated fats are not good.

Eat more fruits, vegetables and whole grains, you can't cook meat all the time!

Use sweeteners only when necessary.

Read the expiration date of any canned food before you eat it.