Mezology...

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

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.

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.

Face Recognition, Pareidolia : A face in the clouds

2008-12-26T12:05:00.000-08:00

Face recognition is the ability to recognize faces. Sometimes our brain tends to see faces in alot of things. An interesting psychological phenomenon called "Pareidolia". The brain can see/find faces in anything. Pareidolia is perceiving a vague stimulus (a tree,cloud) as specific one (a face, a person, a word, etc).

An excellent example of Pareidolia

Upset?

You can clearly see a face here, too.

More face here at Dr.Deb's blog.

One famous example of pareidolia is seeing some religious symbols or words in clouds or other things.

Click here for ALOT of faces :)

More faces at Faces in Places.

Celine Dion and Aspirin! (Hints on using pain killers)

2008-12-15T16:04:00.000-08:00

Scientists have been and still trying to understand the exact mechanisms of pain as well as methods/theories on how to stop pain.
A friend once told me that the song "My Heart Will Go On" by Celine Dion kills his pain ! :)
There are alot of natural methods today claiming to ease and relief pain such as meditation, music therapy and Yoga, etc.

So, if these don't work with you and you are just a normal person who takes a pill when you get a headache, let's focus on some important things you should know about analgesics/ pain killers. This info might be useful for doctors and medical students as well.

There are 2 important types of drugs :

1) Drugs with analgesic effect only :

These drugs only reliefs pain. The most common and famous drug in this group in Paracetamol (Acetaminophen).
A very widespread drug with many generic all over the world. It's very safe and has a great safety profile, only toxic when taken in very large doses. It also has an Antipyretic effect which means anti-fever. It's said to be safe in pregnancy, too.

Some famous brand names are : Panadol, Tylenol, Feverall and Aceta.
Paracetamol is used to relief mild pain as headache, mild arthritis and fever.

2) Drugs with analgesic AND anti-inflammatory effect: (NSAIDs)

[Non-Steroidal Anti-Inflammatory Drugs = NSAIDs]

These drugs has 3 actions : analgesic , antipyretic and anti-inflammatory actions. Together with their pain reducing and antipyretic effects; they reduce the underlying inflammation in conditions such as :

Acute gout.
Rheumatoid Arthritis.
Metastatic bone pain
Inflammatory Arthropathies.
Also used in migrain and headache as they have an analgesic effect.

There's a wide varity of these drugs and alot of drug families. Some famous examples of NSAIDs include :

-Aspirin (Salicylic acid derivatives).
-Ibuprofen, ketoprofin.
-Indomethacin.
-Diclofenac (voltarin).
-Piroxicam, meloxicam.

So in conditons where both inflammation and pain are present, these drugs are used. But when only pain is present(as in headache), the drugs in the first group (i.e. Paracetamol) are much more recommended and better as they have less side effects.

It's important to note that the effect of pain killers is different to each individual! Every person responds to a specific dose. Some individuals feel reliefed after only 1 tablet of panadol while others may need higher doses. Also, a certain drug ma produce an effect in some persons but not in others; in such case, use another drug.

Important Notes (Precautions for prescribing pain killers/analgesics) :

Select the proper drug for the patient as regard his age, general condition, liver condition. Avoid long term use of these drus if possible.
Never exceed the therapeutic dose.
It's better to avoid NSAIDs when there's no inflammation.
Never combine more than one NSAID, this will only increase the side effects without getting better results.
Consider variations of effect according to each patient (as above).

How to relief a headache ?

2008-12-13T15:31:00.000-08:00

What Causes A Headache?

That's a very big question in fact and it requires us to mention some of the different types of headaches and it's causes:

1) Tension Headache:
The most common type of headache that we all feel after stress or a long day at work, also known as Myogenic Headache.

90% of headaches are tension headaches. Usually described as mild to moderate pain in the forehead or all over the head as if someone is squeezing your head!

It's cause is unkown, some theories say it's due to emotional stress or may be myogenic = muscular in origin. As in people who are used to frown for hours during studying who feels a headache specially at the forehead. Or after a long day at work when your neck and eye muscles are fatigued, the pain is referred from these muscles to your head, forehead and eye brows.

Some of the common causes:

Frowning for long periods.
Eye strain.
Fatigue in neck/spine muscles.
Lack of sleep.
A long stressful work day.
Caffiene withdrawal.
Exposure to noise for long periods.

Tension headache is not associated with other symptoms and not a part of another condition, they are painful but not dangerous.

It can be easily treated with over-the-counter analgesics/pain killers such as Aspirin, Paracetamol and Ibuprofen. Note that these drugs shouldn't be overused (they cause overuse headache!) shouldn't be taken on an empty stomach, Aspirin shouldn't be given to children.

The headache can be reliefed and prevented by avoiding the causes mentioned above.

2) Migrane:
The second most common type of migrane. Migrane maybe severe and usually in one side of the head, sometimes all over the head. The mechanism of migrane may be vascular due to vasodilatation or neurogenic. It's more common in women and is usually preceeded by an (aura), smelling of a strange smell, blurring of vision or vomiting.

Tension headache and migrane are classified as "Primary headaches".

A secondary headache is due to an underlying problem in the head and neck structures,teeth or spine. I'll only list some of the common types.

3) Sinusitis headache:
A pain in the forehead or over the cheeks associated with sinusitis and flu. It's maximum at the morning and can disappears when sinusitis is treated and with pain killers.

Usually headaches are not dangerous, specially tension headaches. But in some cases the headache may be an alarm indicating a disease or a condition that needs attention and can be seriuos. So when to worry?

When Should You Seek Medical Advice?

If the headache is very severe, different from the usual headaches you get
If associated with symptoms like blurring of vision, fever, persistant vomiting.
If it is associated with altered consciousness or change of behaviour.
Preceeded by a recent head trauma.
Disabling and excruciating headache.
Headache that is resistant to pain killers.
If asociated with convulsions/seizures.

Other types of headache include:

Meningitis: The headache is associated with fever, vomiting and neck stifness.
Hangover.
Brain tumors causing headaches.
Underlying cervical/vertebral disease.
Hypertension Headache.
Sex headache. (rare)

Bronchitis:Causes, Symptoms and Treatment

2008-12-09T06:25:00.000-08:00

Bronchitis:
We always suffer from coughing usually just when we think that flu is almost over. So What Is Bronchitis?
It's infection to the air passages. The lining mucosa of the bronchi (air passages delivering air to your lungs) get's inflammed and swollen due to bacterial infection.
Always associated with flu, increased with smoking, exposure to pollutants and cold air draghts.

source of image

There are 2 types of bronchitis:

Acute Bronchitis: Defined above and mostly preceeded by cold/flu. Lasts for a few days usually.
Chronic Bronchits: A persistent, productive cough lasting at least three months in two consecutive years.

Causes:
In most cases , the very same influenza virus can cause bronchitis, and in some cases it is a bacterial infection. The cause can be non infective as in GERD (Gastro Esophogeal Reflux Disease) sometimes or chemical/smoke irritation. Allergy is the cause of bronchitis in some cases.

Symptoms and Signs:

Dyspnea (Shortness of breath)
Coughing and expectoration of mucus (phlegm).
fever sometimes.
Wheezes and chest pain.
Hemoptysis (coughing of blood) sometimes.
Fatigue and exhaustion by the continious coughing.

The cough may continue even up to 3 weeks after all the symptoms disappear.

Treatment:
1-Fluid intake and stopping of smoking and exposure to smoke. Make sure to drink alot of fluid and water as water is the best natural mucolytic.

2-Rest.

3-Expectorants and mucolytics.

4-Antibiotics are used if bacterial infection is suspected by the doctor, otherwise antibiotics are not neccesary as the cause is usually viral.

5-Bronchodilators/inhalers in cases of asthma or acute exacerbation over chronic bronchitis.

6-Antihistaminics should be avoided as they cause more thickining and drying of mucus. So becareful with antihistaminics.

Related Articles:

- How to cure a cold?

A new online test for depression!

2008-12-03T15:57:00.000-08:00

PredictD. A new online test developed by doctors at University College London (UCL) to measure your risk of depression.

ScienceDaily.com said that a special algorithm can be used to discover the liability of depression.

Professor Michael King, UCL Department of Mental Health Sciences, says: “Depression is a common problem throughout the world, but although we know how to treat it, we know very little about how to prevent its onset. We have ways of predicting the onset of heart disease or stroke, but none for predicting people’s risk of major depression. Our study is one of the first to develop a risk algorithm for just this purpose.”

The online test website :
http://www.ucl.ac.uk/predict-depression/

The immune system

2008-12-02T01:36:00.000-08:00

Here are some interesting videos I found which may help you understand the Immune response in easy and fun way :

See how the neutrophil is chasing a bacterium

This is a 3D animation of the antibody response
Click Here for video

Chemotaxis: How neutrophils and WBCs move to the site of infection:

The angry macrophages :D

I hope you enjoy them

Ear Wax

2008-11-30T14:04:00.000-08:00

What is ear wax?

Ear wax is the yellow greasy material in the external auditory canal. It's a mixture of secretions of the ceruminous and sebaceous glands and desquamated epithelium.
It is normally present in our ears and is expelled outside by the movement of the epithelium, in the form of flakes.

Functions of wax in the ear :
1-lubrication for the skin lining the external auditory canal.
2-Contains enzymes that kill bacteria and harmful organisms.
3-Acts as a filter against dust and sand as they stick to it.

But wax in large amounts, accumulates in the canal and may block it causing hearing loss and fullness.

Why is wax accumulated?
-It may accumulate due to abnormal over production
-Or due t narrow external canal.
-May be caused by attempts of the patient to remove the wax by himself using cutton beds leading to pushing of the wax deeper into the external auditory canal.

Symptoms of wax accumulation :
-The commonest sympton is hearing loss (conductive deafness)
-It may affect one or both ears.
-Sense of fullness and tinitus.

On Examining the ear, the physician finds a brownish mass in the external auditory canal.

Treatment and removal :
-Ear wash :
It shuould be done by a physician, avoid any violent unskilled attempts by the patient.
-By special instruments.

Steps of ear wash (for doctors) :
-Make sure that your syringe and other instruments are sterile and clean.
-Ask the patient no to make any sudden movements.
-Hard wax is softened first by glycerine sodium bicarbonate before removal.
-Pull the auricle upwards and backwards (to straight the canal).
-Direct the nozzle upwards and backwards in the external auditory canal and be gentle and careful during the wash.

Contraindications to ear wash :
-Drum perforation or the presence of a fistula between the middle and inner ear.
-Inflammation of the external auditory canal (it's called otitis externa)
-Large, impacted or vegetable foreign bodies (in case of foreign bodies inside the ear)

Possible complications of ear wash :

-Reflex syncope or cough caused by stimulation of the vagal nerve.
-Trauma due to sudden movement or lack of skill.
-Vertigo and nystagmus in case of using cold water ( use warm water of body temprature)
-Infection due to unsterile water or instruments.

So what is mesothelioma?

2008-11-29T12:06:00.000-08:00

According to Wikipedia this is the definition of mesothelioma:

Mesothelioma is a form of cancer that is almost always caused by previous exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart, the pericardium (a sac that surrounds the
heart) or tunica vaginalis.

Mesothelioma is linked with the inhalation or swallowing of asbestose, thus people in certain occupations are more liable to develope mesothelioma along with other diseases caused by asbestose such as asbestosis (which is a chroinic lung diseas) and lung cancer.

Mesothelioma can occur in other areas than the lungs such as the pericardium (the sac lining your heard) and the peritonium (the one lining abdominal viscera).

Symptoms and Signs:
The signs and symptoms vary acording to the site of the disease, but symptoms begin to appear after 10-20 years of exposure to asbestose, symptoms of pleura mesothelioma (mesothelioma in the outer lining of the lungs) include:

Shortness of breath.
Pain in the chest.
Fatigue.
Cough with or without blood.
wheezes.

As the symptoms are vague and mostly general symptoms, the diagnosis must be done by X-ray which is suggestive. Diagnosis must be confirmed by biopsy.

Incidence of the disease:
Still defined as a rare disease although the rates of mesothelioma has increased in the past 20 years. 20,000 cases of mesothelioma are diagnosed in the U.S. every year.

Exposure to Asbestose:
Asbestose is now prohibited by laws in some countries. Soem industries where Asbestose is used include : Cement, brake lining, textiles and insulation of roofs, buildings. The workers at these industries are highly exposed to Asbestose.

Asbestosis and Mesothelioma had become a legal issue and a source of many court cases and compensations have been paid to large numbers of people affected by Asbestose exposure.

Funny non medical pictures!

2008-11-28T12:58:00.000-08:00

A break from medical blogs...

It's funny how people can mistranslate English in some countries, sometimes the signs are just hilarious :)

images from www.engrish.com

Can I do anything, then?

Please, not on the floor:P

lo0l

Smoking and excercise

2008-11-22T07:59:00.000-08:00

Introduction:

Smoking and excercise seem to be two irrelative or even opposite words as smoking have a bad impact on your fitness and health. That's what you discover after 10 minutes of running or playing sports, you feel shortness of breath and air seems to be shy to enter your lungs, your heart isn't like a few years ago, you feel older.

Well, first let's agree on something: Excercise is of great value and importance to improve your health no matter if you are a smoker or non-smoker. It's obvious that non-smokers will have great benifits of excercise. It's good for your shape, your health, it strngthens your muscles, your immunity and your mood.

***

What about smokers? Let's try to explain how smoking affects your body first.

Cigarette smoke contains three substances : Nicotine, Carbon monoxide (CO) and Tar. Simply, smoking decreases the oxygen reaching your tissues, your muscles and your body. CO is responsible for this action as it binds to haemoglobin and limit it's Oxygen binding capacity, thus depriving your tissues (and your heart) from oxygen.

Your heart tries to work harder to compensate the oxygen deficiency (remember that your heart itself isn't receiving enough oxygen, so it's a huge load on it).Smoking also stiffens and clogs your blood vessels, thus increasing the risk of atherosclerosis in younger age. Nicotine also raises your blood pressure and increases your heart rate too, making things worse! And it's also responsible for the habituation and psychic dependence. While tar contributes to cancer occurance.

Excercise (for smokers and non) will strengthen your muscles (including the heart, which is a muscle!). It improves your respiration and oxygen delivery to the tissues.

***

Smoking and Excercise :
Excercise will also lower your blood pressure and lower your average heart rate (during rest) and decreases bad cholesterol in the blood protecting you from astherosclerosis, angina, infarction and coronary heart diseases. Excercise together with healthy food will also make your blood vessels stronger and protect you from a big list of cardiovascular diseases.

So, for smokers, excercise strengthens your heart so it can withstand the serious effect of smoking on it for a longer period. It doesn't cancel the effect of smoking and it can't. But it improves the condition of your heart, your cardiovascular system and your body in general, providing a more powerful enemy for smoking.

The most important part is the decision to start excercise, then to continue excercising. Doctors recommend 30 minutes of practice 3 times weekly. Walking, running, swimming, soccer playing tennis or any other type of working out will be good for you according to your age and health status. Start with what's easiest to you and by time you can increase the duration and the violence of excercise later on.