i care

Ectopic pregnancy (illustrative pics)

2011-06-19T00:50:00.001+02:00

Today i decided to decrease the number of words in the post and include more illustrations in the form of diagrams.

The following images will discuss the symptoms and causes of ectopic pregnancy.

Before ending this post, i would like to state that symptoms can be variable from one pregnant woman to another. Besides, ectopic pregnancy can occur in other sites, other than the fallopian tube, as in the ovaries or cervix.

If you have any doubts, post it as a comment and i will be glad to clarify it.

Normal labour (process of childbirth), Pics included

2011-05-11T13:56:00.002+02:00

Have you ever wondered about the process of childbirth ? Actually it is complex, that's why i decided to bring it in pics.

Note: the following pics are from William's Gynecology, 23rd edition

Head floating (before engagement):

Engagement of the head:

Internal rotation and descent:

Complete rotation and beginning extension of the head:

Complete extension:

Restitution (external rotation):

Delivery of the anterior shoulder:

Delivery of the posterior shoulder:

I hope these images were helpful to you in illustrating the details of labor.

Insomnia linked to Diabetes

2011-05-04T14:56:00.003+02:00

A recent study had succeeded in showing a clear relationship between insomnia and diabetes.
The results of this study showed that diabetics who sleep poorly, have higher insulin resistance and have a hard time controlling their blood glucose levels.

Insomnia can be defined as sleep difficulty in any of the following forms:

- Difficulty falling asleep.

- Waking up frequently during the night with difficulty returning back to sleep.

- Waking up too early in the morning.

- Unrefreshing sleep.

More info about insomnia can be found here: http://med50.blogspot.com/2010/07/insomnia-definition-risk-groups-how-to.html

"Poor sleep quality in people with diabetes was associated with worse control of their blood glucose levels" said Kristen Knutson, PhD, assistant professor of medicine and lead author of the study. Generally, diabetics have poorer sleep when compared to the general healthy population. In fact, poor sleep had been proposed as a risk factor for developing the disease.

This study is a great advance as it revealed a risk factor for diabetes and also revealed a cause of uncontrolled diabetes which will allow doctors to use it as a treatment measure beside hypoglycemic drugs or insulin.
"This suggests that improving sleep quality in diabetics would have a similar beneficial effect as the most commonly used anti-diabetes drugs," said Eve Van Cauter, PhD, professor of medicine and co-author of the study.

A clinical approach to a patient with generalized oedema

2011-04-22T01:27:00.001+02:00

A common complaint: I Feel That A Lump Is Present At Throat

2011-04-09T01:14:00.001+02:00

A common complaint that many ENT doctors hear daily at their clinics is:
" i feel that a lump or something is present at the back of my throat and i keep swallowing to clear it out "

This can be due to a functional oesophageal disorder called "Globus pharyngeus"

Symptoms of Globus pharyngeus:

Persistent sensation of a lump in the throat that leads to frequent hemming to clear one's throat, this usually ocurs with swallowing the saliva.

This sensation is absent during swallowing of food or fluids. There is neither difficulty nor pain on swallowing.

Causes of Globus pharyngeus:

- Can be attributed to stress.
- Mucosal ulcer or irritation by previous mechanical trauma.
- Gastro-oesophageal reflux disease.

Treatment:
1. Reassurance.
2. Trial of anti-reflux therapy: proton pump inhibitors.
3. Trial of antidepressants.

Drug-Induced Psychosis

2011-02-23T23:37:00.002+02:00

Let's start this article by defining psychosis. Psychosis is a term describing mental disorders causing an individual to lose touch with reality. Psychosis is not a specific diagnosis but it is associated as a feature in many diseases.

Psychosis is seen with schizophrenia, schizoaffective disorder, mood disorder (as mania or depression), drug-induced, medical condition (as tumor, porphyria, Wilson disease, thyroid disorders, syphilis) and postpartum.

In this article, we will concentrate on drug-induced psychosis.
There are a variety of drugs that are associated with psychosis. These drugs are:
Anabolic steroids, Amphetamines and its derivatives, L-dopa, Anticholinergics, Anticonvulsants, Cycloserine, Ketamine.

Symptoms of drug-induced psychosis are:

- Visual and auditory hallucinations.
- Delusions.
- Disorganzied speech or behaviour.
- The belief that one has special powers.

Can you prevent drug-induced psychosis from happening ?

Yes you can. Any doctor should follow some guidelines so that his/her patient doesn't proceed to drug-induced psychosis. A doctor must:
- Start any medication with the lowest effective dose.
- Re-adjust the dose for an elderly patient.
- Taking a complete careful medical history that includes the intake of medication, alcohol and illicit drugs.

Psychosis can also occur on withdrawal of benzodiazepines and opiates.

If you feel any of the above symptoms that had occured after the intake of the above drugs, you must consult your doctor as soon as you can.

The relationship between Interstitial Cystitis and Fibromyalgia

2011-02-09T23:42:00.001+02:00

First of all, let's start by defining the word "cystitis". Cystitis refers to inflammation of the urinary bladder.

Interstitial cystitis is a refractory bladder condition which, till now, has no specific cause. Most patients are females with a mean age of 40 years at onset. The most common symptoms are pain with bladder filling that is relieved with urination or urgency, frequency and nocturia.
Interstitial cystitis is associated with other diseases as severe allergies, fibromyalgia, irritable bowel syndrome and focal vulvitis.
Both "interstitial cystitis and fibromyalgia" share the following points:
- diffusely increased peripheral nociception.
- increased sensitivity for pain.
- natural history.
- demographics.

Both conditions have unknown etiologies. Since that they are related to each other, researches will reveal new advances concerning the causes and their management.

Crohn's Disease (Regional Enteritis)

2011-01-25T01:16:00.004+02:00

Crohn's disease, also known as regional enteritis or granulomatous colitis, is an inflammation of any part of the gastrointestinal tract that involves all the layers of the intestinal wall. Most commonly it affects the terminal ileum and proximal colon. But it can affect any part of the G.I tract.

The disease was named after Dr. Burrill Bernard Crohn, who was an American gastroenterologist. In 1932, Dr Crohn and two other colleagues published a landmark paper describing the features of the disease.

What are the risk factors of Crohn's disease ?

1. Smokers are at a higher risk of having Crohn's disease. Smoking is the most important risk factor.]
2. Age: most individuals are diagnosed at the age of 20-30.
3. Race: Ashkenazi Jews are at a higher risk.
4. Individuals who have a first-degree relative (parents, siblings or children) diagnosed with Crohn's disease.
5. Eating a diet rich in fats, low in fibre and high in refined sugar increases the risk.

The exact cause of Crohn's disease is unknown. It is believed that it is due to a combination of genetic factors, environmental factors and immunologic abnormalities.

What are the symptoms of Crohn's disease ?

The symptoms depend on the region of the GIT affected. There are two main categories for presentation:
- Acute Crohn's disease: it occurs in only 5% of the cases and it resembles acute appendicitis.
- Chronic Crohn's disease:
The patient usually presents with a history of diarrhoea (that may be associated with blood in stools) that had been extending over many months, occuring in bouts accompanied by intestinal colic. Weight loss, intermittent fever and anaemia can be present.
After repeated attacks of inflammation, the affected area of the intestine begins to narrow with fibrosis and causes obstructive symptoms.

What are the complications of Crohn's disease ?

Complications include small bowel obstruction, fistula formation, perforation, abscess formation, rectal hemorrhage, colorectal cancer.
Systemic complications of Crohn's disease are shown in this image:

Here is an image of erythema nodosum, which can occur in Crohn's disease and Ulcerative colitis:

Now it's time to discuss the diagnosis and treatment of Crohn's disease.

How is Crohn's disease diagnosed ?

From the patient's history and physical examination, a doctor will suspect the presence of Crohn's disease. Investigations can be done to help confirm the diagnosis as:
- Full blood count.
- Colonoscopy.
- Barium enema.
- CT / MRI.

What is the treatment of Crohn's disease ?

Based on the fact that Crohn's disease is an inflammatory disease, then the treatment will involve suppressing the inflammatory reaction so that the intestines will heal and symptoms will be relieved. This is done by the use of drugs.

When symptoms are under control, this is referred to as a state of remission.
Drugs used to induce remission and prevent relapses include:
- Steroids: the mainstay of treatment. They suppress the immune system and helps to relief inflammation. Prednisone and methylprednisolone are available orally and rectally. Side effects can limit their uses.

- Antibiotics: they are used in patients presenting with an abscess. Metronidazole is used as it is believed that it suppresses the body's immunity.

- Immune system suppressors: as Azathioprine (Imuran) or mercaptopurine (6-MP). These drugs are the standard maintenance therapy. They are effective and useful in patients who suffer from steroids side effects or experience multiple relapses.

- Infliximab (Remicade): given to those who had not responded to conventional treatment or those who are at a higher risk of surgical interventions.

- Good nutritional support. A well balanced diet is important for inducing remission.

In some cases, surgery plays a role in the treatment of Crohn's disease.

What are the indications of surgery for a patient having Crohn's disease ?

Although surgery is not curative in Crohn's disease, but it is a must in the following conditions:
- In case of failure of medical treatment.
- Occurence of complications as perforation, hemorrhage, fistula, abscess.
- In case of recurrent intestinal obstruction due to strictures.

Advices about the patient's diet and lifestyle:
Reduce stress and live a peaceful stress-free life. Drink an adequate amount of water. Avoid:
- Spicy foods.
- Fatty foods.
- Caffeine drinks.
- Carbonated beverages.

How to get rid of a bad cold ?

2011-01-20T03:07:00.001+02:00

Let's start our article by defining common cold. Common cold is a contagious viral infection of the nose and throat. It is usually a self-limited condition, which means that it resolves by itself without medications.

What are the symptoms of common cold ?

Symptoms can vary from one person to another but it may include the following: runny nose, sore throat, watery eyes, headache, sneezing, tiredness.
In fact, sore throat and runny nose seem to be the chief disturbing symptoms.

How to get rid of a sore throat and a cold ? Are there home remedies to help relieve the symptoms of a cold ?

Common cold can be treated without the need to see a doctor by following these advices:
- Have plenty of rest.
- Drink plenty of fluids as tea, herbal teas, warm fluids.
- Frequently prepare and have a chicken soup.

- If you would like to get rid of a sore throat, here is the magic solution: Gargle with saltwater as long as you feel that your throat is sore. Prepare it by adding a 1/2 teaspoon salt to 8-ounce glass of warm water. Then stir till the salt dissolves in water.
- If symptoms are really bad, then you can have some medications to help relieve them. If you are complaining of a congested nose, then you can use saline nasal drops which is available over-the-counter. Pain relievers as acetaminophen can be used in case of headaches and fever. Please note that acetaminophen is hepatotoxic so please do not take more than the recommended dose of the drug shown on the drug's pamphlet.

Home remedies to help heal a common cold:

Garlics help to increase the body's immunity. Try to include it in foods in your diet. Besides, add lime juice to a glass of warm water and add a teaspoonful of honey to it.
Honey has a soothing effect on the throat. Try to have a teaspoon of honey twice per day and it will be better to have it as the first thing in the morning. Concerning diabetics, avoid taking honey as it may disturb your sugar levels.

Here are some commonly asked questions concerning common cold:

Q. Will having echinacea and zinc supplements help to relief common cold ?

Ans. Recent studies have not shown convincing results when using the two above stated materials in the treatment of common cold.

Q. What are the measures to be done to prevent transmitting my cold to other individuals ?

Ans. Avoid going to crowded places. Always cover your nose and mouth during sneezing and coughing. Using warm water and soup, wash your hand frequently and thoroughly.

Q. How can i differentiate between common cold and allergy ?

Ans. In fact this is an important question. Allergies, in general, are caused by an allergen (a substance that the body react to as a foreign substance) as pollen, dust, certain foods, certain pets, insect stings. However, common cold is caused by a virus.
Seasonal allergies tend to occur suddenly at the same time every year. Allergies will never cause muscle aches or fever. If any are present, then it is a common cold.
Differentiation is a must because the treatment of each condition is different.

Q. Do i need to take an antibiotic for relieving a common cold ?

No you don't. Antibiotics are given to treat and fight bacterial infections. Common cold is caused by a virus. Antibiotics do not kill viruses. Note that taking antibiotics without medical supervision can be harmful to you in the future.

Q. How long will it take to heal from a common cold ?

Ans. The period of time is variable. In many cases, it will relieve in less than a week. But it may extend up to 2 weeks. If you notice that symptoms persist for more than 2 weeks, then you must consult your doctor.

At last, i wish that you always enjoy the best state of health.

High Blood Pressure (Hypertension)

2011-01-17T03:30:00.001+02:00

Hypertension is defined as the elevation of the systolic or diastolic pressure. In other words, the pressure of the blood in the arteries is above normal values.
Before we discuss more details about hypertension, we must outline the normal values of blood pressure:

If the systolic B.P is <120 and diastolic B.P is <80, this is known as optimal blood pressure.
If the systolic B.P is <130 and diastolic B.P is <85, this is a normal blood pressure.
If the systolic B.P is between 130 - 139 and diastolic B.P is between 85 - 89, this is a high normal blood pressure.

These were the variations in the values of normal blood pressure. (all blood pressure values written in this article are in mmHg).
Hypertension is said to be present if the systolic B.P is more than 140 and the diastolic B.P is more than 90.

How is hypertension diagnosed ?

If an individual measures his/her blood pressure in 3 different occasions and finds out that the systolic B.P is greater than 140 and the diastolic B.P is greater then 90, then this person is hypertensive.

What are the types and causes of hypertension ?
1- Essential hypertension: there is no a specific underlying cause for hypertension. More than 85% of hypertensive patients have this type.

What can increase the risk of having essential hypertension ?

Factors include family history of hypertension, old age, smoking, obesity, sedentary lifestyle, high intake of sodium or saturated fats in the diet.

2- Secondary hypertension: a specific cause is present. It can occur due to:

Renal diseases: as renal vascular disease, renal parenchymal diseases (especially glomerulonephritis) and polycystic kidney disease.
Endocrine diseases: as pheochromocytoma, cushing's syndrome, conn's syndrome, hyperparathyroidism and thyroid diseases.
Drugs: as oral contraceptives, corticosteroids and non-steroidal anti-inflammatory drugs.

Any of the above causes can cause hypertension. Therefore, treating the cause will abolish high blood pressure forever.

What are the grades of hypertension ?

There are three grades for hypertension:

Grade I (mild): systolic B.P is between 140 - 159 and the diastolic B.P is between 90 - 99.
Grade II (moderate): systolic B.P is between 160 - 179 and the diastolic B.P is between 100 - 109.
Grade III (severe): systolic blood pressure is equal to or more than 180 and the diastolic B.P is equal to or more than 110.

What are the symptoms of hypertension ?

In many cases, it causes no symptoms. That's why it is called the silent killer. Because it can cause a serious fatal complication without warning symptoms.
In some cases, symptoms of hypertension can present as any of the following:
- Occipital headache: headache felt at the back of the head.
- Epistaxis: nosebleeds.
- Blurry vision.
- Vaginal bleeding in a menopausal woman.

What are the dangers of uncontrolled high blood pressure ?

Complications of hypertension include:
- Heart attack: high blood pressure can increase the rate of atherosclerosis. This leads to narrowing of the blood supply to the heart which can result in a heart attack or myocardial infarction.
- Stroke: by the same mechanism explained above.
- Aneurysm: high blood pressure can cause weakening of the arteries and lead to formation of an aneurysm. (Aneurysm is a localised dilatation of an artery). The following image shows the mechanism involved.

- Metabolic syndrome.
- Retinal damage that can lead to loss of vision.
- Kidney damage.
- Heart failure: imagine a heart which is pumping blood and is met with a high pressure in the arteries. On long term effects, the heart will start to fail.

Treatment of hypertension:

Management of hypertension is consisted of two major components: Lifestyle modifications (see below) and anti-hypertensive drugs. In cases of secondary hypertension, treatment of the cause will treat hypertension.
Anti-hypertensive drugs can be any of the following:
Diuretics, beta blockers (metoprolol, atenolol, bisoprolol), ACE inhibitors, angiotensin receptor blockers, calcium antagonists.
Treatment should be started once an individual is diagnosed as having grade I hypertension. Some doctors recommend starting treatment once the individual is diagnosed with high normal hypertension.

How to prevent hypertension ?

Preventing hypertension is possible and it involves making some lifestyle modifications in order to have a better health and a life free from hypertension.
- Exercise regularly at least 30 minutes daily.
- If you are overweight, do your best to lose weight and maintain a normal body weight.
- Limit your intake of foods that contain excess salt.
- If you are a smoker, quit smoking. Click here to learn how to quit smoking.
- Avoid alcohol consumption.
- Eat excess fruits and vegetables.
- Avoid foods containing saturated fats and cholesterol.
- Relax and try to live a stress-free or low-stress life.

Take care:
- White coat hypertension is a common condition. What happens is that the individual's blood pressure rises when examined by a doctor. That's why it is important to take various measurements before diagnosing hypertension.
It's solution is to let a family member measure the blood pressure of that individual at home.
- Hypertension during pregnancy, also known as preeclampsia, occurs more commonly in first pregnancies. It needs a careful follow-up with a gynecologist otherwise can progress to eclampsia.

At the end of this article, i hope you had benefited from it. I tried to be comprehensive as much as possible.
If you have any questions, please post them as a comment below.

Hepatitis A

2011-01-15T01:21:00.001+02:00

Hepatitis is defined as the inflammation of the liver. The causes of hepatitis are numerous. Viral hepatitis is one of the important causes of liver damage. The most important types of viral hepatitis are hepatitis A, B and C. In this article, hepatitis A will be discussed in details.

Hepatitis A, also called infectious hepatitis, is the infection with hepatitis A virus involving the liver. It is responsible for about 30% of hepatitis cases in the United States. Although it is highly contagious, permanent liver damage does not occur in hepatitis A.

Mode of infection with hepatitis A virus:
Infection can occur through eating or drinking contaminated foods or drinks respectively. This situation usually occurs in daycare centers when caregivers do not wash their hands after changing a diaper and then prepare or serve food.
This mode of infection is known as fecal-oral infection.

Ways of transmission of hepatitis A virus:

Drinking contaminated water.
Eating food that is prepared by an infected food handler who does not wash his/her hand after using the toilet.
Eating shellfish, such as clams and oysters, that can be contaminated if harvested from waters contaminated with hepatitis A virus.
Although rare, sexual transmission can occur in some cases.

There is a period of time between when an individual gets infected and when the symptoms appear. This is known as the incubation period. In case of hepatitis A, this period of time varies from 2 - 6 weeks.

What are the symptoms of hepatitis A ?

In children, it can cause no symptoms. The disease's severity correlates with age. Symptoms of hepatitis A are:

- Abdominal pain or discomfort, specifically in the right of the abdomen under the lower ribs.
- Loss of weight and weakness.
- Nausea and vomiting.
- Fever.
- Dark urine.
- Yellowish discoloration of the skin and eyes (jaundice).

If you had been exposed to hepatitis A virus, like if you ate at a restaurant who reported a hepatitis A outbreak or if you live with a family member who is diagnosed with hepatitis A, you can prevent the disease from happening by taking the immunoglobulin therapy.
Immunoglobulin given within 2 weeks after exposure prevents the illness in 80 - 90 % of the cases.

What is the treatment of hepatitis A ?

Hepatitis A is a self-resolving disease which means that the body can heal on its own without using any medications.
But there are important steps that a patient must follow, which are:
- Hand washing thoroughly after using the toilet.
- The patient must not prepare or serve food as he/she may spread his/her infection to others.
- Eating a well balanced diet.
- Avoiding alcohol.
- Rest.

What are the measures that should be taken to prevent hepatitis A ?

First of all, a good hygiene is the basis of prevention. Washing your hands after using the toilet and before handling food can be a very effective tool in prevention of hepatitis A.
Active vaccination for hepatitis A is available and effective in prevention. Immunoglobulin can prevent the disease if given within 2 weeks from exposure.

What can kill hepatitis A virus ?

- Iodine.
- Chlorine.
- Heating to 185 degrees Celsius for 60 seconds.

How to prevent food poisoning ?

2011-01-10T00:12:00.001+02:00

Food poisoning is a condition that results from eating food or drinking water which is contaminated with a bacteria, virus or a parasite.

90% of the cases in the United States are caused by the following:
- Salmonella.
- Campylobacter jejuni.
- Shigella.
- Clostridium perfringens.
- Staphylococcus aureus.

What can be done to prevent food poisoning ?

Organisms grow best at room temperature. So always keep your food either hot (above 140 degrees Fahrenheit or 60 degrees Celsius) or cold (below 40 degrees Fahrenheit or 4 degrees Celsius).
Do not eat raw or undercooked seafoods, meat, poultry and eggs. Avoid purchasing fresh-cut fruits or vegetables that are not refrigerated. Avoid eating raw or unpasteurized dairy products.
Food should not be kept, at room temperature, for 2 hours.
Thoroughly, wash fruits and vegetables before eating them.
Besides, clean the counter and utensils that came in contact with raw meat or poultry.

After using the bathroom, wash your hands thoroughly. Take care that after having contact with animals, you should wash your hands as they may carry bacteria on their skin.

One important note that many people miss during defrosting food:
Defrost food in the refrigerator or in the microwave and not on the counter at room temperature. This is done to avoid the "Temperature Danger Zone", which is the temperature at which food poisoning bacteria grows best. It ranges between 5 degrees Celsius to 60 degrees Celsius.
Once the food is defrosted, cook promptly.

Colorectal cancer

2011-01-09T03:13:00.000+02:00

Colorectal cancer, also named colon cancer, is defined as a neoplasm in the colon or rectum. It is the third most common cancer world-wide. In many cases, the situation starts by the appearance of adenomatous polyps which, by the passage of time, can progress into an invasive cancer.

An image showing the normal abdominal contents. The brown organ is the liver. The purple one is the spleen. The tubular structure is the large intestine or the colon.

(Image from Sabiston Textbook of Surgery, 18th ed.)

At what age should individuals get screened for colorectal cancer ?

All individuals should be screened for colorectal cancer after the age of 50. In some cases, screening can start at an earlier age if there is an increased risk of colorectal cancer.

What are the factors that increase the risk of having colon cancer ?

- Increasing age.
- Red meat.
- Low dietary fibre intake.
- Family history of colon cancer.
- Smoking.
- Obesity.
- Alcohol excess.
- Colorectal polyps.
- Chronic inflammatory bowel diseases.

What are the factors that decrease the risk of having colon cancer ?

- Increased fibre intake.
- Fruits and vegetables.
- Garlic.
- Calcium consumption.

What are the symptoms of colon cancer ?

Symptoms include change in bowel habit, rectal bleeding, tenesmus and symptoms of anemia, unexplained weight loss.
The above symptoms can be caused by other disorders affecting the large intestine and are non-specific to colon cancer.
That's why screening should be started immediately, in high risk individuals, if there is any of the above symptoms. If these symptoms occur in any individual over 35 - 40 years, colon cancer should be excluded.

What are the screening tests for colon cancer ?

- Fecal occult blood testing. It is done annually.
- Stool DNA tests.
- Flexible sigmoidoscopy. It is done every 5 years.
- Double-contrast barium enema. It is done every 5 years.
- Colonoscopy every 10 years.
- CT colonography every 5 years.

Although that genetic factors can play an important role in colon cancer, most patients do not have a strong family history.

What does colon cancer look like ?

Colon cancer can be: annular, tubular, ulcer or cauliflower in shape.

(From Bailey and Love's, Short Practice of Surgery, 25th edition)

Psoriatic Arthritis

2011-01-07T02:48:00.000+02:00

Let's start by the definition: Psoriatic arthritis is an inflammation that involves the joints (arthritis) in someone who is having psoriasis. In many cases, individuals develop psoriasis first and then have psoriatic arthritis but the reverse can also occur.
The onset is usually between the age of 25 to 40 years old.

What is the cause of psoriatic arthritis ?

The exact cause is unknown but it is most probably due to abnormal immune response which results in attacking the body's joints. This results in inflammation and if left untreated, can cause damage to the joints.

What are the different forms of presentations that can occur in psoriatic arthritis ?

There are five main presentations for psoriatic arthritis:

1. Asymmetrical inflammatory oligoarthritis.
The joints of the upper and lower limbs can be affected. This will cause a painful, sausage-like swelling of the fingers and toes.

Notice the "sausage" middle finger.

2. Symmetrical polyarthritis.

There is symmetrical involvement of the small and large joints of the upper and lower limbs. This form predominates in women.

3. Predominant distal interphalangeal joint arthritis.

This is the most typical pattern of joint involvement in psoriasis. It mainly affects men. It is associated with nail dystrophy.

4. Psoriatic spondylitis.

Spondylitis is an inflammation of the joints between the vertebrae of the spine. This can manifest with lower back pain.

5. Arthritis mutilans.

It affects about 5% of patients with psoriatic arthritis. It is an erosive painful arthritis which affects fingers and toes and can cause a deformity.

(From Kumar and Clark's clinical medicine, 7th edition).

The prognosis in all, except arthritis mutilans, is generally good.

Advices to be followed during management:

- Exercise regularly and avoid prolonged rest.

- Maintain a normal body weight. Excess body weight can add loads to the joints.

- Avoid trauma and protect your joints.

There is no cure for psoriatic arthritis but the management lines are directed towards relief of symptoms and prevention of disability.

Different types of drugs are used in the management of psoriatic arthritis:

1. TNF alpha inhibitors: as infliximab and etanercept.

2. Methotrexate and sulfasalazine.

3. Azathioprine: it is an immuno-suppressant drug which suppresses the immune system which is attacking the body's own tissues (joints).

Feel free to post your questions by commenting on this post.

Irritable Bowel Syndrome (IBS)

2011-01-06T03:27:00.001+02:00

What is IBS ?
IBS, also called spastic colon or irritable colon, is a functional gastrointestinal disorder characterized by a chronic abdominal pain associated with alteration in bowel habits.

What are the symptoms of Irritable Bowel Syndrome ?

Symptoms include:
- Recurrent, colicky or cramping, abdominal pain which is relieved by defecation.
- Constipation or diarrhea or both.
- Abdominal distention.
- Feeling of incomplete defecation.
- Mucus in stools.
- Urgency of defecation.

IBS can co-exist with fibromyalgia, chronic fatigue syndrome, migraine, dyspareunia.

What can trigger IBS ?

Certain factors had be associated with triggering the onset of IBS, which are:
- Psychological stress and trauma.
- Sexual, verbal and physical abuse.
- Depression.
- Antibiotic therapy.
- Eating disorder.
- Gastroenteritis.

Irritable bowel syndrome is more common in females than in males.

How is the diagnosis of IBS made ?

In addition to the above symptoms, in an individual less than 40 years old, the following tests are done:
- Complete blood count.
- ESR (Erythrocyte sedimentation rate).
- Sigmoidoscopy: a sigmoidoscope is used by the doctor to examine the sigmoid colon, a part of the colon.

In older patients, colonoscopy is done to exclude the presence of colorectal cancer.

What is the treatment of Irritable Bowel Syndrome ?

An important part of the treatment lies in the doctor's explanation of the nature of this condition to the patient. Stress should be abolished, otherwise can cause recurrence. So, reassurance plays a great role in the treatment of IBS.
Fiber supplements, as Metamucil or Citrucel, will help relief constipation.
The patient is advised to avoid caffeine, fatty foods and large meals.
Tricyclic antidepressants are helpful as they help relief pain and diarrhea. Besides, they will help in controlling depression, which can co-exist with IBS.
Probiotics had showed a beneficial effect in patients with diarrhea and bloating.
Specific women having IBS can benefit from these two drugs: Alosetron and Lubiprostone, for women having non-responsive diarrhea and non-responsive constipation respectively.

Irritable Bowel Syndrome does not progress to cancer or cause an inflammatory disease. Abolishing stress and anxiety forms the base of the treatment.

If you have any questions, you can post them in the comments.

How to prevent and treat constipation ?

2011-01-01T22:24:00.001+02:00

Constipation is a common condition which involves having two or more of the following for at least 12 weeks:
- Infrequent passage of stools (<3/week).
- Straining.
- Passage of hard stools.
- Incomplete evacuation.
- Sensation of rectal block.

Constipation can cause the following symptoms:
Headaches, malaise, nausea and abdominal discomfort.

What can be done to prevent and treat constipation ?
Before taking any medications or going to the doctor, you must do all of the following. They involve changing your lifestyle in order to have a healthy bowel movements.

Eat a normal fiber-containing diet. Foods that contain high fiber content include beans, bran, fruits and vegetables. The fiber content in the diet should be increased gradually.

Drink adequate amounts of water and fluids.
Bowel habit training: you should take enough time during defecation. The best time to move bowels is in the morning, after eating breakfast.
Regular exercise will help in relieving constipation.
Avoid drinking excess tea and coffee.
Get plenty of rest.

Special attention should be given to constipation and it would be considered "serious" in the following cases:
- Constipation occuring in an individual aged more than 50 years.
- If there is associated black tarry stools.
- If there is associated anemia or unintentional weight loss.

It is highly advisable that the above steps are done before consulting your doctor.
"Do not take laxatives without medical supervision."
If, inspite of following the above steps, constipation persists then you must consult a Gastro-enterologist.

2 common questions concerning constipation:

Q. Can depression cause constipation ?
Ans: Yes it can.

Q. Can alcohol cause constipation ?
Ans: Yes it can. Alcohol dehydrates the body and suppresses the normal peristaltic intestinal movements.

Pseudotumor Cerebri

2010-12-28T00:11:00.004+02:00

Pseudotumor Cerebri, also called benign intracranial hypertension or idiopathic intracranial hypertension, is a condition in which the pressure inside the skull increases without any obvious reason. Most commonly, it affects obese women of childbearing age.

Most of the symptoms are related to:
1. Increased intracranial pressure.
2. Papilledema: a swelling around the optic disc (the site of entry of the optic nerve to the eyeball). It occurs due to increase in the intracranial pressure.

Symptoms of pseudotumor cerebri include:

Symptoms due to increased intracranial pressure:

1. Headache, ranging from moderate to severe, that originates deep to the eye and that worsen with eye movements.
2. Pulsatile tinnitus: ringing sound in the ears which are synchronous with the pulse.
3. Double vision.
4. Nausea and vomiting.

Symptoms due to papilledema:

    1. Dimming or black-out of vision in either eyes or both that lasts for seconds (visual obscurations).
    2. Blurring of vision.
    3. Having a difficulty to look to the sides.

How is pseudotumor cerebri diagnosed ?
- Fundus examination: a doctor will examine the patient's eye to confirm the presence of papilledema.

Normal fundus Fundus exam showing papillledema

- Imaging studies as CT scan and MRI to visualize any other pathology causing similar symptoms.
- A lumbar puncture can be done to measure the intracranial pressure.

What is the treatment of Pseudotumor Cerebri ?
Untreated cases can be complicated by secondary optic atrophy and permanent blindness.

Medical treatment options:
It aims for decreasing the intracranial pressure. Acetazolamide (Diamox) is used in cases without visual loss. Corticosteroids (prednisone) can be used if there are severe symptoms or visual loss. Obese women must reduce their weight.
If medical treatment is not successful in controlling the symptoms or there is progressive visual loss, surgery is done.

Surgical options:
Either i.) CSF shunting procedure: using a lumboperitoneal shunt is commonly used. It will allow excess CSF to pass directly into the peritoneum. So the intracranial pressure is maintained at a normal level. Disadvantages of the use of a shunt include infections and low pressure headaches.

Or ii.) Optic nerve sheath fenestration:
The aim of this surgery is to relieve the pressure from around the optic nerve and so preserves vision. This will allow CSF to pass to the orbital fat and then to the venous circulation where it will be absorbed.

Should the patient change his/her diet ?
Yes. It is a must that all patients should be put on a weight-reduction diet. Besides, exercising is important in helping reducing one's weight.

First aid measures for nosebleeds (epistaxis)

2010-12-26T02:09:00.008+02:00

Epistaxis or nosebleeds is defined as the bleeding from the nose and is classified as either anterior or posterior.
Anterior nosebleeds occur when the source of bleeding originates from Kiesselbach's plexus (Little's area) which is present in the anterior part of the nasal canal. Anterior epistaxis usually occurs in children and young adults.

(From Fleisher GR, Ludwig S: Textbook of Pediatric Emergency Medicine. Philadelphia, Lippincott, Williams & Wilkins, 1999.)

However, posterior nosebleeds originates from the sphenopalatine artery which is present in the posterior part of the nasal canal. Posterior epistaxis usually presents in old individuals.

First aid measures for controlling epistaxis:
In most cases, the bleeding will be from Little's area. You must sit down and lean slightly forwards. You must breath through your mouth.
Pinch the nose so that the nostrils are closed between your thumb and forefinger for 10 minutes. Apply cold compresses to the bridge of the nose, if possible. Besides, you can suck on ice to achieve the same result.
This is done so that vasoconstriction of vessels is obtained which will reduce the amount of blood supplying the nose.

If epistaxis didn't stop, you must contact your doctor immediately. He/she will put a cotton gauze with medication into the nostril. This is called nasal packing.

(From Auerbach P: Wilderness Medicine, 5th ed. St. Louis, Mosby, 2006.)

After bleeding ceases, cauterization can be done chemically with the use of silver nitrate.

For posterior epistaxis, a posterior nasal pack is introduced by a special maneuver to stop the bleeding.

Furthermore, if the above measures fail to control epistaxis then surgery will be the life-saving solution.

10 easy effective tips for GERD (or heartburn) relief

2010-12-21T01:37:00.006+02:00

Gastroesophageal reflux disease (GERD) is defined as the reflux of the gastroduodenal contents into the esophagus, larynx or lungs with or without resultant oesophageal inflammation. In other words, the stomach acid and/or bile flows, in the reverse direction, into the esophagus causing heartburn.

Here are 10 effective tips for treatment of GERD or heartburn:

Avoid foods that increase GERD symptoms as chocolate, peppermint, citrus, onions, spicy foods and fatty foods.
Avoid alcohol and caffeine.
Eat small meals.

Avoid lying down soon after meals. Try to give a 2 hour period between the meal and lying down.
Maintain a healthy weight. If you are obese, work to slowly lose weight.
Avoid tight-fitting clothing as this can increase the abdominal pressure and can increase heartburn symptoms.
Avoid stooping and bending.
Elevate the head of the bed so that your head is slightly higher than the level of your body.
Avoid drugs that can increase GERD symptoms as calcium channel blockers, beta blockers, theophylline, alpha-adrenergic agonists.
If you are a smoker, try to quit smoking. Smoking decreases the ability of the lower esophageal sphincter to function properly.

If symptoms persist inspite of following the above instructions, consult a doctor as you may need to try medications as proton pump inhibitors. In some cases, a surgery can be done for treatment of GERD.

Surgeries done in breast cancer management

2010-12-19T01:11:00.003+02:00

Breast cancer can be treated especially when discovered early. Mammogram is a very helpful imaging investigation that helps in the diagnosis of breast cancer.
The findings in mammography that are suggestive of malignancy include the presence of clustered micro-calcification and star shaped mass. The following mammogram belongs to a woman diagnosed with breast cancer:

Surgery has a great role in the management of breast cancer. Surgery can be done with or without radiotherapy. Early treatment can lead to cure. Besides, it helps in controlling the local malignancy and preventing the occurrence of metastatic lesions.

What are the surgeries done for treatment or management of breast cancer ?

Lumpectomy: as its name suggests, the surgeon removes only the malignant lump and a small portion of the surrounding tissues.
Partial mastectomy: the surgeon removes the malignant portion, the surrounding tissues and a part of the underlying muscle.
Simple mastectomy: the surgeon removes the entire breast.
Modified radical mastectomy: the breast and lymph nodes are removed. The chest muscles are kept intact.
Sentinel node biopsy: it is the standard investigation in patients with clinically negative lymph node affection. A methylene blue dye or a radioactive isotope is injected around the nipple. Then the surgeon will follow up the dye till he/she finds the sentinel lymph node. It is excised and sent for histological analysis.
Reconstructive surgeries: it can be done at the time of mastectomy or can be done later. Click here to read more details about breast reconstructive surgeries.

What are the early symptoms that may indicate breast cancer ?

The presence of a breast lump or a bloody discharge from the nipple or changes in the skin of the breast like dimpling or a skin color change.

Breast cancer update:

Studies proved that the inflammatory process within the breast itself promotes the growth of breast cancer stem cells responsible for tumor development.

Mechanism and treatment of herniated disc (lumbar disc prolapse)

2010-12-18T01:58:00.001+02:00

Herniated disc can be the cause of intolerable back pain. Let's first clearly summarize the basic anatomy of the vertebral column. The vertebral column is made up of vertebrae (bones) that are separated by intervertebral discs. Here is a normal spine:

A normal intervertebral disc is shown below (seen from above).

The disc consists of a central soft area known as nucleus pulposus and a tough outer ring known as annulus fibrosus. Factors as trauma and degeneration may cause a tear in the annulus fibrosus which will lead to herniation of the nucleus pulposus outwards. This is simply the mechanism of a herniated (slipped) disc.
The herniated disc will start to compress the nearby nerves causing back pain which is accompanied with a sharp lancinating leg pain (known as sciatica and femoralgia). The mechanism is illustrated in this image:

The following video clearly illustrates the mechanism of a herniated disc:
http://www.youtube.com/watch?v=putDjJ9k1u0

What is the treatment of a herniated disc ?

There are two options: medical treatment and a surgical one. In 90% of the cases, the medical treatment relieves the symptoms.
Medical treatment measures include:

Avoid painful positions.
Apply local heat to the area of pain.
Medications as analgesics can help relief the pain.
Physiotherapy, vitamin B supplements, muscle relaxants and weight reduction can contribute to the success of the medical treatment.

Surgical treatment is done in these cases:

Failure of the medical treatment to relief symptoms.
Progressive motor weakness.
Cauda equina syndrome.

Surgical discectomy is the procedure done.

Causes and the treatment of bad breath (halitosis)

2010-12-17T00:07:00.001+02:00

Foetor oris or halitosis are the medical terms that refer to bad breath. This can be an embarrassing problem that may lead to social problems. It is a common condition but many avoid to admit having it.

The causes of bad breath are:

Eating certain foods as garlic and onions.
Hunger and fasting for a prolonged period of time.
Tooth decay or dental caries.
Poor oral hygiene.
Gum disease as periodontitis.
Smoking, as it can cause periodontitis.

Unusual dryness of the mouth, which is known as xerostomia. This can normally occur during sleep. Some medications can cause dry mouth as antihistaminics, decongestants, high blood pressure medications, Parkinson's disease medications.

In the above causes, the cause of bad breath was from the mouth. However the cause can originate from other sites as the nose and the paranasal sinuses.
Other causes of bad breath include:
Respiratory infections, sinusitis, tonsillitis and gastro-oesophageal reflux (GERD).

What is the treatment of halitosis ?

Maintain a good oral hygiene by brushing your teeth at least twice daily (especially after eating sugary food). Brush your tongue as this will brush away all food remains and bacteria. Use a dental floss every day to remove food remains between your teeth. The following video shows the correct way to brush your teeth:

http://www.youtube.com/watch?v=1GXQLnTalcg

Drink water regularly or chew a sugarless chewing gum. This will stimulate production of saliva which will wash away remained food particles and bacteria.
Avoid eating foods containing garlic and onions.
If bad breath persists, schedule a dental checkup. A normal individual must do a dental checkup every 6 months.

Symptoms of appendicitis

2010-12-10T22:16:00.003+02:00

Acute appendicitis is defined as the acute inflammation of the appendix. It is the most common surgical emergency. Acute appendicitis can affect all age groups but the majority of cases occur between ages 11 and 20.

Symptoms of acute appendicitis:

It starts with pain around the umbilicus or below the xiphisternum (the lowest part of the sternum) which is called the epigastrium. In the next 4-18 hours, the pain will migrate to the lower right quadrant of the abdomen. Pain can be present in back or the right flank. Pain of acute appendicitis increases in intensity with passage of time.

Vomiting and anorexia can occur after the feeling of pain. Besides, an elevated body temperature is a sign of an ongoing inflammation in the body.

Causes of acute appendicitis:

The appendix contains a lumen in it. Anything that causes obstruction of the lumen will cause appendicitis. In adults, the lumen is commonly obstructed by fecaliths. Fecalith means hard fecal matter.

In teens and children, the lumen can be obstructed due to inflammation (submucosal lymphoid hyperplasia).

If symptoms are present, then the next step is to immediately go the nearest emergency room. The doctor will examine the patient and will order blood tests to check the white blood cells count. Besides, a CT scan can be done to confirm the diagnosis.

What is the treatment of acute appendicitis ?

Urgent appendectomy is the cure. It can be done either laparoscopic or open. This choice will be taken by the surgeon according to the general condition of the patient and the degree of inflammation.

Metabolic syndrome: diagnosis and prevention

2010-12-09T01:13:00.003+02:00

Let's start by defining metabolic syndrome. It is a common condition in which obesity, high blood glucose, high blood pressure and an abnormal cholesterol (lipid) profile cluster in one person.

How common is metabolic syndrome ?

Some researchers suspect that 35% of American adults have metabolic syndrome.

What is the mechanism behind metabolic syndrome ?

There is no confirmed mechanism till now but many researchers think that any obese individual is liable to get insulin resistance. When the body is resistant to its own insulin, a lesser amount of glucose is taken by the body cells. This stimulates the pancreas to increase more and more insulin. This leads to high glucose levels and hyperinsulinemia and will also cause a high triglycerides and cholesterol levels.

What are the criteria needed for the diagnosis of metabolic syndrome ?

To be diagnosed as having metabolic syndrome, an adult must have three or more of the following:

Waist measurement of 40 inches or more in men and or 35 inches or more in women.
High triglycerides level (greater than or equal to 150 mg/dl) or being treated for high levels of triglycerides.
Low level of HDL (good cholesterol). In males, a low level means less than 40 mg/dl. In females, a low level means less than 50 mg/dl.
High blood pressure or being treated for hypertension.
High level of blood sugar when measured after fasting for about 8 hours.

What are the complications of metabolic syndrome ?

Metabolic syndrome increases the risk of having diabetes and cardiac diseases.

Can metabolic syndrome be prevented ?

Yes. Metabolic syndrome can be prevented by following these instructions:

Eat a well balanced diet. Avoid foods that contain a high amount of saturated fats. Eat more foods that are rich in fibres as green vegetables.
Maintain a normal body weight. As mentioned earlier that obesity plays a great role in the mechanism of metabolic syndrome.
Exercise regularly for at least 30 minutes daily.
Avoid alcohol intake. If you are a smoker, quit smoking.
Go for regular medical check-ups. You must regularly check your blood glucose level, blood pressure and cholesterol level.

I hope you benefited from this article. Thank you for reading.

What are the banned drugs for athletes?

2010-12-08T00:01:00.000+02:00

In sports, fair play involves treating all competitors equally and fairly. According to the International Olympic Committee, a list of drugs should not be used by athletes.

These drugs include:

Stimulants: as caffeine, ephedrine, amphetamines. These drugs will speed up and stimulate some areas in the brain which will make the athletes' reflexes faster.
B2-agonists: these are similar to stimulants in its action. Besides, these drugs have significant anabolic effects.
Anabolic steroids: as testosterone. They increase the muscles strength and weight. Besides, they improve an athlete's overall performance and acceleration.
Diuretics: as furosemide and mannitol. These drugs help in reducing the body weight by excreting more water out of the body. And this can have a positive effect on the athlete's performance.
Narcotics: as morphine and pethidine. They increase the pain threshold so the athlete will feel pain after a longer period of time. This is beneficial in sports in which aggression is required.
Hormones: as erythropoietin. Erythropoietin is secreted normally by the body. But it can be taken from external sources. It stimulates the bone marrow to produce more red blood cells. In turn, the athlete's blood will have a greater content of hemoglobin.

All the above drugs can lead to the manipulation of a fair game. That's why all athletes are advised to avoid taking them because if the drug test came back positive, then this will have a negative effect on the athlete's reputation.