eHealth

What the Whites of your Eyes say about your Health

2014-06-23T08:44:00.002-07:00

Abstract:

Medicine is an art. Some thinks that doctors always need modern investigations to diagnose diseases. That is not true. Almost all the diseases can be diagnosed only by taking a proper history and by carrying out a thorough physical examination. Not only doctors but also fortune tellers, palm readers and people who tell about people’s lives have the knowledge and ability to gather information from what they see. There are certain parts of the body that give information more than any modern test can give. Your eyes play a leading role in that list.

Eyes of a person tell a lot about him. The eye is composed of several components. Each one of these components is very important to your vision. The white of the eye, also known as the sclera is one such part. The whites of the eyes tell a lot about your health. Most of the time, the color of the sclera is the most apparent change in relation to the underlying disease.

Muddy Sclera

Before going to know about the abnormal presentations of your eyes, you should know about the normal variations. Usually a healthy person has a pure white sclera, but not always. Some people sometimes can have light brown discoloration of their eyes. This is known as muddy sclera. Muddy sclera commonly occurs as a result of repetitive exposure to wind, dust and other physical and chemical insults. That does not indicate any serious underlying illness, but it says that you are carrying out a life that exposes you to a lot of dust, wind and sunlight.

Yellowish Discoloration

Yellowish discoloration of eyes, also known as icterus or jaundice always indicates an underlying disease. The eyes become yellow as a result of increased amount of bilirubin in your blood. Bilirubin is produced by breakdown of red cells. The initial molecules produced immediately after breakdown of red cells are called unconjugated bilirubin. Then these unconjugated bilirubin molecules are carried to the liver and the liver converts them in to conjugated bilirubin and excretes them in the bile. Any illness that increases red cell destruction or interferes with the above mentioned pathway results in increment of serum bilirubin levels. These excess amounts of bilirubin deposits in the sclera and make it look yellow. Some of the commonest causes of yellowish discoloration of eyes are hemolytic anemias (thalassemia, hereditary spherocytosis), hepatitis, Gilbert’s syndrome, Crigler Najjar syndrome, sclerosing cholangitis, carcinoma of bile duct, gall stones, carcinoma of the head of the pancrease etc.
Blue Sclera
Blue sclera is beautiful, but the underlying disease is not. People with diseases such as osteogenesis imperfect have blue sclera. Osteogenesis imperfect usually present at a very early age with recurrent bone fractures. The presence of blue sclera helps the physicians to come to a final diagnosis.
Bitot Spots
Bitots spots are characteristic of vitamin A deficiency. They appear as white or gray triangular or oval spots on the temporal side of the eye. Bitot spots are very rare nowadays because almost every child is given vitamin A supplements to help them maintain their tissue stores.

Scleritis and Episcleritis

Red eyes are sometimes due to scleritis or episcleritis. These two conditions are usually linked with connective tissue disorders such as rheumatoid arthritis. Sometimes they are associated with sero negative arthropathies such as ankylosing spondylitis.

Conjunctivitis

If your eyes have become red, teary and inflamed, you are having conjunctivitis. Conjunctivitis is inflammation of the sclera. It can be allergic conjunctivitis, viral conjunctivitis or bacterial conjunctivitis.

Subconjunctival Hemorrhage

Subconjunctival hemorrhage appears as a spot of bleeding. Sometimes it indicates base of skull fracture. Sometimes it is simply due to local trauma. The presence of posterior margin of the hemorrhage indicate that is only a local condition but if there is no posterior margin, it is most probably due to base of skull fracture.

Above mentioned are only an outline of most common disease conditions that causes changes in the whites of your eyes. There are many other rare disease conditions that give rise to changes in the sclera.

Use of Penicillin during Pregnancy

2014-06-23T08:41:00.002-07:00

Abstract:

Before starting the article I would like to say that penicillin is not the â€˜onlyâ€™ safe antibiotic to use during pregnancy, because there are few other drugs that can be considered as safe during pregnancy.

Before starting the article I would like to say that penicillin is not the ‘only’ safe antibiotic to use during pregnancy, because there are few other drugs that can be considered as safe during pregnancy.

Most drugs are contraindicated during pregnancy. This is because most of the drugs that are taken during pregnancy can cross the placenta and enter the fetus. Most of these drugs can act negatively on the fetus, and cause various abnormalities. They can result in morphological abnormalities, as well as growth and developmental abnormalities. Therefore use of any drug during pregnancy should be done with caution.

Drugs are given in order to cure a disease, but what if the patient is pregnant? She should be given medications. We can not keep her without giving any treatments just because she is pregnant. This is where the few drugs that are safe during pregnancy come in to play.

Antibiotics are a class of drugs that are given to cure various infections. As mentioned above most of the antibiotics too can be hazardous to the fetus, but the patient should be given antibiotics, if she acquires a serious infectious disease during pregnancy. Otherwise the disease it self could be life threatening to the fetus as well as to the mother.

Penicillin plays a major role among the drugs that are safe during pregnancy. It is used in pregnancy without any fear, because there is no evidence of fetal harm from this drug. It is the treatment of choice if the mother acquires any of the following infectious diseases.

Syphilis – This is a disease cause by Treponema pallidum. Protein penicillin is prescribed for primary, secondary or early latent syphilis. It is given 1.2 MU daily, intramuscularly, for 12 days. It should be given for 21 days for later stages of syphilis. Even though this is considered as safe, it can also have some adverse effects. Penicillin causes the death of organisms. Sometimes these dead organisms can trigger the release of pro-inflammatory cytokines, which leads to a Jarish-Herxheimer reaction. As a result the symptoms can become worsen and fever may rise for about a day after starting the treatment. This can also trigger preterm labour, so the mother is admitted to the hospital before starting the treatment.
Group B streptococcus infections – This is an organism that belongs to the normal flora of the gut and the vagina of 20-40 % of the normal women. It can cause upper genital tract infections that could lead to septicaemia, which is detrimental to the mother. Its infections are fatal to the neonate too. Therefore it should be cured by antibiotics. Fortunately penicillin is a safe and effective drug in treating this condition. Penicillin is given intravenously at the time of delivery, after the diagnosis has been made by culture. It is not given in early pregnancy because of common occurrence of re-colonization.
Gonorrhoea – This is a disease caused by Neisseria gonorrhoeae. It is also treated successfully with penicillin.

Even though there are many incidences of penicillin resistance, it is still widely used because of its high effectiveness and safety.

None of the drugs can be considered as safest, but comparing with other drugs, we can say that penicillin is fairly safe.

Finally I would like to say that penicillin is not the only drug that is safe during pregnancy, as the topic implies. Other antibiotics that are considered as safe during pregnancy are Cephalosporin, Erythromycin, and Nitrofurantoin in first and second trimesters.

How Staphylococcus Aureus in Blood can cause Fatal Infections

2014-06-22T08:58:00.000-07:00

Abstract:

The presence of bacteria in the blood is called bacteraemia. Blood is a sterile medium. Therefore there are not any bacteria in the blood under normal circumstances. So, presence of any organism can cause various diseases. Transient bacteraemia can occur in normal individuals after defecation and after brushing teeth. Usually these bacteria are removed from the blood stream by the spleen and liver, but sometimes, some of these bacteria get the chance to stay in organs like the heart, and in the ends of growing bones, and thereby avoid reaching the spleen and liver.

Staphylococcus aureus is one such bacterium that can stay in these organs, and cause serious diseases, which could be fatal if untreated. Infective endocarditis is a potentially fatal disease caused by staphylococcus aureus. It is responsible for 25% - 66.7% of infective endocarditis cases occurring world wide.
Intravenous drug users are at a high risk of developing infective endocarditis, because a lot of Staphylococcus aureus organisms enter the blood when they inject drugs into their body. These bacteria enter the blood stream and establish themselves in the damaged heart valves (especially in prostatic heart valves). They can produce adhesins, dextran and fibronecting binding proteins, which help them to attach to the heart valves.
The organism starts multiplying after attaching to the wall. This leads to attraction of more platelets and deposition of fibrin. So finally the organisms are covered with platelets. These growths are called vegetations and can be of several centimeters in size. Vegetations help organisms to hide from the body’s surveillance system. It takes about five weeks for this process to occur. These vegetations act as foci that continuously introduce bacteria to the blood stream. So these bacteria can spread to various organs and cause diseases in other organs too.

Staphylococcal infective endocarditis could be dangerous in several ways. The local damage done to the heart valves can give rise to various cardiac problems, which can be life threatening. Sometimes the vegetations can dislodge from their site of origin and travel to different organs in the body. These emboli are septic and can cause serious illnesses throughout the body. There are also immune complexes formations in response to the presence of micro-organisms in the blood. Immune complexes are composed of microorganisms and antibodies and complement proteins. These immune complexes circulate in the blood. They can deposit in organs like kidneys and cause serious problems like kidney failure, which is a life threatening disease.

The patients with infective endocarditis may initially present with pyrexia of unknown origin. Heart murmurs are always detected in patients with this disease. Apart from those main symptoms, the patient may have loss of weight, loss of appetite nausea, vomiting, malaise and night sweats. On examination the doctor may find Osler nodes, splinter haemorrhages in nail beds and petechial lesions in the skin. Earlier this was invariably a fatal disease. Now with the discovery of antibiotics, staphylococcus aureus infections can be treated successfully if identified earlier.
The disease is diagnosed by doing a blood culture. The condition is treated with antibiotics that are powerful enough to eradicate the organisms from the blood. This may take several weeks. Treating infective endocarditis caused by staphylococcus aureus is very hard, because of the emergence of antibiotics resistance strains, especially when the organism is hospital acquired. Therefore beta lactamase stable penicillin such as cloxacilline is given along with an aminoglycoside, rifampicin or fusidic acid. Vancomycin or teicoplanin is given if the patient is allergic to penicillin. They are also given to treat methicillin resistant staphylococci.

How can Breast Milk Transmit HIV

2014-06-22T08:44:00.001-07:00

Abstract:

HIV (Human Immunodeficiency Virus) is a virus belonging to the retrovirus group. It infects cells expressing the CD4 antigen. These cells include T helper cells, monocytes, macrophages, Langerhanâ€™s cells and dendritic cells.

HIV (Human Immunodeficiency Virus) is a virus belonging to the retrovirus group. It infects cells expressing the CD4 antigen. These cells include T helper cells, monocytes, macrophages, Langerhan’s cells and dendritic cells. The immune system gets progressively damaged and the CD4 positive cells count declines steadily. As a result the cells mediated immune response is lost, so the host becomes immuno-compromised. When the CD4+ cell count drops below a critical level, the patient is said to have AIDS (Acquired Immune Deficiency Syndrome). This favors infections with various opportunistic organisms. The AIDS patients die not due to the HI virus, but due to serious infections caused by other organisms.

HIV is transmitted from an infected person to another through body fluids like, blood, semen, vaginal secretions and breast milk, because these body fluids contain the virus. When an HIV infected woman gets pregnant, the next problem she faces is “Will my child also get HIV?” The child can acquire HIV from the mother during second or third trimesters of pregnancy, during delivery, or during breast feeding. There are successful intervention methods that can prevent vertical transmission of HIV during pregnancy and labour, but unfortunately we still do not have an effective way to prevent transmission during breast feeding.

The exact mechanism by which breast milk transmit HIV is not known, but scientists have found out that the breast milk contains the virus. The breast milk contains both the cell free virus and the cell associated virus, but which of these is important in infecting the child is not known. The plasma virus concentration that is required for it to appear in the breast milk is also yet to be studied.

When the child drinks the mother’s milk, the virus enters the child’s gut, but the mechanism by which they cross the mucosa is not well understood. The virus can penetrate the mucosa especially when there is a breach in the submucosa. Trancytosis through M cells and enterocytes with specific receptors can also occur. Tonsils are the next place where the virus can enter the blood stream. As the frequency and duration of the breast feeding increases, the risk of the child to acquire the infection also increases.

If the mother has mastitis, there is a higher chance for the virus to appear in large numbers in the breast milk. This occurs as a result of vasodilatation of the blood vessels. As a result the child is exposed to a higher number of virus, making him more viable to acquire the infection.

As discussed above HIV infected mothers can transmit the virus to their children during breast feeding. Therefore, reduction of HIV infected females in the reproductory age group in is very essential.

Sources: Medical Microbiology 2nd edition (Mims)
www.unfpa.org/.../276_filename_HIV_PREV_BF_GUIDE_ENG.pdf

Causes of Hepatomegaly

2014-06-22T08:26:00.003-07:00

Abstract:

Hepatomegaly is enlargement of the liver detected during medical examination. Both palpation and percussion techniques are used during abdominal examination to assess the size of the liver. O

Hepatomegaly is enlargement of the liver detected during medical examination. Both palpation and percussion techniques are used during abdominal examination to assess the size of the liver. On percussion the normal liver span is 7 cm for women and 10.5 cm for men. Hepatomegally is diagnosed when the liver size is found to be 2 to 3 cm larger than the above mentioned values.
Enlargement of the liver can be an apparent enlargement or true enlargement which can be due to several disease conditions. The disease conditions can be classified as cirrhosis, inflammatory conditions, cysts, metabolic conditions, haematological conditions, tumors, venous congestion and biliary obstruction.

Diseases which can cause apparent enlargement of the liver are low lying diaphragm and Reidel’s lobe. The liver is situated just below the right hemidiaphragm. Chest pathologies such as pneumothorax, emphysema, chronic obstructive pulmonary disease etc. push the right hemidiaphragm down along with the liver. This is noted as hepatomegaly on abdominal examination. Reidel’s lobe is defined as downward tongue-like projection of the anterior edge of the right liver lobe to the right of the gallbladder. This condition is commonly seen in women and can be an accessory lobe or a normal variant, which may extend up to the right iliac fossa. On palpation and percussion this can also be detected as enlarged liver.
One of the commonest causes of hepatomegaly is early cirrhosis which is the final outcome of most of the liver pathologies. Some of the causes of cirrhosis are Hepatitis C, alcoholic liver disease, non alcoholic fatty liver disease, hepatitis B, autoimmune hepatitis, primary and secondary biliary cirrhosis, primary sclerosing cholangitis, haemochromatosis, Wilson’s disease, Alpha-1 antitrypsin deficiency, Sarcoidosis, Type IV glycogen storage disease, Drug-induced liver disease etc.
Cysts which cause hepatomegaly are Hydatid cysts and cysts seen in patients with polysystic kidney disease. Hydatid cysts are caused by the larval stage of the tapeworm Echinococcus granulosus. The cysts can occur in many organs but the liver is commonly involved. These cysts increase in size at an average rate of approximately 1-1.5 cm/year. The disease manifests as hepatomegaly when these cysts enlarge up to a detectable size.
Metabolic diseases causing hepatomegaly are fatty liver, Amyloid and glycogen storage disease. Fatty liver can occur with (alcoholic fatty liver disease) or without (non-alcoholic fatty liver disease) alcohol consumption. It is caused by accumulation of triglycerides and other fats in the liver cells. The ultimate outcome of the disease can be liver inflammation and cell death. Its prevalence is increasing worldwide along with the increasing number of obese people. Liver is a commonly affected organ in Amyloidosis and can rarely cause massive hepatomegaly. The next metabolic disease causing hepatomegaly is glycogen storage disease which is a disease characterized by defective metabolism of glycogen.

Haematological diseases causing hepatomegaly are leukaemia, lymphoma, myeloproliferative disorders, and thalassaemia. In leukaemia, extra-medullary infiltration by leukemic cells may cause hepatomegaly along with Lymphadenopathy and splenomegaly. In patients with thalassaemia hepatomegaly occurs due to engorgement of hepatic paranchymal and phagocytic cells with hemosiderin deposits.

Tumors causing hepatomegaly can be either primary or secondary. Liver is one of the commonest sites for secondary deposits, especially from malignancies from the gastro-intestinal tract. Venous congestion caused by heart failure, hepatic vein occlusion can also lead to enlargement of the liver. Biliary obstruction particularly caused by an extra-hepatic cause is also an important cause of hepatomegaly.

Since there are a lot of causes of hepatomegaly, careful history taking, examination and investigations plays a vital role in detecting the correct eatiology and planning the future management.

Cause for Left Side Abdominal Pain in Females

2014-06-15T01:58:00.004-07:00

There are several pathologies which can cause left side abdominal pain in a female. They can be mainly divided in to two categories. They are pathologies limited to females and pathologies affecting bo th males and females. The pain can arise from any structure that is situated in the left abdomen. These structures include the abdominal wall, peritoneum, colon, small intestine, omentum, left kidney, left ureter, spleen, and pancreas. Sometimes pathologies in the left lung and the heart can also present as left side abdominal pain. All the above mentioned pathologies are common to both females and males. Pathologies restricted to females are those arising from the female reproductive organs. Female reproductive organs which can give rise to left side abdominal pain are left ovary, left fallopian tube, and the uterus.

Ovarian diseases causing left side abdominal pain are mid cycle pain, benign and malignant ovarian cysts, ruptured ovarian cyst, twisting of the ovary, chocolate cyst, and ovarian carcinoma. Mid cycle pain occurs at the midpoint of the woman’s menstrual cycle. This occurs as a result of ovulation. During ovulation, the ovarian capsule is broken and the ovum is released in to the peritoneal cavity. This can cause little amount of bleeding which gives rise to abdominal pain. In a woman who has 28 day cycles, ovulation occurs at the 14th day. This is the middle of the menstrual cycle. So, pain arising at the middle of the menstrual cycle is referred to as mid cycle pain. As a rule, ovulation occurs in every woman 14 days prior to the next expected day of menstruation. If you are having left side abdominal pain on this particular day, it can be due to ovulation. This is a physiological phenomenon and therefore, does not require special treatment. If the pain is disturbing, you can take simple analgesics. Ovarian cysts and tumors are major causes of abdominal pain. When they occur in left ovary, they cause left side lower abdominal pain. There are many types of ovarian cysts. Chocolate cysts arise from the presence of endometrial tissues in the ovary. These endometrial tissues undergo cyclical bleeding in to the ovary. As there is no pathway for blood to drain, they accumulate within the ovary, causing abdominal pain during menstruation. The accumulated blood looks exactly like chocolate, hence the name chocolate cyst.

Diseases of the fallopian tube causing abdominal pain are ectopic pregnancies, fallopian tube tumors, infection etc. Ectopic pregnancy occurs when the blastocyst implants within the fallopian tube. The embryo slowly grows and becomes larger. Finally, the fallopian tube ruptures when it cannot accommodate the enlarging embryo, giving rise to severe abdominal pain and circulatory collapse. This is a gynecological emergency and therefore need immediate surgical intervention.

Diseases of the uterus causing abdominal pain are fibroids, Braxton Hicks contractions during pregnancy, labour pain etc. There are several types of fibroid. They are sub-mucosal, intramural, sub-serosal, pedunculated and parasitic fibroids. They cause pain when they become very large. Pedunculated fibroids can give rise to severe pain if they become twisted. The blood supply to the fibroid is cut off when it gets twisted. This causes ischemia to the fibroid, which ultimately give rise to pain.

Two of the common diseases involving the pelvic cavity are pelvic inflammatory disease and endometriosis. Pelvic inflammatory disease is inflammation of the pelvic cavity and it can be either acute or chronic. This occurs mainly due to infection. Chlamydia and gonococci are the commonest organisms causing pelvic inflammatory disease. Endometriosis is the presence of endometrial tissue in places other than the endometrium of the uterus. Chocolate cyst is also a type of endometriosis. Same as in chocolate cyst, the endometrial tissues in all other places undergo cyclical bleeding and give rise to abdominal pain.

Above mentioned are the commonest causes of abdominal pain specific to females. Apart from that abdominal pain also occur due to other common pathologies such as bowel diseases (irritable bowel syndrome), urinary tract infections, urinary tract stones, pancreatitis, pneumonia, musculoskeletal pain, etc.

Ankylosing Spondylitis

2014-03-12T06:16:00.001-07:00

A 23 year old male patient was presented to the medical ward with one year history of joint pains. He was mainly complaining of large joint involvement. He complained of back pain, shoulder, elbow, hip and knee joint pains, but there was no small joint involvement. The pain was more in the morning and there was significant morning stiffness. He was having the symptoms for a long period of time hasn't got any regular treatment up until now.

On examination, he had restricted movements of his spine, but there were no joint deformities. Schoeber's test was positive indicating the presence of significant spinal stiffness. Schoeber's test is performed by marking a spot on the back, at the mid line, at the level of iliac crest. Then two points vertically 10 cm above and 5 cm below this point is marked while the patient is standing. The the patient is asked to bend as much as he can and the distance between the two marked point is measured. A reading less than 5 cm implies spinal stiffness. The reading of this particular patient was only 2 cm. The patient also had reduced chest expansion as a result of costochondral junction involvement (normal chest expansion should be at least 5 cm at the nipple level).

With all these findings, the patient is clinically diagnosed to have ankylosing spondylitis. Three out of four of following clinical criteria should be there to diagnose a patient as having ankylosing songilitis. These clinical features are,

Morning stiffness lasting more than 30 min.
Improvement of back pain with movements but not with rest.
Awakening because of back pain during second half of the night only
Alternating buttock pain.

Ankylosing spondylitis, as the name implies, is a inflammatory disorder of the spine. This is mainly seen among young males who are in their late teen or early twenties. Even though both men and women (2.5: 1) can be affected but symptoms are more prominent in men. The disease has a strong association with HLA B27 gene. These patients are also more susceptible to develop iritis also.

Investigations are performed to confirm the diagnosis.

ESR - elevated

The patient's ESR was 112 mm/1st hour

CRP (C reactive proteins) - elevated

The patients CRP level was 24

HLA B 27 testing
MRI - shows sacroilitis before it is seen on X rays
X rays

X ray lumbar spine

The fusion of vertebra leads to a

bamboo spine

X ray sacroiliac joint

The following radiograph is taken from our patient. There is sclerosis of either sides of the joint with irregular joint space suggestive of sacroilitis, but there is no ankylosis of the sacroiliac joint.

Ankylosing sondylitis - Sacroilitis

Treatment

Exercising - Exercising plays a major role in preventing the progression of the disease and improving the symptoms.
NSAIDs - Sometimes, the pain makes it impossible for the patient to carryout exercises. This is where NSAIDs come in to play. An evening dose of slow releasing NSAID, oral or as a suppository will reveal pain and help in carrying out an active lifestyle and improve sleep.
Methrotexate is helpful if there is peripheral joint involvement, but will not improve spinal disease.
Sustained and dramatic reduction of inflammation can be achieved by TNF alpha blocking drugs.
Rituximab does not help in seronegative arthritis.

Prognosis

The prognosis is good with adequate exercises. Fifty percent of the HLA B27 positive patients have the risk of transmitting the gene to their offspring. Thirty percents of these offspring may get the disease eventually.

Pneumothorax

2014-02-16T02:54:00.000-08:00

Case History

A 30 year old, previously well male patient was admitted to the casualty ward with sudden onset of left side chest pain. The pain was severe in the beginning. On admission the patient was complaining of pleuritic type of chest pain. On examination, his respiratory rate was 18 breaths per minute, and saturation was 100% without oxygen. His vocal fremitus and air entry was reduced on left side of the chest. His heart sounds were difficult to auscultate too. The clinical diagnosis of pneumothorax was made and an emergency chest x ray was taken. The chest x ray showed a left sided pneumothorax. The patient was immediately referred to the chest physician who put an intercostal tube to the left side of the chest to take out the air.

Pneumothorax

Air in the pleural space is called pneumothorax. Air can accumulate within the pleural space as a result of injury to the chest wall or as a result of injury to the lungs.

Spontaneous pneumothorax

Spontaneous pneumothorax is commonly seen among young, tall and thin men. This is mainly due to a rupture of a pleural bleb. The male to female ratio of spontaneous pneumothorax is 6:1.

Pneumothorax in a diseased lung

Pneumothorax is common among people with an already diseased lung. Patients with COPD, asthma, carcinoma of the lung, bronchopulmonary fistula etc are at a higher risk of developing pneumothorax. Pneumothorax in such patients should be taken seriously regardless of the size.

The following x ray shows a right sided small pneumothorax in a COPD lung. This lung also shows a band of bronchiectasis in the right upper zone.

Right sided pneumothorax in a COPD lung

Tension Pneumothorax

Sometimes a valve mechanism develops which allows air to fill in the plueral space during inspiration and prevents air from getting out of pleural space during expiration. As a result, each time the patient breaths, the air accumulates within the pleural space and the pressure gradually increases causing the mediustinum to shift to the other side. The patient gradually becomes breathless and tachycardic and can even die unless the pressure is not relieved immediately. This is an emergency and requires immediate aspiration of the air.

Aspiration of pneumothorax

Aspiration of a pneumothorax is performed by first taking informed consent from the patient. Then 2% lidocaine is injected in to the pleural space. Then 3-4 cm of 16 french guage needle is inserted in to the pleural space in the second intercostal space midclavicular line. The cannula is connected to a three way tap and 50 cc syringe. Upto 2.5 liters of air can be aspirated through the syringe.

What happens right before a C-section?

2013-07-19T19:42:00.001-07:00

Cesarean section is the surgical procedure designed to deliver the fetus through the abdomen. It is the only way to deliver a baby when it cannot be delivered through the vagina. Anything that prevents vaginal delivery leads to cesarean section. Conditions such as contracted pelvis, large baby, anatomical abnormalities of the birth passage and obstructed labor prevent safe delivery of the fetus vaginally. These abnormalities leave cesarean section as the only hope to deliver the baby safe without damaging the mother as much as possible.

The preparations for the cesarean section are carried out from the moment the obstetrician decides to deliver the baby by a cesarean section. Then the mother is managed accordingly and a date for the C-section will be booked. The preparations for a C-section are started from the day before the surgery. You will be advised to stay without eating anything. The duration should be not less than 6 hours. This is done to keep your stomach empty at the time of the surgery to prevent regurgitation and aspiration of stomach contents. On the night before the C-section, you will be also given some other medications. These medications include an anxiolitic to ease your anxiety and an anti-emtic to prevent vomiting during the surgery. These medications will help you to sleep well at night.

Usually an elective cesarean section is done in the morning. They will give you another dose of anxiolytic and anti-emetic. Before you are sent to the operation theatre, the doctor will check you to see how you and your baby are doing. He will check everything you need to undergo a surgery is present. For example, the presence of crossed matched blood is checked. C-section is a surgery that can lose a lot of blood. Therefore, blood should be preserved to give to the mother if such thing happens. He will also explain the procedure and answer any questions that you have. Then you will be sent to the operation theatre.

After you arrive to the theatre, the surgery will not be started right away. Still there are some procedures that you will have to undergo just before the surgery. The obstetrician and the anaesthetist will double check your medical records. Then you will be taken to the anaethetic room where you will be given anaesthesia. An intravenous cannula will be inserted and you will be connected to a saline drip. Usually, C-sections are performed under spinal anesthesia. Spinal anesthesia only anesthetizes the body below the waist line. Then you will be taken to the operating theatre. During this whole time you and your baby’s vital signs will be checked to see whether you two are doing fine. Just before the surgery a urinary catheter will be inserted and the perineal area will be shaved. Meanwhile, you will be connected to various machines to monitor your vital signs throughout the procedure.

C-section is a surgical procedure designed to deliver the baby abdominally when it cannot be done through the vagina. Sometimes the procedure is done when the parents specifically request to deliver the baby by a C-section. Like any other medical procedure, C-section also has some complications. Above mentioned pre-operative preparations are carried out thoroughly to minimize these complications.

Medical conditions that can lead to a reduction in appetite

2013-07-15T06:02:00.000-07:00

Reduction of appetite is an important symptom in medical practice. It is paid more attention because it can indicate an underlying serious illness. Most of these illnesses have treatment at their initial stages. Therefore, it is important to identify them before they advance. Any disease can give rise to reduction of appetite, but a significant reduction of appetite is a characteristic feature for some diseases.

Physicians consider several parameters when analyzing reduction of appetite. The duration is one among them. As mentioned earlier, any illness can result in reduction of appetite, but it is considered serious when it becomes significant. If you are having reduction of appetite for weeks or months, it is considered significant. Your physician will also inquire regarding the type of foods that you have reduced appetite for. The amount of food that you take for a meal is also inquired. Through this information, the physician will confirm the presence of reduction of appetite and the extent of the condition. Reduction of appetite and reduction of weight go hand in hand. So, it is important that you keep track of your weight to help the diagnostic process.

There are several illnesses that can give rise to reduction in appetite. Not only physical illnesses but also psychological illnesses can result in loss of appetite. It is a typical symptom of malignancies and tuberculosis. Loss of appetite is a diagnostic criterion for depression as well.

Malignancies

Reduction of appetite, loss of weight, fatigue and lethargy are characteristic features of malignancies. These symptoms are known as constitutional symptoms. The reason for most of these non-specific symptoms including reduction of appetite is the loss of balance between endogenous cytokines and their natural antagonists.

Reduction of appetite is subjective, but loss of weight can be measured objectively. Therefore, physicians use the amount of weight lost during a certain period of time to quantify the severity of reduction in appetite.

Even though cancers are generally considered to cause loss of appetite, some cancers do not give rise to this characteristic feature. For example esophageal carcinoma is a malignancy with preserved appetite. This feature is also used for the diagnostic process of cancer. For example, both esophageal carcinoma and stomach carcinoma can give rise to difficulty in swallowing, but physicians can differentiate the two by the presence of reduction of appetite. As mentioned earlier, if the patient is having an esophageal cancer, there will be no reduction in appetite. On the other hand, gastric carcinoma is a well known malignancy to cause significant reduction in appetite.

Tuberculosis

Reduction in appetite is a characteristic feature of tuberculosis. Tuberculosis is a common disease in the developing world. The initial symptoms of tuberculosis can be very non specific. Therefore, there should be a high degree of suspicion to diagnose tuberculosis based on these non specific symptoms. Loss of appetite is a common symptom among them. It is usually associated with other constitutional symptoms such as loss of weight, fever, night sweats, etc.

Depression

Not only medical conditions, but also psychological conditions can cause reduction in appetite. Depression is one such psychological disorder. It is one of the diagnostic criteria of depression according to the ICD 10 classification.

Apart from malignancies, tuberculosis and depression there are many other diseases that can give rise to reduction in appetite. Even simple viral fever, cold, gastroenteritis can have reduction of appetite. So, it is an important symptom that can be used to identify many illnesses.

Possible causes of genetic mutations in animals

2013-07-03T05:22:00.002-07:00

Genes carry tons of information regarding structure and function of the animals. Almost everything in animals’ body is controlled by the genes. The skin color, the height and even the emotions are primarily controlled by the genes. Genes are situated in almost all the cells of animals. Each cell has a copy of genetic materials. Most of the genetic material is contained within the nuclei of the cells, but a very little amount is contained within the mitochondria. These genes express proteins that finally control the function of those cells. Genes are the main control centre of a cell.

Any change in the structure of the genome is called a mutation. The genome is composed of nucleotides. Information is stored according to the nucleotide sequences. A single change in arrangement of these nucleotides results in a mutation. As a result, a defective protein is made instead of a correct one. The structure or the function of the cell is changed according to the gene involved. Most of these mutations give rise to abnormal animals, but some has contributed to the evolution of present animals. Therefore, mutations can be harmful or helpful according to the outcome of the mutation.

As mentioned earlier, a single change in nucleotide sequence can give rise to a mutation. These changes can occur at any time during life. Some mutations occur when the cell is replicating (dividing). Some mutations occur as a result of an outside force. As mentioned earlier, even a change in one nucleotide can result in a mutation. Therefore, even a very little force from outside can change the genome. There are many such causes of genetic mutations in animals.

Mutations Occurring During Cell Replication

Cell replication results in production of two identical cells. In order to achieve this task, a copy of each and every part of the cell should be synthesized, so they can be equally divided among the two daughter cells. This involves the synthesis of genetic materials as well. Anything that interferes with this process gives rise to a mutation.

Ultraviolet Light

Ultraviolet light may be the commonest cause of mutations in animals. The rays of the sun contain light. Some part of sun light is composed of ultraviolet light. Ultraviolet light has the ability to act on animal cells and change the structure of genetic materials. Skin is widely opened to the sun light. Therefore, it is at a high risk of developing mutations. This is why people are advised to use sun cream when they are going out.

Nuclear Radiation

It is a well known fact that nuclear radiation gives rise to mutations. This is proven by the deformities seen among the victims of nuclear bomb explosions (E.g.: People of Hiroshima). Radiation is also used in medicine for various purposes. It is used in radiology for imaging. It is also used as a therapeutic material to kill cancer. Unwanted exposure to any of these procedures can result in mutation.

Chemicals

Chemicals can also cause genetic mutations. Chemicals can enter the cells and directly damage the genome. This finally results in mutations. Examples of chemicals that can cause mutations are hydroxylamine, alkylating agents, base analogues etc. Oxidants can also cause mutations. That is why people are advised to eat fruits with anti-oxidant. Vitamin C and E contained within fruits act as antioxidants and prevent formation of mutations.

Mutations usually results in deformities, but rarely, they are helpful for development of new structures or functions of an animal that helps in evolution of animals. Knowing the causes of mutations is important to understand the behavior of genes.

How to support a loved one that is quitting smoking

2013-06-22T04:48:00.000-07:00

Quitting smoking is not an easy task. The smokers need help when they are quitting. This is where family members’ and friends’ roles become very important. The first thing that you should have before you support a loved one quit smoking is empathy towards the person. Empathy is the capacity to recognize emotions that are being experience by another person. To develop empathy towards a person who is addicted to smoking requires proper understanding about the pathology of addiction.

The general idea towards a smoker is that he is not quitting smoking because he doesn’t want to. The will does play a major role in quitting smoking, but sometimes the smoker may not succeed in quitting smoking because they are strongly addicted to it. When a person is addicted something, it is very hard to get rid of it. When a person takes an addictive substance, the chemicals in the brain change. With time, the brain cells loose the ability to stay without that addictive substance. When the concentration of that substance in the brain reduces, the person experience unpleasant feeling and sensations which leads them back to taking the substance. The same thing happens to a smoker also. Therefore, the first thing you should understand is that difficulty in quitting smoking is not entirely their fault.

Encouraging the person to quit smoking is very important. When your loved one is try to quit smoking you must do everything you can to admire his decision. Frequent admiration, encouragements and reminding of the benefits of quitting smoking make it easy for a person to quit smoking. If you keep on reminding him, it will be a great help for him to get over overwhelming feelings of smoking.

People, who are quitting smoking, get the idea of smoking again more frequently. They always get the desire to smoke again. They have got used to keeping something in their fingers and in their mouth for a long time. Therefore, if you can provide your loved one to find things that he can keep in his hands and something to put in his mouth, it will be a great help. You can provide him some hard candy. You can also prepare some fruits or vegetables (carrots) that he can put in to his mouth whenever he wants.

Smokers who are trying the quit often gets the idea to smoke again, especially when they are free and along. At such times, the person is at very high risk of smoking again. The best way to prevent this is by keeping the person busy throughout the day. Always try to stay with the person. Always try to find something for him to work on, so he doesn’t have much time to think about smoking.

Reducing other stressful situations in the person’s life is very important. Quitting smoking itself is a very stressful situation. Therefore, your loved one must be in real stress. They must have got used to smoking especially when they are under stress. Therefore, by removing other stressful situations from his life, you can make the process of quitting smoking much easier. Never forget to reward your loved one. Rewarding the person for taking this life changing decision encourages him to hang on to quitting. It will help him to get over the feelings of smoking again.

Quitting smoking is not easy. It requires the help of loved ones. Understanding the pathology behind smoking and about the way the brain works helps to understand the situation/

How to Identify the Cords of Brachial Plexus in a dissected Specimen

2013-06-15T22:06:00.001-07:00

brachial plexus supplies nerves to the upper limb. The books describe the cord of the brachial plexus nicely in relation to the axilllary artery. The cord lateral to the artery is the lateral cord. The cord medial to the artery is the medial cord. The cord posterior to the artery is the posterior cord. But, when it comes to dissected specimen of brachial plexus, at ones it might look like a total mess. Therefore, the students usually find it confusing to identify each cord and its branches.

First start with simple things. Then you can read more and go in to details. First the way to identify the main 3 cords, their terminal branches and their main branches will be described. When you are given a dissected specimen of brachial plexus, first try to find out the muscularcutaneous nerve. Muscularcutaneous nerve passes laterally in to a muscle in the arm. You will see this nerve piercing through the muscle. This muscle is called coracobrachialis. Once you identify this nerve, the rest is easy.

Now trace the nerve backwards towards the plexus. The you will find the cord which the nerve arise from. This is the lateral cord. Now you will see that there is another branch arising from the medial aspect of the lateral cord. That is the lateral root of the median nerve. This branch goes downwards and units with another short branch coming from the medial side. That is the medial root of the median nerve. The nerve formed by the union of these two roots is the median nerve.

Now trace the medial root of the median nerve up to find the medial cord. You will see that the medial cord continues downwards along the medial aspect of the arm. That is the ulnar nerve. Now that you have identified the medial and lateral cords, median nerve and the ulnar nerve, the remaining cord posterior to the artery is the posterior cord. Now isolate the posterior cord and look carefully. You will see that the cord goes through the muscles of the upper arm. that is the radial nerve. Higher up in the posterior cord, you will find a branch arising. This branch goes through muscles of the arm. That is the axillary nerve. Now that you have identified the 3 cords and their main and terminal branches, it will be easier to find out the rest.

Veins Without Valves

2013-06-15T21:42:00.003-07:00

Generally veins have valves. This is to prevent the backward flow of blood within veins. Arteries carry blood from the heart to peripheral tissues. At tissue levels, the arteries branch out and finally give rise to capillaries. The capillaries then unit and forms the veins. Veins carry blood from peripheral tissues to the heart. As the vessels branch out in the above manner, the pressure within those vessels gradually decline. When it comes to the capillaries, the pressure is very low compared to that of major vessels such as the aorta. The pressure within the veins is even more less. Therefore, there is less force to pump blood back to the heart.

Usually, the body takes the help of muscle contraction to pump blood up the veins. So, when the muscles contract, they squeeze blood up in the veins. When this happens, there should be mechanism to prevent blood from going back. This is where the valves come in to play. They prevent backward flow of blood.

Not all the veins in the body contain valves. There are some veins that do not have veins. They are,

The pulmonary veins
Superior vena cave
Left and right bracheocephalic trunks
Azygos system of veins

Revolution in Ophthalmology : Discovery of New Corneal Layer

2013-06-13T18:06:00.001-07:00

Harminder Dua, a professor at the University of Nottingham has conducted a research to find out the number of layers in human cornea. Up to now it was believed that human cornea was made of only five layers, but with the findings of the Professor Harminder Dua, the anatomical description of the cornea has changed.

The professor and his team have used cornea that were donated for research purposes. Then they have injected air into these cornea to separate and visualize the layers easily. They have scanned each and every layer through an electron microscope. Through this technique they were able to find a new layer. They have named the new layer as 'Dua's Layer'.

They have also stated that the reason for corneal hydrops is tear of Dua's layer. They have also pointed out the association of this layer with many other diseases of the cornea. Therefore, the discovery of this layer will take the field of ophthalmology in to a whole new level.

How is Chlamydia treated during pregnancy?

2013-06-13T07:35:00.001-07:00

There is a wide variety of genital tract infections. Some of them are sexually transmitted. Treatment of these infections is important to prevent complications. Chlamydia is one such infections requiring immediate medical attention. It is also a sexually transmitted disease. Chlamydia is an obligate intracellular organism. That means that the organism lives in side the cells. The pathogen chooses only the noncilliated columnar, transitional and cuboidalcells to live in. These are the cells found in the upper genital tract and urethra.

Unlike many other sexually transmitted diseases, Chlamydia infection gives rise to few symptoms. The patients will be completely normal until they develop complications. The complications are more when the infections occur during pregnancy. In pregnancy, not only the mother but also the baby can get affected by the infections. Chlamydia infection during pregnancy can lead to preterm birth, preterm prematue rupture of membranes and choriamnionitis. Usually, Chlamydia infection in non-pregnant women can be treated with several antibiotics. These antibiotics include azythromycine, doxycycline, erythromycin, levofloxacin and orfloxacin, some of these antibiotics cannot be used during pregnancy. That is because they can cross the placenta and can give rise to adverse effects in the baby. Therefore, the drug should be chosen carefully.

The antibiotic of choice in pregnancy is tetracycline, usually doxycycline. Out if these two, tetracycline binds to the developing bones and teeth of the fetus during second and third trimester. This results in brown colored teeth and dysplastic bones. Therefore, it should be avoided in the second and third trimesters. Erythromycin 500 mg twice a day for two weeks is the treatment of Chlamydia infection during pregnancy.

Erythromycin is usually a drug with many gastrointestinal side effects. Once ingested, the mother can get nausea and vomiting. As a result, the drug might not get absorbed properly. The pharmacokinetics of the drug during pregnancy can also get altered and the efficacy of the treatment is doubtful. Therefore, pregnant mothers who are treated with erythromycin should be tested later for presence of infection 2 weeks after the completion of antibiotic therapy. For women who cannot tolerate erythromycin, azythromycin as a single 1g dose is given. Scientists have found that Co-amoxyclave have a protective effect against neonatal infection. Therefore, it can also be used to treat Chlamydia infection during pregnancy.

As mentioned earlier, Chlamydia is a sexually transmitted infection. Therefore, not only the pregnant mother, but also her partner should be tested for the presence of infection. If the male partner is also found to have the infection, he should also be treated before resumption of sexual intercourse. If the mother is found to have infected with Chlamydia after delivery, she should be given tetracycline as definitive treatment. Breast feeding can be continued while on treatment.

Sometimes, Chlamydia infection goes unnoticed during pregnancy. In such cases the first presentation could be eye infection of the neonate. This is called ophthalmia neonatarum. If the baby develops ophthalmia neonatarum, it should be treated with tetracycline eye oinements. They should be also given erythromycin syrup for two weeks. This is to reduce the risk of neonatal pneumonia.

As described earlier, treatment of Chlamydia infection is very important to prevent its complications. The treatment of the mother as well as her sexual partner and the baby after birth is very important.

Causes for Loss of Motor and Sensory Functions of Limbs

2013-06-08T00:44:00.000-07:00

Loss of motor and sensory functions of limbs is a common neurolgical disorder. Both young and old can get this condition. Peripheral neuropathy is the commonest cause for this disease. If a patient has difficulty in moving his limbs or abnormal sensation, then he might be suffering from peripheral neuropathy. This is a disease that requires immediate medical attention because some can progress rapidly.

Following are some common causes of peripheral neuropathy. it can be easily remembered by the mnemonic STAGLAND.

Sarcoidosis
Thyroid
Amyloidosis
Guillian Barre
Lead
Alcohol
Nutritional
Drugs/ Diabetes

Can Adults Form New Brain Cells?

2013-06-07T20:55:00.001-07:00

Some human organs have the ability to grow until death (e.g: hair, skin), but some stop growing at very young age (e.g: neurons) . It is believed that the development of the brain is completed at very young age. Scientists believed that after that certain age, the human brain does not grow. But, according to the latest research findings, human brain cells grow even at adult age.

Kirsty Spalding, a molecular biologist at the Karolinska Institute in Stockholm, Frisén, and colleagues have done a research to find out the ability of brain cells to divide even at adult age. For this research they have used brains of deceased humans who were exposed to above-ground nuclear weapon testing 50 years ago. During these nuclear weapon testing Carbon 14 were released in to the atmosphere. These Carbon 14 were incorporated in to DNA of cells of people who were exposed. They have found out a way to test the amount of Carbon 14 with in DNA of these cells. In their study they have extracted hippocampi of 55 deceased people who had given their consent to use their brains for research purposes. They have found out that every day about 1400 cells in hypoccampal region are being replaced.

According to this research, it is confirmed that the brain cells have the ability to regenerate even in adult age. The results of this research will help the development of many aspects of science, especially the field of medicine.

Treatment of Supraventricular Tachycardia

2013-05-31T19:35:00.000-07:00

Tachycardia is defined as heart rate of more than 100 beats per minute. The heart beats as a result of electrical activity that spread throughout the myocardium (heart muscle). This electrical activity normally originates at sinu-atrial node, a focus in right atrium. Tachycardia occurs as result of increased frequency of electrical discharge from the sinu-atrial node (SA node) or from another focus. When this focus in situated in the atrium, it is called supra-ventricular tachycardia.

Atrial fibrillation, atrial flutter also leads to supraventricular tachycardia. Supraventricular tachycardia can lead to reduced cardiac output and embolisation. When there is tachycardia, the diastolic time reduces. Diastole is the time period where the heart is relaxed. During this period, the atria and ventricles get filled with blood. When there is tachycardia, the amount of blood coming to fill the atria reduces significantly. As a result, the cardiac output reduces. Arrhythmias such as atrial fibrillation creates a turbulent flow. Turbulence results in blood clot formation. These blood clots can shoot in to the systemic circulation and block small blood vessels and give rise to strokes, myocardial infarction etc. Therefore, it is important to treat supraventricular tachycardia.

Medical treatment of supreventricular tachycardia includes several drugs and manures. They can be remembered by the mnemonic ABCDE.

A - Adenosin

Adenosin is an alpha 1 receptor blocker. It acts on the atrio-ventricular node (AV node). AV node transmits impulses from atrium to the ventricle. When the drug is given intravenously, it blocks excessive impulses passing to the ventricles. As a result the ventricular rate reduces.

Beta Blocker

Beta blockers also reduce the heart rate.

Calcium Channel Blocker

Digoxin

Digoxin is a cardiac glycoside. It inhibits sodium potasium ATPase pump. As a result the heart rate reduces. It also has a positive inotropic effect (increases myocardial contractility) on the myocardium. Its effect on AV node, prevent excessive impulses passing in to the ventricles.

Excitation

Excitation includes manueurs used to stimulate vagal activity. These manuers include carotid massage, sprinkling cold water on to the face etc.

Above medications helps to keep the heart rate down and prevent clot formation.

Nipple Discharge? Is it breast Cancer?

2013-03-06T20:22:00.001-08:00

Nipple discharge can be a scary experience for all men and for women who are not breast feeding. The biggest concern when a person experience nipple discharge is the possibility of carcinoma. Even though breast carcinomas often present with nipple discharge, all nipple discharges are not due to breast cancer. If you are experiencing nipple discharge, the following information will help you to find out the cause for the nipple discharge.

So, you are experiencing nipple discharge. The first thing you should clarify when you are having nipple discharge is whether it is from one nipple or from the both. If you have discharges form both your nipples, it is most probably due to a systemic disease more than a local disease, such as carcinoma.

Bilateral Nipple Discharge

If you are having bilateral nipple discharge, you are having one of the following conditions. Bilateral nipple discharge does not indicate breast cancer unless the cancer has spread to the both breasts.

Lactation
Pituitary tumor

Out of these, pituitary tumor should take immediate attention because they should be ablated. Some people with pituitary tumor experience some specific symptoms which can be used as diagnostic tools. Pituitary tumors enlarge in size and increases the intracranial pressure. As a result, the person experiences early morning headache, nausea and vomiting. The visual pathway runs close to the pituitary gland. Tumors arising from the gland compress the visual pathway. As a result, the affected person looses vision of his both temporal sides. This is called bitemporal hemianopia. If you are having bitemporal hemianopia, when you are looking at something, you will feel like you are looking through a tunnel. This is called tunnel vision.

Unilateral Nipple Discharge

If you are having discharge only from one breast, it is due to a local pathology affecting only that breast. You should also consider your age because carcinomas are very rare in younger ages. If you are in your twenties or early thirties and there is no family history of breast cancer among first degree relatives, there is very low chances for you to develop breast cancer. If you are very young there is nothing to worry about. If you are still anxious, you can consult a doctor. He will also reassure you after doing the triple assesment. Consulting a doctor is important because he can analyse your data decide on the possibility of cancer.

The next thing you can do to know whether it is due to cancer or not is by looking for a lump. To do this you will have to carry out a self breast examination. A careful self breast examination can detect most of the lumps in the breast, but some breast cancers are very small and therefore, cannot be palpated. If you are more than 40 years of age and have a family history of breast cancer, you should immediately see a doctor even you do not feel any lump.

Then the next thing you should focus on is the color of the discharge. The color of the discharge gives diagnostic clues. As mentioned earlier, breast cancers can give rise to nipple discharge, but not all discharges are due to cancer. There are many benign conditions that can give rise to nipple discharge. These benign conditions are,

Duct ectasia
Papilloma of the duct
Mammory dyslasia
Fibrocystic disease (fibroadenosis)
Infection
Hypothyroidism
Pituitary tumor

The nature of the secretion is very important in differentiating each of these condition. Blood stained discharge is suggestive of cancer, but benign conditions such as duct ectasia, papilloma of the duct, fibrocystic disease can also give rise to blood stained nipple discharge.

The commonest form of nipple discharge is serous discharge. This is commonly physiological and sometimes due to duct papilloma, duct ectasia, mammory dysplasia or fibrocystic disease.

If the discharge is black or green, it is due to duct ectasia. This is a benign condition which does not progress to breast cancer. If the discharge is purulent (pus), it is due to an infection. In infection, in addition to the discharge you may also experience pain, fever, warmth of the breast.

Milky discharge is due to lactation, hyperthyroidism or pituitary tumor. One of the commonest pituitary tumors are prolacting secreting tumors. Prolactin stimulates milk production and gives rise to galactorrhea.

Above mentioned are the possible causes of nipple discharge. According to these information it is vivid that nipple discharge is not always due to breast cancer. There are many benign diseases that can cause nipple discharge.

Hemifacial Spasms

2013-03-04T21:05:00.000-08:00

Are you experiencing spasms in one side of your face? You might be having the disorder called hemifacial spasms. You must know that each and every spasms that occur in your face is not always due to hemifacial spasms.

Hemifacial spasms is a rare disorder most commonly seen among middle aged females. It is characterized by sudden irregular clonic spasms of the facial muscles. The severity of the spasms can vary from very mild to severe. People with very severe spasms may usually find it very distressing and disfiguring.

What is the cause for hemifacial spasms? There are several causes, but most of the time it is idiopathic. It means that there are no identifiable cause. Following are some well identified causes for hemifacial spasms.

Following Bell's palsy - Bell's palsy is a disorder characterized by sudden onset of facial muscle weakness. People can develop hemifacial spasms after recovering from Bell's palsy.
Acaustic neuroma - Acaustic neuroma is a type of tumor involving the eighth nerve that can also have its effects on the facial nerve as well. As a result, the muscles of the face supplied by the affected nerve can start aving spasms.
Paget's disease withing the skull base
Pressure from the vessels in the cerebellopontine angle.

The disorder is treated according to the severity Mild cases do not require any treatment. Severe disease is managed with botulinum toxin injection. Decompression of the facial nerve at the cerebellopontine angle can also be done.

What is the difference between isometric and isotonic exercise?

2013-03-01T07:34:00.000-08:00

Exercises keep you healthy and strong. Regular exercises increases your circulation and helps to burn excess fat. People engage in exercises for various reasons. Some do it to lose weight. Some do it to stay healthy. Athletes are obligated to do exercises every day. Some do it just for fun. There are many types of exercises. The type of exercises differs according to your goals. Therefore, it is important that you clarify and set your goals before starting exercising. Then you should choose the type of exercise you need. Therefore, it is important to have a basic understanding about the types of exercises.

Exercises are divided into many categories. Strength training exercises are one such category. Strength training exercises are divided in to two. They are isometric exercises and isotonic exercises. Strength training exercises are designed to increase muscle strength. This is achieved by combining both isotonic and isometric exercises. The effects of the exercise are more when it is done against resistance. When the resistance is more the tension within each muscle fiber increases. As a result, with time the muscles become bulkier and stronger.

How to differentiate isometric exercises from isotonic exercises?

The main difference between these two is the movement at the involved joint. Isometric exercises keep the joint immobile while the isotonic exercises involve all the movements of the joint. Now you might wonder how to exercise without moving anything. The following explanation will answer your question.

Isometric Exercises

As mentioned above, isometric exercises do not involve movements at joints. These kinds of exercises increase muscle strength by increasing the tension of the muscle while keeping the muscles at a static level of contraction. How can you do this? It is done by keeping your body in a static posture for a long time. It might seem that staying at the same posture does not require any muscle activity, but it is not true. Maintaining posture involve contraction of opposing muscle groups at an equal intensity. Maintaining the same posture requires a lot of energy. Examples of isometric exercises include pushing or pulling against an immobile object and yoga exercises that maintains a posture for a long time. The disadvantage in this type of exercise is that one should use many postures in order to strengthen each muscel group in the body.

Isotonic Exercises

Unlike isometric exercises, isotonic exercises involves joint movements. The muscles are made to lengthen as well as shorten, but the tone of the muscles is kept static throughout the range of motion. Isotonic exercises include pushups, running, jumping, curls and climbing.

Both isotonic and isometric exercises increase muscle strength as well as endurance. To achieve maximum benefit from your exercise program, you should combine both of these types of exercises.

How Obesity Gives Rise to Hernia

2013-02-26T04:11:00.000-08:00

Obesity is major health threat that gives rise to various health problems. It is associated with many systemic illnesses such as dyslipidemia, hypertension, diabetes mellitus etc. Apart from that, obesity can cause many other surgical problems as well. One such problem is formation of hernia.

Hernia and obesity usually go hand in hand. Hernia is defined as protrusion of an organ from its containing cavity. This is either due to weakened coverings of the cavity or due to increased pressure inside the cavity. Obesity causes hernia by both of these mechanisms. Obese people have fat not only in the skin but also inside the abdomen, within the mesenteries. As a result the intra-abdominal pressure increases. Fat also deposits within the muscle fibers. They separate each muscle fiber from one another and make them weak. Fat also deposits within the aponeurosis and weakens it too. As a result, para-umbilical, direct inguinal and hiatus hernia occurs.

Is hernia repair is enough to cure hernia?

2013-02-25T19:31:00.001-08:00

Is hernia repair is enough to cure a hernia? The answer is no. If you have a hernia, you might think that everything will be OK after getting it operated, but this is not true. There are a lot of things that you have to do. The surgeon can only repair the hernia. It is up to you to make sure it does not come back.

So, what are the things you should do to prevent hernia from coming back? The first thing you should do is to identify the cause for hernia. Everybody do not get hernia. So, what went wrong in your case? One of the commonest cause of herniae is smoking. Smoking causes collagen deficiency. As a result, the strength of the abdominal wall reduces and predisposes for formation of hernia. Therefore, if you want to prevent recurrent hernia, you should stop smoking.

The next most commonest predisposing factor for hernia is chronically raised intra-abdominal pressure. Several things can lead to raised intra-abdominal pressure. They are chronic cough, straining during urination as well as straining during defecation.

In conclusion, hernia repair is not enough to cure hernia. It also requires elimination of predisposing factors. Therefore, if you have a hernia, first think whether you have any of above mentioned predisposing factors. If you do, you must take necessary steps to eliminate them. It might require consulting a doctor and taking appropriate steps.

Most of the time your doctor will inquire about these factors and refer you to take necessary treatments. Therefore, you don't have to worry too much about it. But, you should pay more attention to eliminate these predisposing factors by following the medical instructions correctly.

How can a strangulated hernia get reduced on its own after taking pain killers?

2013-02-24T21:11:00.001-08:00

Hernia is a common surgical problem. Hernia can be complicated with many things. Strangulation is one such thing. A hernia gets strangulated when the contents of the abdomen comes out and twists. As a result the vessels supplying the hernial contents get crushed and the blood supply is cut off. If your hernia has got strangulated, you will feel colicky abdominal pain, with nausea, vomiting, abdominal distention and constipation. This is a surgical emergency that requires immediate attention. Unless, the contents can become gangrenous and rupture.

If you have a strangulated hernia, the doctors will advice you to have strict bed rest and elevate the foot end of the bed. They will also prescribe you analgesics. Surprisingly, some people improve with the provision of pain killers. This occurs as a result of relaxation of the muscles surrounding the neck of the hernia. Analgesics can relax the muscles. The same thing happens when your are taken to the theater and anaesthesia. Anasthetics are also muscle relaxants. Sometimes the muscles can get too loose and the hernial contents can get back in to the abdominal cavity. This can be an disadvantage, because the surgeon might have to open into the abdominal cavity, in order to find the strangulated bowel loops and look for possible perforation.