Heat stroke: Prevention of heat stroke

Dr Nisreen Nakhoda answers all your questions on heat strokes and how you can prevent them.

What is a heat stroke?

A heat stroke is when the body temperature gets elevated to a higher level from a normal of 98.4 degrees Fahrenheit. It happens more in athletes, infants, the elderly and workers who are always out in the sun.

What are the symptoms of heat stroke?

The symptoms of a heat stroke include

• Nausea or vomiting
• Increase in body temperature
• Agitation or disorientation
• Dizziness
• Halluciantions
• Excessive sweating

Prevention of heat strokes

• Always wear a wide brimmed hat or carry an umbrella when you are stepping out in the sun
• Avoid synthetic and tight fitting clothes
• Stay hydrated, carry a bottle of water
• Avoid caffeine or alcohol

First aid when someone is suffering from a heat stroke

• The most important thing is to cool the person down
• Cool the person under a tap or any other source
• Just fanning the victim with a newspaper also helps
• Keep the victim hydrated
• If the victim can’t take water, its important to shift him to a hospital.

You may also like:

• Avoid prickly heat this summer
• Five things to keep your skin healthy this summer
• Alternative healthy drinks for summer

Heat stroke: Prevention of heat stroke is a post from: mDhil

What is an epidural? 

Epidural anaesthesia or an epidural, is used to block pain by injecting drugs through a catheter placed in the epidural space (the space outside the spinal canal, which contains spinal fluid).

The objective is to block transmission of signals from the spinal nerves that arise from that point. This numbs the lower back, thighs and legs.

Other names for an epidural are intraspinal anaesthesia, epidural block and peridural anaesthesia.

Epidural procedure

• If an epidural is planned, you will be advised to avoid drugs like aspirin, which are blood thinners and interfere with blood clotting, a few days before the procedure.
• The lower back area will be cleaned thoroughly with an antiseptic solution in the operation theatre.
• The doctor will ask you to bend forward so that your back is curved in a convex shape. After giving local anaesthesia, a needle is inserted into the epidural space, just outside the spinal canal. The analgesic drug is then injected into it to block the nerve responsible for pain to the lower body. The drug takes 10 to 20 minutes to produce numbness.
• The needle is taken out but a catheter is kept in the epidural space to inject additional medicine at a later time.

This is a completely safe procedure when done by an experienced anaesthesiologist.

Why choose an epidural?

• It is a type of regional anaesthesia, which can substitute  general anaesthesia — which is more complex and has a longer recovery time — in possible situations.
• It is advised when labour pain cannot be borne by the woman. The main advantage is that it does not interfere with the progress of labour. It can be given continuously throughout labour and the woman can remain alert and awake as it does not cause drowsiness.
• It is also used for surgery in the pelvis and legs. If you need to have a Caesarian section, an epidural can numb the area quickly and effectively.

Risks associated with an epidural 

• Allergy to medicine: The person may develop an allergic reaction to the drug used to give pain relief.
• Infection: Meningitis or an abscess may form.
• Hematoma: A collection of blood called hematoma may form around the site of injection.
• Urinary problems: After this procedure there may be difficulty in urinating.
• Hypotension: There is a mild chance of having a drop in blood pressure after an epidural. This could affect the heart rate of the baby.
• Headaches: Severe headaches may occur for days after an epidural.

Epidural anaesthesia precautions

1. Getting up suddenly from a lying down position into a sitting or standing position may cause dizziness, light-headedness and fainting. Therefore, one must change positions slowly to avoid this.
2. You may not be able to walk to the bathroom or move around after an epidural is given. Discuss this with your gynaecologist beforehand.
3. You may not be able to feel the contractions and push voluntarily. This increases the chance of an assisted delivery by means of forceps or vacuum.
4. It is important to monitor the faetal heart rate after an epidural as hypotension (abnormally low blood pressure) in the woman can cause slowing of the heart rate of the baby.
5. If the baby is born before the effect of the epidural medication wears off, the baby may have breathing difficulty and grogginess. However, it can be reversed with another drug

Photograph via sxc.hu

Written by Dr Nisreen Nakhoda, General Physician

You may also like:

Medical Procedures: Epidural is a post from: mDhil

Wear proper-fitting shoes and sandals to prevent an ingrown toenail.

What is an ingrown toenail?

An ingrown toenail is a painful condition where the corner of the nail goes into the skin beneath it. If neglected, conservative treatment may not work and it has to be surgically removed.

Causes for an ingrown toenail

• It generally occurs in adults and rarely in children. Men are more likely to get an ingrown toenail in comparison to women.
• Repeated injury to the toes for e.g. while playing football or an acute injury to the nail may lead to ingrown toenail.
• If someone in the family has had an ingrown toenail, the chances of one getting it are higher.
• Wearing high heels or tight-fitting shoes for long periods of time leads to pressure on the nail, which then may then grow abnormally.
• A fungal infection of the toes may lead to a thickened or wide toenail predisposing one to this condition.

 Symptoms and signs of an ingrown toenail

• It generally occurs on the outer edge of the big toe, but it can occur on any edge of any toe.
• The condition is characterised by pain, swelling and redness, initially, which are signs of an inflammation. The pain is moderate to severe in intensity.
• It is unusual to get fever unless the patient is a diabetic.
• In later stages, it may become infected causing pus to accumulate in the area. It may become impossible to wear closed shoes.

Diagnosing an ingrown toenail

The physician may ask for a history of any injury to the toe, kind of footwear worn and about the pain. It is easy to diagnose based on examination of the foot.

Treating an ingrown toenail

Prompt treatment is important in case of an ingrown toenail. In initial stages, home remedies are useful but in later stages surgery may be the only option.

Home treatment for an ingrown toenail:

• Soak foot in warm water four times a day.
• Wash the foot with soap and water twice a day. Keep the foot area dry throughout the day.
• If you are diabetic, ask your doctor for tips to prevent foot problems.
• Take a small piece of cotton wool and roll into a wick. Try to insert this between the nail and skin after soaking the foot. Doing this repeatedly will encourage the nail to grow in a direction away from the skin and lessen the pain.

Surgical treatment for an ingrown toenail:

• It is done as an out-patient procedure in the doctor’s clinic or in the hospital. A tetanus injection is given before the procedure if it has not been taken in the last five years.
• An anesthetic is injected to numb the affected toe.
• An incision is made to drain the abscess. Any extra tissue in the area is removed. A portion of the nail is also removed to help the area heal properly.
• In case of recurrent ingrown toenails, phenol may be applied to the nail-bed, as it prevents the nail from growing and causing the problem.
• Another procedure called lateral matriectomy is considered where a part of the nail bed is removed; this is for recurrent ingrown toenails.

Preventing ingrown toenails

• Toenails should be clipped carefully straight across and not rounded. The nail should project beyond the skin to avoid it irritating the skin.
• Footwear should fit properly and not be too tight.
• Feet should be kept dry and clean.

Photograph via sxc.hu

Written by Dr Nisreen Nakhoda, General Physician

You may also like:

Ingrown toenail is a post from: mDhil

The Dhuaa effect:

In India, some of the commonly used tobacco products are beedis, hookah, cigarettes, gutka, pipes, cigars, cheroots, dhumti, chuttas, chiium, hooklis, pan masala, mawa, Manipuri rabacco, khaini, mishri, suns, gul, bajjar and some in the sniffing and chewing forms.

If you use or plan to use one of these products, maybe you should check out these statistics first:

(Statistics according to a study conducted by the National Institute of Health)

Still feel like lighting a cigarette?

Cigarette smoke and ash are harmful

Hang on! Below is a list of the devils it feeds:

• Cancer of all sorts: lung, mouth, penis, urinary & gall bladder, pharynx, larynx, stomach, cheeks-oral, kidney
• Heart & blood vessels diseases, heart attack, angina or chest pain, sudden cardiac death, stroke, peripheral vascular disease (gangrene of legs), paralysis
• Various lung diseases like chronic bronchitis, tuberculosis and emphysema. It also damages the lining of the arteries.
• It reduces blood flow to heart, increases blood pressure, increases risk of diabetes and reduces good cholesterol.
• It decreases physical fortitude which affects our stamina for physical activity.
• Impotence, early menopause and decreased oestrogen levels are also by-products of heavy smoking. Combining them with birth control pillsincreases the chance of stroke for women.
• Cosmetically, smoking is one of the fastest ways you can age yourself. It leads to stained teeth, darkened lips, hair loss and wrinkling of the skin. And then there’s the bad breath and smelly clothes that smokers suffer from that tend to be real turn-offs.

It doesn’t stop here!

Don’t smoke but live with a smoker? Well, passive smoking is equally dangerous. About two packets of passive-smoking is equivalent to about three cigarettes a day, as detected in urine nicotine levels.

Third-hand smoke

While the concept of second-hand smoke has been around for a while, researchers now point towards third-hand smoke. This includes smoking residue found on carpets and other upholstery; lifts and rooms with smokers. Infants are especially susceptible to the third-hand smoke as they crawl and come in contact with this hidden residue.

Startling huh? It’s never too late to stop smoking. So look around, read more, talk to friends and family, reach out for help and free yourself of this life-threatening addiction – NOW!

Photograph by Seb Creane, via sxc.hu

You may also like:

• Kick that butt. Stop smoking!
• Chronic Obstructive Pulmonary Disease – Diagnosis and Treatment
• Top 10 – Health tips for a healthy heart

Why smoking and tobacco are never cool is a post from: mDhil

What is a hookah?

The hookah, also known as sheesha or goza, was once seen only in Bollywood movies, being puffed at by spoilt nawabs and patrons of the nautch girls. Today, this age-old tradition has come back as a trendy hobby for young people unwinding at coffee shops or hookah bars. While, this tradition has been around for many years and is, in fact, a part of many Asian cultures, it does have health issues that one should be be aware of.

Anatomy of a hookah

Most hookahs consist of a water pipe attached to a smoke chamber. Tobacco used in hookahs is specially prepared, making it possible for the smoke to pass easily through water.

Many young people smoke hookahs for their fruity flavours and are under the impression that hookahs do not contain any tobacco. This is in fact, not true. While most modern hookahs do come with a fruity aroma, tobacco is also used and has the same ill-effects as any other form of tobacco.

Ill effects of hookah smoking

According to the World Health Organization, hookah contains numerous toxicants known to cause lung cancer, heart disease and other diseases. If you’re into hookahs, be aware of the ways in which it can be harmful to you:

• A hookah session may expose the smoker to more smoker over a longer perod of time than when smoking a cigarette.
• Hookahs are typically smoked for a longer time than regular cigarettes. Cigarette smokers typically take 8 to 12, 40-75 ml puffs over 5 – 7 minutes and inhale 0.5 to 0.6 litres of smoke. In contrast, hookah smoking sessions last 20 – 80 minutes, during which the smoker may take 50 – 200 puffs which range from 0.15 to 1 litres of smoke each.
• Also, the reduced concentration of nicotine in the waterpipe smoke may result in smokers inhaling higher amounts of smoke.
• There is no filter in a hookah and the water in a hookah can’t filter out lethal tobacco ingredients.
• Another health hazard the hook presents is in the form of its pipes and bowls. As these are typically not cleaned for long periods of time, they become a hotbed for spreading infectious diseases amongst users.

Are hookahs safe for teens?

In one word, no. Smoking hookahs is as harmful as cigarette smoking. It leads to the inhalation of many toxic compounds like tar, carbon monoxide and heavy metals, making it a major cancer risk.

It can also cause lung or oral disease, heart disease and other critical illnesses in youngsters. Worse, it could lead to a non-smoker getting addicted to nicotine.

 Are hookahs safer than cigarettes?

• That hookahs are safer than cigarettes is one of the biggest misconceptions that’s lead to their popularity. Hookahs are as dangerous or maybe even more harmful than cigarettes. The long duration (typically 40 minutes) as well as the absence of any filter makes them highly unsafe. So if you want to stay away from tobacco, as you should, then stay away from hookahs as well.

Hookahs that use herbal molasses

Some hookah bars offer tobacco-less hookah, using herbal molasses instead. These are definitely safer than regular hookahs, but do check with the hookah bar first if they offer this option.

Hookah Smoking – Dangers you should be aware of is a post from: mDhil

A skin infection is an infection of the skin, including hair, scalp, and nails. The infection can be caused by various bacteria, fungi or viruses affecting any of the three separate layers of skin.

Bacterial skin infections

Generally, thousands of bacterial species live on the skin without entering. These bacteria create colonies on the skin and are considered as regular and healthy, but over exposing the skin to pollution, natural trauma, pre-existing skin illnesses, and poor hygiene, can result in the bacteria entering deeper layers of the skin and cause infections.

Different types of bacterial skin infections and treatment

Boils are bacterial infection of hair follicles, which results in painful swollen area on the skin caused by an accumulation of pus and dead tissue. Cluster of boils together is called carbuncle.

Carbuncles are large, painful, round bumps under the skin, which are filled with pus. They mostly occur on the neck, face and buttocks. They collect pus around the hair of the infected area. Fever may occur when infection is deep. These may be treated with warm compresses to promote natural drainage of pus, as well as with antibiotic cream and tablets.

Cellulitis is characterised by redness, warmth, swelling and tenderness. They mostly occur on the legs and arms. It occurs when bacteria enter through cracks in skin like abrasions, cuts, burns, insect bites, etc.

Fungal skin infections

Fungi can cause many kinds of skin infections on almost any part of the skin. Some typical skin infections caused by fungi are athlete’s foot, jock itch, and yeast infections. Typical symptoms include constant itching sensation, flaking of the skin, and eruptions on the skin. Without proper care they can become extremely hard to clear up.

Another very common fungal illness is ringworm, which cause typical enlarging raised red rings over body.  Ringworm usually infects the region of the groin where it is slightly wet, though it can infect almost all parts of the body.

Treatment for skin infections

There are many different skin infections, which can vary from mild to severe. Most of the infections are treated by locally applying anti-microbial creams but when infections are deep then medicines are also given.

Preventing skin infections

• Personal hygiene is very important, take a bath regularly and do not share towels.
• Wear loose fitting clothes to allow your skin to breathe.
• Cover and treat any trauma to the skin, including, cuts, scrapes, burns, new tattoo etc..
• Do not touch any infection. Wash your hands immediately if you do touch an infection.
• Fungi like to live in damp and dark places. So keep your room light and dry to prevent fungi settlements.
• Avoid sharing clothing, sports equipment, towels, or sheets to prevent infection.
• Eat healthy food, as diet can play a huge role in keeping your skin healthy.

Photograph via sxc.hu

You may also like:

• Treating stressed-out skin
• Skin cancer: Squamous-cell carcinoma
• Erysipelas, a skin infection

Skin Infection: Causes, treatment and prevention is a post from: mDhil

What are breathing-related sleep disorders?

Marked by sleep disruption, breathing-related sleep disorders result in excessive sleepiness or insomnia due to abnormal breathing during sleep.

Types of breathing-related sleep disorders

1. Obstructive sleep apnoea syndrome

The most common type of breathing-related sleep disorder, it is characterised by abnormal pauses in breathing or instances of abnormally low breathing during sleep. Most patients with this disorder are overweight and their symptoms often grow worse as the weight increases. In patients who are not overweight narrow breathing passages cause this problem.

Symptoms of obstructive sleep apnoea syndrome:

• Frequent episodes of upper-airway obstruction during sleep.
• Patients alternate between loud snores and silent periods.

2. Central sleep apnoea syndrome

It is characterised by episodes of airway blockade or stoppage of breathing during sleep because of cardiac or neurological conditions affecting airflow regulation. It mostly occurs in elderly patients.

Symptoms of central sleep apnoea syndrome:

• Patients experience periods when the lungs temporarily stop giving oxygen to blood, but do not suffer any obstruction.
• Patients may have mild snores during sleep.

3. Central alveolar hypoventilation syndrome

It is a condition where some brain disorders affect breathing, which leads to decreased exchange of oxygen in blood during breathing. It is a rare condition which may be present at birth, or may develop due to severe damage to the brainstem. It is common in people who are overweight.

Symptoms of central alveolar hypoventilation syndrome:

• Drowsiness
• Fatigue
• Headaches
• Inability to sleep at night
• Respiratory arrest during sleep
• Shallow breathing often occurs when people are awake

Diagnosing breathing-related sleep disorder

A diagnosis of breathing-related sleep disorder usually requires:

• Thorough physical examination of the upper respiratory tract of the patient by specialist doctor
• Followed by observation of the patient in a sleep clinic where breathing patterns are recorded by an instrument called polysomnogram
• Interviews are also conducted with the patient and his or her partner

Treatment for breathing-related disorders

General treatment measures for breathing-related sleep disorders include:

• Weight loss is a key to effective treatment of breathing-related sleep disorders in overweight people. Weight loss is often considered the first step in treating any disorder involving sleep apnoea. Increased exercise and reduced-calorie diets are the most important components of an effective weight loss regimen.
• Respiratory stimulants and depression medication (in case of depression or anxiety) are usually prescribed for patients suffering from breathing-related sleep disorders.
• Surgery is increasingly preferred by many patients. It includes procedures to   increase upper-airway size, to bypass upper airway, and surgery to aid weight loss.

Other treatments for breathing-related disorder:

• Behaviour  modification aimed at improving sleep hygiene
• Avoidance of ethanol and sedative medicines
• Use of a dental appliance
• Avoid lying flat on back during sleep
• Successful treatment of other conditions, such as obesity, cardiac or neurological conditions in the elderly or enlarged tonsils in children

Preventing breathing-related sleep disorders

• Effective weight management
• Good general health
• Treatment of related physiological conditions

Photograph via sxc.hu

You may also like:

• Does alcohol help you sleep better? 
• Are you sleeping enough?
• Sleepwalking

Breathing-related sleep disorder is a post from: mDhil

Also read: Cleft lip — Time To Raise an alarm

What is a cleft palate?

A cleft palate is a split or opening in the roof of the mouth. It can involve the hard palate (the bony front portion of the roof of the mouth), and/or the soft palate (the soft back portion of the roof of the mouth).

Causes and incidence of cleft palate

Combined cleft lip and palate is the most common presentation (50%), followed by isolated cleft palate (30%).

Children with a positive family history of cleft palate, exposure in early pregnancy to cigarette smoke, alcohol or illicit drugs and malnutrition are more likely to have cleft palate. Cleft palate can be associated with syndromes too.

Problems associated with cleft palate and suggested lifestyle modifications

Feeding difficulties: Infants with a cleft palate have feeding difficulties. Using a special cleft feeding equipment, and altering the rate and method of feeding will thus be of help. With regard to positioning, a semi upright or upright position is best while feeding babies with a cleft palate.

Ear infections/hearing loss: Kids with a cleft palate are prone to ear infections and hearing loss. Ensure regular hearing checkups. Special tubess placed in the eardrums to aid fluid drainage may be required.

Dental problems: Crooked, poorly shaped or missing teeth and deformities of the upper jaw are seen in kids with cleft palate. Regular dental checkups are a must to monitor development of face and teeth.

Frequent burping:  It may be beneficial to give the baby smaller feeds, as babies tend to take in a lot of air with sucking.

Airway obstruction: Airway obstruction is another problem associated with kids who have a cleft palate. This can be avoided by placing the child in a prone position to prevent prolapse of the tongue.

Speech problems: Special appliances are fabricated to help close the nose from the mouth so that speech sounds more normal.

Treatment for cleft palate

• Children with a cleft palate may need to wear a man-made palate to help them eat properly and ensure that they are receiving adequate nutrition until surgical treatment is provided.
• Surgery is typically carried out when between 9 to 12 months of age. Various procedures may be used to close the separation and rebuild the hard and soft palate (roof of the mouth). The repair is then stitched and closed, usually along the mid-line of the roof of the mouth.
• A bone graft may also be needed, to fill in the upper gum line so that it can support permanent teeth. Multiple surgeries are often required over the course of 18 years. The whole treatment needs multiple specialists during the developmental phase.
• Currently, optimising treatment and surgical repair programmes to rehabilitate patients in an integrated manner and prepare them for normal social life, free from prejudice and discrimination, is an important objective, to address ‘the ignored problem’!

Photograph via sxc.hu

You may also like:

• Club Foot – Congenital Talipes Equinovarus (CTEV)
• Turner Syndorme
• Intellectual Disability

An introduction to cleft palate is a post from: mDhil

What are thyroid disorders?

It’s safe to say that you probably know someone or have heard of someone who’s suffering from a thyroid disorder. And chances are, that person is probably female. After all, women are 4 times more prone to thyroid disorders than men.

Thyroid disorders are amongst the most baffling disorders faced by the medical community. These autoimmune diseases have no real known cause and while doctors see some link between them and diabetes, the sudden rise in incidence has got them worried.

Meet the thyroid gland

The thyroid gland is a very vital part of the human body. It is found below the neck and below the thyroid cartilage (popularly referred to as the Adam’s apple). The thyroid is one of the larger glands in the human endocrine system and is invaluable for the proper functioning of the human body. Its primary role is to secrete thyroid hormones that regulate production of other hormones and also affect the growth and metabolism of many other systems in the human body. The thyroid controls the body’s metabolism, use and generation of energy and sensitivity to other hormones.

The thyroid’s function is in turn controlled by a hormone secreted by the pituitary gland called the Thyroid Stimulating Hormone (TSH). Additionally, the hypothalamus in the brain releases a hormone called Thyrotropin Hormone (TRH) that also controls the thyroid.

 Thyroid Disorders

The two most common disorders associated with the thyroid are hypothyroidism and hyperthyroidism. An under active thyroid condition is termed ‘Hypothyroidism’ and an over active thyroid is called ‘Hyperthyroidism’.

Other than these, an enlargement of the thyroid is caused by iodine deficiency is called goitre. This could happen in cases of hypothyroidism, hyperthyroidism or even cancerous thyroid nodules. Though thyroid nodules are common, about 5% of these are cancerous.

Thyroid disorders not only leave a person feeling exhausted and weak, but if untreated, they can also cause infertility and miscarriages amongst women.

Signs and symptoms of thyroid disorder

Symptoms of Hypothyroidism

Hypothyroidism in infants manifests itself by lowered growth rate, constipation, inadequate feeding, excessive tiredness and jaundice (yellowing of eyes and skin).

In children and adults, fatigue and poor performance at work and school are also signs of hypothyroidism.

Early symptoms in adults include:

• Exhaustion
• Constipation
• Intolerance to lower temperatures
• Wrist pains
• Numbness of hands.

At later stages, the symptoms become more pronounced:

• Fatigue or lack of energy
• Weight gain despite poor appetite
• Hair loss
• Skin dryness
• Puffiness around eyes
• Hoarsening of voice
• Worsened intellectual ability
• In females, irregular or missed menstrual cycles are a sign of hypothyroidism

Symptoms of Hyperthyroidism

Hyperthyroidism is identified by a declining performance at work or school and or behavioral concerns.

Symptoms among adults include:

• Nervousness
• Hand tremors
• Insomnia
• Frequent bowel movements
• Excessive sweating
• Weight loss in spite of large appetite
• Joint pains
• Bulging eyes
• Females may experience lowered or a complete stop of menstrual activity

Amongst the older population, worsening chest pains, shortness of breath and weakening of shoulder and thigh muscles are indications of hyperthyroidism.

Both conditions exhibit a range of symptoms and often symptoms like tiredness and fatigue are attributed to a person’s lifestyle without suspecting a medical root.  A medical diagnosis is recommended to ensure proper treatment of any thyroid disorder.

Read about diagnosing and treating thyroid disorders

Photograph by Liskina Nora, via sxc.hu

You may also like:

• Thyroid disorders – Diagnosis and Treatment
• Lesser known thyroid diseases
• A complete explanation of a well-woman check up

Thyroid Disorders – Signs and Symptoms is a post from: mDhil

A high-fat diet can put you at risk of colon cancer

What is colon cancer? 

Cancer of the large intestine or rectum is referred to as colon cancer.

Causes of colon cancer

The following put one at a higher risk of colon cancer:

• Above 60 years of age.
• High-fat diet and red meat.
• H/O Colorectal polyps
• Individuals suffering from inflammatory bowel disease
• Presence of family history of colon cancer.
• Genetic syndrome like familial adenomatous polyposis and hereditary non-polyposis colorectal carcinoma are also associated with high risk of colon cancer.
• Cigarette smoking and alcohol.
• Obesity and lack of physical exercise are also risk factors for the development of colon cancer.

Symptoms of colon cancer

Common symptoms associated with colon cancer are:

• Pain and tenderness in lower abdomen.
• Blood in stool.
• Change in bowel habit like diarrhea and constipation.
• Weight loss without any reason.
• Fever.
• Nausea and vomiting.

Stages of colon cancer

Stage 0: Early cancer on the innermost layer of intestines

Stage 1: Cancer is in the inner layer of the colon.

Stage 2: Cancer has spread through the muscle wall of the colon

Stage 3: Lymph nodes affected by cancer

Stage 4: Other organs affected by cancer

Diagnosing colon cancer

• Imaging tests like colonoscopy and sigmoidoscopy are important diagnostic measures for colon cancer.
• Blood tests like complete blood count and liver function tests can be done.
• A fecal occult blood test helps detect small amounts of blood in stool.

Treatment for colon cancer

Treatment depends on the stage of cancer, age of individual and presence of other associated risk factors.

1)  Surgery – Surgery to remove cancer cells is an option to treat colon carcinoma. Stage 0 colon cancer is treated by removing cancer cells during colonoscopy. Colon resection, which is removal of a part of the colon that is cancerous is done for stage 1, 2 and 3 of colon cancer.

2) Chemotherapy – Stage 3 colon cancer is treated with chemotherapy for 6-8 months. For improving the survival rate and treating the symptoms, chemotherapy is given for stage 4 cases of colon cancer.

3) Radiation therapy – Radiation therapy along with chemotherapy is given for treating patients with stage 3 colon cancer.

Prognosis for colon cancer 

Good prognosis is seen in early cases of colon cancer. Colon cancer is usually treatable if diagnosed early. Stages 0, 1, 2, 3 are potentially curable. Stage 4 cancer is not curable in most cases.

Complications seen in colon cancer 

• Blockage of colon
• Recurrence of cancer
• Spread of cancer to other body parts

 Colon cancer prevention 

• Individuals in the age group of 50 and above should undergo colon cancer screening.
• Colorectal polyps should be treated adequately and should be removed.
• Changing lifestyle by inclusion of diet rich in whole grains, fruits and vegetables and avoidance of red meat help prevent colon cancer
• Physical activity can moderately reduce the risk of colon cancer.
• Vitamin D intake is associated with low risk of colon cancer.

Photograph via sxc.hu

You may also like:

•  Germ Cell Cancer
• Cancer - arm yourself with knowledge
• Dealing with the psychological trauma of cancer

Colon cancer: Causes, symptoms, treatment and prevention is a post from: mDhil

Also read: Wet Gangrene

Diabetics, keep your blood sugar levels under check to reduce risk of gangrene.

What is dry gangrene?

Dry Gangrene is a condition in which some part of the body, especially fingers and toes decays and turns black in colour due to loss of oxygen supply to that part. It is a dry form of gangrene because the infection causes the affected part to dry without the oozing of any pus or liquid. One also experiences coldness in the affected part.

It mostly occurs in the toes and feet of elderly patients due to hardening of the blood vessels. People with diabetics are at a greater risk of developing dry gangrene.

Causes for dry gangrene

1. Dry gangrene can result from a number of diseases and external injuries that slowly reduce or block blood flow, such as:

• Diabetes
• Arteriosclerosis (hardening of the blood vessels)
• Tobacco addiction
• Various external injuries like burns, accidents, wounds, or surgery
•  Frostbite (exposing fingers and toes to very cold temperature)

2. Dry gangrene can also occur quickly due to rapid blockage in very small blood vessels.

Symptoms of dry gangrene  

• The early signs are  a numb sensation and coldness in the affected area
• The affected area then starts to discolour, it usually turns from reddish to brown and then finally turns into black colour
• Dry gangrene caused by immediate loss of blood supply first turn pale or bluish and then black
• The affected area shrinks and becomes dry
• If not removed surgically, the affected area may eventually fall off from the body, which is termed as auto-amputation.

Treatment for dry gangrene

Dry gangrene is usually treated by surgically removing the dead part, such as a toe, by a doctor. Often, the patient is treated with antibiotics to prevent infection in other parts of the body. Medicines, which prevent blood from clotting, may also be given to reduce chances of blockade of blood vessel due to a blood clot.

Supportive care: Supportive care can consist of surgical wound care and rehabilitation therapy for reuse of the affected finger, toe, arm or leg.

Prevention of dry gangrene

• Avoiding tobacco use and external trauma like frostbite can help prevent gangrene
• Patients with diabetes should keep sugar levels under control and keep notice of their feet for any signs of cuts, infection, or redness
• Patients with diabetic neuropathy (numbness in arms, legs, fingers and toes) should do this daily.
• Any wound or burn should be treated immediately, especially in the case of diabetics.  
• Those who notice coldness and redness of a local area (for example toes, fingers) should immediately visit a doctor. Early diagnosis of any blockage in the blood vessel can prevent dry gangrene.

Photograph via sxc.hu

You may also like:

•  Why smoking and tobacco are never cool
• Hookah Smoking - Dangers you should be aware of
• Diabetes - Recognition and Prevention

Dry Gangrene: Symptoms, treatment and prevention is a post from: mDhil

What is rheumatic fever?

Rheumatic fever is a disease in which there is inflammation (redness, ache, tenderness and swelling) in the heart, joints, skin and brain.

Causes of rheumatic fever

It occurs because of some bacterial infection. Most commonly, rheumatic fever is preceded by a throat infection. The bacterium causes inflammatory response in people, which leads to numerous signs and symptoms. It mostly affects children between 6 to 15 years of age.

Symptoms of rheumatic fever

The symptoms of rheumatic fever generally develop within 2-3 weeks of infection

• Fever
• Heart  problems: shortness of breath and chest pain
• Pain in joints, mainly in the knees, elbows, ankles, and wrists
• Joint swelling, redness or warmth
• Skin nodules
• Skin rash
• Sydenham chorea: muscle weakness and rapid,  uncontrolled,  jerky movements of face, feet, and hands

Diagnosing rheumatic fever

There is no simple diagnostic test for rheumatic fever. Several major and minor criteria have been developed to help doctors to clinically diagnose rheumatic fever.

Major criteria for rheumatic fever

• Polyarthritis:  Inflammation of the large joints
• Inflammation of the heart muscle
• Nodules (small round lump) under the skin mainly on the back of the wrist, the outside elbow, and the front of the knees.
• Erythema marginatum: A long-lasting ring shaped reddish rash which continue to spread and merge with other rings, ultimately taking a snake-like appearance.
• Sydenham’s chorea : This occurs very late, at least 3 months from onset of infection.

 Minor criteria for rheumatic fever:

• High fever
• Joint pain without swelling
• High ESR
• ECG will show a heart blockage
• Other laboratory findings

If a person shows two or more signs from the first list, or two or more signs from the second list, in addition to a history of a streptococcal throat infection are required to confirm rheumatic fever.

Treatment for rheumatic fever

Infection: The first step in treating rheumatic fever is removal of bacteria with antibiotics like penicillin. For penicillin-allergic patients, there are other options such as erythromycin or azithromycin. Rheumatic fever is likely to come back in people who don’t take antibiotics continually, especially during the first 3-5 years after the first episode of the disease.

The pain in the joints is treated with very high doses of aspirin or aspirin-related medication.

Heart inflammation is treated by high-dose steroids, but other cardiac medications may be needed.

In case of Sydenham’s chorea, it often responds to antipsychotic medications such as haloperidol.

Complications seen in rheumatic fever

Heart problems

• Arrhythmias
• Damage to heart valves (a severe complication)
• Endocarditis
• Heart failure
• Pericarditis

Sydenham chorea

It can be the most difficult complication, since it interferes with daily activities. Individuals with this complication may see a recurrence of the disease. A few may require a lifetime treatment of antibiotics.

Photograph via sxc.hu

You may also like:

• Typhoid Fever – Causes, Symptoms, Treatment and Prevention
• Viral respiratory infections 
• Dengue – Spread and Signs & Symptoms

Rheumatic fever: Causes, symptoms, diagnosis and treatment is a post from: mDhil

Long-term smoking can put you at risk of wet gangrene.

What is wet gangrene?

Wet gangrene is a condition in which there is decay in some part of the body, due to reduced blood supply to that part. Wet gangrene mostly occurs in wet parts of the body like mouth, lungs, intestine and outer openings of sex organs (cervix and vulva). It is a very serious condition often associated with diabetes and long-term smoking.

Causes of wet gangrene

It is caused by bacterial infection in a part of the body where blood supply is blocked due to an illness or injury. This bacterial infection kills the tissues in that part, which turn into thick liquid mass.

The bacteria grow very fast and produce toxic products that enter the blood stream (sepsis), which leads to death within a few hours or days.

Symptoms of wet gangrene

• Initial redness and then signs of decay (rotten tissue, pus, local oozing of fluid)
• Swelling and pain in infected area
• A very bad smell from the infected area
• A moist and black appearance of the infected area
• Fever

When an internal organ becomes infected (internal gangrene) typically the initial symptoms are few but the patient may be very ill. Sometimes the skin above the infected part may become reddish or faded, and the area may become swollen and painful.

Treatment for wet gangrene

Wet gangrene is a medical emergency, and requires immediate attention.

Debridement: Surgical removal of the dead and dying tissue is the immediate treatment. Sometimes infected arm or leg needs to be cut off (amputation). Such patients with amputation require rehabilitation therapy.

Treatment with antibiotics (usually a combination of two or more antibiotics) will need to be taken. Antibiotics alone are not effective because they do not enter infected muscles sufficiently.

Hyperbaric oxygen: Oxygen is given under pressure to the patient inside a chamber, this improves the oxygen supply to the affected area, which can, therefore, help stop or even kill the bacteria present there. This therapy can be used along with above methods.

Supportive care: Internal gangrene requires an operation in the hospital to remove the infected part. Some patients develop sepsis and require the support of an intensive-care unit for other serious problems such as low blood pressure.

Prevention of wet gangrene

• Avoiding tobacco use and external trauma like frostbite (exposing fingers and toes to very cold temperature) can help prevent gangrene
•  Patients with diabetes should keep the sugar levels under control and check their feet regularly for any signs of cuts, infection, or redness.
• Patients with diabetic neuropathy (numbness in arms, legs, fingers and toes) should do this daily.
• Any wound or burn should be treated immediately, especially in the case of diabetics and people with a weak immune system

Photograph via sxc.hu

You may also like:

•  Why smoking and tobacco are never cool
• Hookah Smoking - Dangers you should be aware of
•  Inflammatory Bowel Disease (IBD) 

Wet gangrene: Causes, symptoms, treatment and prevention is a post from: mDhil

Good dental hygiene can keep this infection at bay!

What is actinomycosis?

Actinomycosis is an infectious bacterial disease caused by bacteria of the actinomyces species. It rarely occurs in humans.

Causes of actinomycosis

•  This is caused by bacteria of actinomyces species.
• Conditions predisposing the person to development of actinomyces are recent dental work, poor oral hygiene, periodontal disease, radiation therapy causing local tissue damage to the oral mucosa.
• Abdominal actinomycosis occurs following removal of appendix.

The three most common sites of infection are decayed teeth, lungs and intestines.

Infection is also seen in certain women who had an intra-uterine device to prevent pregnancy.

Signs and symptoms of actinomycosis:

This disease is characterised by the formation of painful abscesses in the mouth, lungs and gastro-intestinal tract. In severe cases, abscess may grow larger and penetrate the surrounding bone and muscle to the skin where they break open and leak large amount of pus.

Cervicofacial actinomycosis is the most common type of infection, comprising 50-70% of the reported cases. This infection typically occurs after oral surgery or in patients with poor dental hygiene. It is characterised by the presence of soft tissue swelling of the perimandibular area.

Thoracic actinomycosis occurs from the introduction of organisms via esophageal perforation. And the condition commonly presents as pulmonary infiltrate or mass which if not treated, can spread to involve pleura, pericardium and chest wall. Symptoms can include dry or productive cough, occasionally blood streaked sputum, shortness of breath, chest pain.

Actinomycosis of abdomen and pelvis occurs in patients with recent or remote bowel surgery or ingestion of foreign bodies. Here, the ileocaecal region (situated at the junction between the large and small intestine) is affected most frequently and the disease, typically presents as a slow-growing tumour. Non specific symptoms can be low-grade fever, weight loss, fatigue, change in bowel habits, vague abdominal discomfort, nausea, vomiting.

Diagnosing actinomycosis

Culture of the tissue or fluid will show the presence of the actinomyces species.

Examination of the drained fluid under a microscope shows “sulfur granules” in the fluid. They are yellowish granules made of clumped organisms.

CBC count shows anaemia and lekocytosis. ESR and C reactive protein levels are usually elevated. Alkaline phophatase levels are usually elevated in hepatic actinomycosis.

Treatment for actinomycosis:

• Penicillin is the drug of choice in the case of actinomycosis. Antibiotic therapy is required for several months to a year.
• Surgical drainage or removal of the lesion may be needed. If the condition is related to an IUD, the device must be removed.

 Prognosis for actinomycosis

Prognosis is good with treatment and person recovers completely.

Advanced and complicated actinomycosis cases require aggressive antibiotic and surgical therapy for optimal outcome; however, deaths can occur despite such therapy.

Complications seen in actinomycosis 

• Osteomyelitis of the mandible, ribs and vertebrae.
• CNS disease, including brain abscess; chronic meningitis.
• Endocarditins
• Hepatic actinomycosis
• Disseminated actinomycosis

 Preventing actinomycosis

Good oral hygiene and regular dental visits may help prevent some form of actinomycosis.

Photograph via sxc.hu

You may also like:

• Aesthetic dentistry – the science of designing the perfect smile 
• Dental health: A dentist’s tips for a healthy mouth
• The Dos and Don’ts of Taking Antibiotics

Actinomycosis is a post from: mDhil

Timely vaccination can prevent the deadly tetanus infection.

What is tetanus?

Tetanus is the infection of the nervous system caused by the deadly bacterium, Clostridium tetani. It is also called as lockjaw.

Neonatal tetanus is a type of generalised tetanus, occurring in newborns. It usually occurs through infection of the unhealed umbilical stump. Infants who have not acquired passive immunity because the mother has never been immunised are at risk of developing this type of tetanus.

Causes of tetanus

Spores of Clostridium tetani remain in the soil and are inactive, but have the potential to cause infection for about 40 years.

Infection begins when spores enter the body through injury or wound. The spores release bacteria that spread and make a poison called tetanospasmin. This poison blocks nerve signals from the spinal cord to the muscles, causing severe muscle spasms. The spasms can be so powerful that they tear the muscle or cause fracture of the spine.

The time between the infection and first appearance of the symptoms is approximately 7 to 21 days.

Symptoms of tetanus

Tetanus begins with mild spasms in the jaw muscles known as lockjaw. The spasm can also affect the chest, back, neck and abdominal muscles.

Generalised tetanus can affect all skeletal muscles. Local tetanus affects the muscles at or near the wound. Cephalic tetanus affects one or several muscles in the face rapidly after a head injury or ear infection.

Sometimes spasm can affect the muscles related to respiration, leading to breathing problem.

Prolonged muscular action can cause sudden, powerful and painful contractions of muscle groups. This is known as tetany. These episodes can cause fracture or muscle tear.

Other symptoms of tetanus include:

• Saliva dripping from the mouth
• Excessive sweating
• Fever
• Hand or foot spasms
• Irritability
• Difficulty in swallowing and
• Uncontrolled urination or defecation

Diagnosing tetanus

No specific lab test can be performed. Doctor can do a physical examination and can ask medical history like incomplete tetanus immunisation.

Treatment for tetanus

• Antibiotics like penicillin can be given
• Bed-rest in dim light, reduced noise and stable temperature are advised.
• Tetanus immunoglobulin should be given
• Muscle relaxant like diazepam should be given.
• Sedatives
• Surgery to clean the wound and remove the source of poison.
• Breathing support with breathing tube and oxygen if symptoms are there.

Prognosis for a tetanus infection

Untreated cases have a poor prognosis. Death rate is high in the case of newborn infants with untreated tetanus.

Wounds on head and face have a poor prognosis than wounds on other parts of body. Uncorrected episodes of hypoxia caused by muscle spasm in the throat may lead to irreversible brain damage.

Complications seen in tetanus infection

• Airway obstruction
• Respiratory arrest
• Heart failure
• Pneumonia
• Fractures
• Brain damage due to lack of oxygen during spasms.

Preventing tetanus

Tetanus is completely preventable by active tetanus immunisation. Immunisation provides protection for 10 years. If it’s your first tetanus shot, then you must take it within 24 hours of injury. In case of a booster dose, take a tetanus shot within 48 hours after injury.

Thorough cleaning of all injuries and wounds and the removal of dead or severely injured tissue may reduce the risk of developing tetanus.

Photograph via sxc.hu

You may also like:

Tetanus: Causes, symptoms, treatment and prevention is a post from: mDhil

A film tackles vitiligo 

The Marathi film, “Nital,” was a sincere attempt to portray the inner turmoil in the life of those with vitiligo and those who have to deal with vitiligo-affected individuals. Literally, the word Nital means crystal clear and transparent, which reflects the inner beauty of an individual irrespective of color of skin.

The film, directed by Sumitra Bhave and Sunil Sukthankar, and produced by Dr. Maya Tulpule (who has vitiligo herself) takes a hard-hitting look at the attitude of society towards people having leukoderma and vitiligo at large. The movie has won many accolades and has bagged the prestigious “V Shantaram Award” in nine different categories.

The main protagonist of the movie, Dr Neeraja, a confident ophthalmic surgeon played by Devika Daftardar, was living with vitiligo since early childhood and was working in the city of Bangalore. Since childhood, she had gone through inner turmoil and had been discriminated by the society. Her own family prohibited her from attending her elder sister’s marriage ceremony as she was considered ‘inauspicious’ for the newlywed couple and also because a sister who has vitiligo might not be acceptable to the groom’s family. Ultimately, she comes to term with herself and accepts the skin blemishes as a part of her individuality. However, society was not so kind and humane to her and she was made to suffer humiliation at every front of life. In spite of her good surgical skills, an ill-informed father of a patient prohibits Dr. Neeraja from operating on his daughter’s eye, though the alternative is to risk his daughter losing vision.

Her friend and colleague Dr. Ananya, played by real-life Dr Shekhar Kulkarni, works with her as an anaesthetist in the same hospital. Both develop affection and mutual respect for each other at the work place. Neeraja visits Dr Ananya’s elite and high-class family, where every member of the family is well educated and well placed in society. The family is taken aback at the possibility of Neeraja becoming their family member as Ananya’s wife. In the movie, Neeraja’s interaction with every member of the family is emotional and has been picturised in an exquisitely nuanced manner. Neeraja’s narration about her experience and humiliation due to the skin blemishes to the youngsters of the family is heart-rending and brings a lump in the throat. The unbiased acceptance of Neeraja by the youngsters of Ananya’s family is heartwarming. Ananya is on the horns of a dilemma swinging pendulously between the stereotypical preferences of the family and his own sensibility. However, at the end Ananya is able to release himself from the shackles of orthodox societal thinking and decides to make her his life partner driven sheerly by Neeraja’s confidence about herself.

Living with vitiligo in the real world

However, the picture is not so rosy for millions of individuals living with vitiligo who are psychologically depressed and suffer from humiliation and social stigmatisation. Many studies have repeatedly proven that vitiligo patients suffer from various psychological disorders like depression and domain-like function, emotion etc. and have low quality of life indices. Youngsters are more likely to have clinical depression and face criticism and nasty comments from peers.

Dealing with the social stigma attached to vitiligo

The visual media is a powerful tool to create awareness among general masses. Dermatologists from Maharashtra, and especially those catering to predominantly rural areas, should screen this film in their waiting lobby at least once a week to create awareness among the general population and dispel the common misbeliefs and misunderstanding about vitiligo.

The film should be dubbed in other regional languages and in Hindi to disseminate the message in the film and reduce the stigma behind this condition. Dermatologists, being in an advantageous position to understand the science and emotions behind this condition, should contribute their mite in this effort by forming a vitiligo support group in their city. The Indian Association of Dermatologists, Venereologists, Leprologists (IADVL) has already taken a lead role in this effort by marking 19 ^th May as “Vitiligo Day,” thereby stimulating and channelizing efforts in this direction. The IADVL, an apex body of Dermatologists in the country, is probably well placed to show solidarity behind the vitiligo-affected persons by financing or arranging finance through well wishers and pharmaceutical industry for such activities.

Written by Dr Bhushan Madke

This article was first published in ijdvl.com - Madke B, Nayak C, Khopkar U. Beauty lies in the eyes of the beholder. Indian J Dermatol Venereol Leprol 2012;78:409-10.

Image via commons.wikipedia.org

You may also like:

• Vitiligo: an innocent disorder, not a disease
• Dr Juvita Rasquinha answers basic questions on skincare
• Five habits of people with “lucky” skin

Vitiligo – The Emotional Impact is a post from: mDhil

Leg is a common site of infection.

What is Erysipelas?

Erysipelas is a type of skin infection caused by group A streptococcus bacteria. This condition affects both children and adults. Historically face was affected in most of the cases but these days legs are the common site of infection in 80% of cases.

Causes of erysipelas:

Most cases of erysipelas are due to streptococcus pyogenes. The rash is due to an exotoxin (a toxin secreted by microorganisms).

Erysipelas infection can enter the skin through minor trauma, insect bites, dog bites, eczema, surgical incisions and often originate from streptococcal bacteria in person’s own nasal passages.

Erysipelas does not affect the subcutaneous tissue (third layer of the skin).

The following can put one at risk of erysipelas infection:

• A cut in the skin
• Diabetes Mellitus
• Immune deficiency
• Alcoholism
• Skin ulceration and fungal infection
• Problems with drainage through the veins or lymph system
• Skin sores

Symptoms of erysipelas:

• Blisters
• Fever with shaking chills
• Painful, red, swollen and warm skin underneath the lesion
• Erythematous skin lesions with a raised border.
• Sores on the cheeks and bridge of the nose.
• Swollen lymph nodes and lymphedema may occur.
• More severe infection can lead to vesicles, bullae and petechiae with possible skin necrosis.

Diagnosing erysipelas

Diagnosis is usually based on the appearance of the skin with well demarcated rash inflammation, and skin biopsy is not required.

Elevation of the antistreptolysin titre (a blood test used to measure antibodies) occurs after around 10 days of illness.

MRI and bone scintigraphy (a diagnostic technique in which a two-dimensional picture of internal body tissue is produced through the detection of radiation) are helpful when early osteoarticular (involving or affecting bones) involvement is suspected.

Treatment for erysipelas

Antibiotics, such as penicillin, erythromycin is used to treat infection. Those who have repeated episodes of erysipelas may require long-term antibiotics. Hospitalisation for close monitoring and intravenous antibiotics are recommended in severe cases, in infants, elderly people and patients who have an  immunodeficiency.

Elevation and rest of the affected limb are recommended in erysipelas treatment to reduce local swelling, inflammation and pain. Patients with acute infection involving extremities should be encouraged to limit their activity.

Saline wet dressings should be applied to ulcerated and necrotic lesions and changed every 2-12 hours, depending on the severity of infection.

Debridement (medical removal dead, damaged and infected tissue to improve the healing potential of the remaining healthy tissue) is necessary only in severe infections with necrosis and gangrene.

Prognosis of erysipelas

Prognosis for patients is excellent. With continuous treatment most of the cases become normal in a few weeks. Complications are not life threatening. However, local recurrence has been reported in up to 20% of cases with predisposing conditions.

Complications seen in erysipelas

• In some cases bacteria may travel to the blood and result in a condition called bacteremia. The infection may travel to heart valves, leading to infective endocarditis (inflammation of the inside of the lining of the heart chambers).
• Other complications can include return of infection and septic shock.
• Necrotising fascitis commonly known as flesh-eating disease or flesh-eating bacteria syndrome.

Prevention of erysipelas

Skin should be kept healthy. Dry skin and cuts and scrapes should be avoided.

Photograph via sxc.hu

You may also like:

• Dermoid cysts: Causes, symptoms and treatment
• How to stop biting your nails
• Basic questions on skincare answered

Erysipelas, a skin infection is a post from: mDhil

Dementia diagnosis

A thorough history from the patient and family as well as a mental status examination will point towards the correct diagnosis. A thorough general and neurological examination must be done to exclude other possible causes. A personal history should include past or present history of substance or alcohol abuse.

The diagnosis is made by the physician after tests for other possible diagnosis are negative. There is no single test to identify dementia. The doctor may conduct simple memory tests for recent, short-term or long-term memory.

Tests to detect dementia

Routine blood and urine tests as well as blood tests to detect thyroid function and infection should be done. Imaging tests like CT scan or MRI of the brain may be advised if hydrocephalus or a tumour is suspected. An EEG may be necessary to see electrical activity of the brain.

Treatment of dementia

The treatment of dementia involves a multi-pronged approach with the general physician, psychiatrist and care-giver working in close proximity.

• Drug therapy is important to slow or arrest the process of dementia although it cannot be stopped. If other conditions like depression or anxiety occur, anti-depressants or anti-anxiety medication can be prescribed. Anti-psychotics must be prescribed with caution as they may cause delirium in a person with dementia.
• Cholinesterase inhibitors are used primarily in Alzheimer’s to maintain the mental function but they can be tried in other types of dementia too. These drugs include donepezil, rivastigmine and galantamine. Rivastigmine has side-effects like nausea and vomiting but the other two are free from side-effects.
• Lifestyle changes like quitting smoking, doing regular exercise and having a diet rich in fruits and vegetables is important; the latter provides anti-oxidants which can boost memory and brainpower.

Precautions to be taken by family and friends of a dementia patient

• Small changes around the house like putting important phone numbers prominently and putting handrails in the bathrooms are important for an elderly person suffering from dementia.
• Family should be well informed about this condition as the patient requires utmost patience, love and care from near and dear ones. It should be explained that dementia does not just go away instead taking small steps like doing the crossword, playing board games or playing scrabble and sudoku can help keep the brain fit and memory intact.
• Counsel ling the family is important especially in cases where the dementia is not reversible like in Alzheimer’s. It is important for the family to come to terms with the present rather than remembering what the person was like in the past.
• Before dementia progresses to advanced stages the affected person should be encouraged to make a will in case if applicable.
• The primary care-giver may also be stressed out and some families make a choice to move the person to a nursing home where care is available 24/7. This is especially in later stages when the person needs help to dress and feed himself and cannot be left unsupervised.

Written by Dr Nisreen Nakhoda

Photograph via sxc.hu

You may also like:

• Dementia: Causes and symptoms
• Introduction to amnesia
• Multiple personality disorder

Dementia: Diagnosis and treatment is a post from: mDhil

Q. My brother has some small tumours in his body. He is 24yrs old and has been suffering from this condition for past one year. The tumors are in his forearm, back and legs. Sometimes he feels pain.  They have been growing in nature and we’re worried they might be cancerous. We have seen a dermatologist but he told us that they are tumors due to excess fat.Please advice.

Anitha

A. I got your problem, these skin tumors can arise from any of the cell of the skin. These small tumors can also arise from fat cells known as lipomas, which are not cancerous and act in a benign way. However,  just looking at the tumors one cannot comment whether they are cancerous or not. The only  sure way of knowing it would be a surgical excision and reporting by an expert dermatopathologist. Ask your dermatologist to do a biopsy and send it to a pathologist.

Write into webinfo@mdhil.com with your fitness related queries

Photograph via sxc.hu

Dermatology Q&A: Are all tumours cancerous? is a post from: mDhil

What is dementia?

Dementia is defined as the loss of brain function in terms of memory, thinking, judgement and behaviour to such a degree that it interferes with a person’s day-to-day functioning. Dementia is also termed as mild cognitive impairment (MCI) and chronic brain syndrome.

Dementia can be reversible or non-reversible in nature. Reversible dementia is mostly due to alcohol or substance abuse and combinations of prescription medicines for other conditions. Severe depression also causes what is called as pseudo-dementia or false dementia. However, true dementia cannot be cured in a majority of cases.

 Causes of dementia

• Alzheimer’s is the most common cause of dementia. Alzheimer’s disease is the cause of 50-60% of all dementia cases. It is a degenerative condition of the brain. Other degenerative conditions like Parkinson’s disease and Huntington’s disease also lead to dementia.
• Dementia is a late-life disease as it occurs mostly in elderly people above 65 years. It is estimated that 5-8% of the elderly population suffers from varying degrees of dementia. After 80 years of age, the frequency of dementia is more.
• Strokes result in a condition called multi-infarct dementia.
• Nutritional deficiencies like folate or vitamin B12 deficiency can cause dementia.
• AIDS dementia complex is a recognized entity due to spread of HIV infection.
• Hydrocephalus, in which fluid accumulates within the brain secondary to infection or tumours is another reason for dementia occurring.
• Illnesses affecting other organs like lung, liver and kidney may sometimes result in dementia.
• Toxic reactions due to alcohol or drug abuse can cause dementia which is reversible once the person is better.
• Head injury is a significant cause of dementia.
• Hypothyroidism and hypoglycemia (low blood sugar) have the potential to cause dementia.
• Creutzfeldt-Jakob disease is a progressive and fatal condition which causes muscle spasms and dementia.

Symptoms of dementia

• Dementia affects the parts of the brain linked to memory, reasoning, judgement and language. Loss of memory may be gradual for e.g. if a series of small strokes occur or may be sudden for e.g. when a single large stroke occurs.
• The afflicted person may become agitated and may deny that he has memory loss and may blame others for his illness. If the person is aware that he is suffering from dementia, he may become withdrawn, depressed and lonely as he feels that he does not fit in with family, friends and society anymore. The person may show changes of mood, personality and behaviour. He may become angry or child-like and may wander alone and get lost. Severe symptoms may prompt the family to shift him to a nursing home where appropriate care can be given round-the-clock.
• A person having dementia in general has a shorter life-span than a normal person of his age.
• People having a mild loss of memory are said to suffer from mild cognitive impairment or MCI. This may be the start of dementia or the person may stay at this stage for a long period of time.

Written by Dr Nisreen Nakhoda

Photograph via sxc.hu

You may also like:

• Dementia – diagnosis and treatment
• Multiple personality disorder
• Bipolar Disorder: Swinging between depression and mania
  

Dementia: Causes and symptoms is a post from: mDhil

Amnesia refers to the loss of memories, such as facts, information and experiences, which can be a painful situation. Treatment for amnesia principally focuses on techniques and strategies to help make up for the memory problem.

Symptoms of amnesia

• Ability to learn new information is impaired.
• Ability to remember familiar events from the past is impaired.
• Uncoordinated movements like tremors may be present.
• Confusion or disorientation
• Problems with short-term memory
• Partial loss of memory
• Total loss of memory
• Failure to recognise faces
• Inability to recognise places

Diagnosing amnesia

While examining the patient, the doctor must try to rule out possible causes of amnesia like dementia, Alzheimer’s disease, depression or a brain tumour.

The patient’s complete medical history will be required to diagnose accurately. Make sure you that these points are covered while taking the history

a)      When did the memory problem started

b)      How it is being evolved

c)      Any family history of neurological or psychological disorders

d)     Any medications the patient is taking

e)      Details of alcohol consumption

f)       Any history of depression

g)      Any history of cancer

h)      Any history of drug abuse

i)        Is there any other neurological symptom like seizures, accompanying the memory loss

j)        Patient’s judgement

k)      Long-term and short-term memory should be examined.

A physical examination, which includes checking the patient’s

a)      Reflexes

b)      Sensory functions

c)      Balance

d)     Some other aspects of brain and nervous systems

Investigations conducted to confirm amnesia

• Magnetic imaging resonance scan: This helps in detecting a tumor in the brain.
• Computerised Tomography scan: CT scan is useful in detecting any bleeding from the brain in case of trauma.
• Electroencephalogram: EEG provides an image of the brain while the patient is performing a task that requires thinking. It allows the doctor to detect the location and magnitude of brain activity involved in several types of cognitive functions. Images are created by using electrodes to monitor the amount of electrical activity at different points on the patient’s scalp.
• A blood test can also show the presence of any nutritional deficiency or infection.

Treatment for amnesia

In a majority of the cases, amnesia resolves without any treatment. However, if any physical or mental disorder is present it requires appropriate treatment.

• Psychotherapy may be beneficial for some patients. Family support is crucial in restoring lost memory.
• Currently, no drugs are available to treat amnesia.
• Underlying causes like nutritional deficiency can be treated by providing adequate diet.
• Occupational therapy is useful to learn new information in order to replace what is lost. Memory training for organizing information will be of help to improve understanding of extended conversation.

Possible complications in amnesia

Complications depend on degree and severity of amnesia. Even with mild symptoms, a person can have difficulty in coping with normal life. The patient can experience social, employment and personal problems.

Some individuals never recover lost memories. In sever cases person may require supervision or extended care facility.

Photograph via sxc.hu

You may also like:

• Depression: Signs And Symptoms
• Perils of self medication!
• Alzheimer’s disease

Amnesia: Symptoms, Diagnosis and Treatment is a post from: mDhil

What is amnesia?

Amnesia is a condition in which memory of a person is lost. Memory appears to be stored in different parts of the limbic system of brain, and any condition that interferes with the functioning of this system leads to amnesia.

Types of Amnesia

Anterograde amnesia: This refers to loss of long-term memory and the loss or impairment of the ability to form new memories. A person may find himself forgetting a piece of information, people or events after few minutes as the data is not transferred successfully from their conscious, short-term memory into permanent long-term memory.

Retrograde amnesia: This type of amnesia refers to the loss of pre-existing memories. Initially, the most recent memory of the patient is affected. Degree of memory loss is dependent on the severity of the case. The person may be able to recall new things that occur after the onset of amnesia, but is unable to recall some or all of their life or identity prior to onset. This type of amnesia occurs on a fact memory to a lower degree than it occurs on autobiographical memory, which can be affected over the whole lifespan of the patient by retrograde amnesia.

Post-traumatic amnesia: This type of amnesia usually occurs due to head injury. It is usually transient, but can be permanent in some cases.

Dissociative amnesia: This type of amnesia usually results from a psychological cause.

Childhood amnesia: This is also known as infantile amnesia. Here one has a difficulty in remembering his/her childhood events.

Transient global amnesia: This type of amnesia typically lasts for less than a day and there is often no clear precipitating factor or any other neurological deficit. The hypotheses of the syndrome include transient reduces blood flow, possible seizure or an atypical migraine. Usually there is typical amnesia of events more than a few minutes in the past, though immediate recall is usually preserved.

Blackout phenomenon: This is an anterograde type of amnesia and is caused by excessive short-term alcohol consumption.

Korsakoff’s syndrome: This can result from long term alcoholism or malnutrition.  It is caused by brain damage due to a vitamin B₁ deficiency and will be progressive if alcohol intake and nutrition patterns are not modified.

Prosopamnesia: In this type of amnesia, a person cannot remember faces.

Hysterical amnesia – This is a very rare phenomenon. Here, the patient not only has difficulty recollecting past events but also forgets who he/she is, thus losing his/her identity. This type of amnesia is usually caused by a traumatic event, which the person’s mind is unable to cope with. In most such cases, memory comes back in a few days.

Causes of organic amnesia (physical causes)

• Stroke
• Encephalitis
• Coeliac disease
• Oxygen deprivation like carbon monoxide poisoning
• Some medications like sleeping pills
• Brain tumour
• Seizures

Causes of psychogenic amnesia (psychological causes)

• Victim of a violent crime
• Victim of child abuse
• Sexual abuse
• Being involved in a natural disaster
• Being present during a terrorist attack

You may also like:

• Depression: Signs And Symptoms
• Treating migraines 
• Perils of self medication!

Introduction to Amnesia: Types and Causes is a post from: mDhil

What is defibrillation?

Defibrillation is the process of treating life threatening abnormal rhythms of the heart (cardiac arrhythmias), wherein the pulse is found to be absent. It involves sending electric shocks to the heart through a device called defibrillator, which depolarises a critical part of the heart muscle, terminates the arrhythmia, and restores the normal rhythm of the heart. Defibrillation can be done by either alternate or direct current although direct current defibrillation is mostly preferred. In non-life threatening situations, atrial defibrillation can be used to treat atrial fibrillation or flutter.

Defibrillation procedure 

Defibrillators deliver a brief electric shock to the heart, enabling the heart to regain control and establish a productive heart rhythm. The defibrillator is an electronic device that includes defibrillator paddles and electrocardiogram monitoring.

During external defibrillation, the paddles are placed on the patient’s chest through a conducting gel, ensuring good contact with the skin. During thoracic surgery, sterile internal paddles are applied directly to the heart. No direct contact with the patient is advised. If additional defibrillation is required, the paddles should be maintained in the same position to increase the likelihood of further shocks being effective in stopping the arrhythmia.

Before starting the defibrillation, patient’s pulse and electrocardiogram should be monitored. To treat the possible cause of abnormal heart rhythm medications can be administered. Defibrillation continues until the patient’s condition stabilises or the procedure is ordered to be discontinued.

Earlier, large-sized defibrillators were used in ambulances and hospitals. But these days smaller, lighter, less expensive and easy-to-use defibrillators are available. They are computerised and provide verbal instructions to the operator and deliver shock to patient whose heart is not fibrillating.

Aftercare post defibrillation

After defibrillation vital signs and cardiac status of the patient is monitored with a cardiac monitor. Additional tests are carried out to measure cardiac damage, including electrocardiogram, chest X-ray and cardiac catheterisation.

Risks associated with defibrillation

Anoxia or acidosis is the cause of failure of defibrillation. Most common complications of defibrillation are skin burns from defibrillator paddles. Other risks include abnormal heart rhythms, injury to heart muscles and blood clots.

Sometimes complete defibrillation is not possible when electric current becomes inadequate. Causes of inadequate electric current include low voltage applied, defective electrodes and the manner in which electrodes are applied to the heart.

Precautions to take before defibrillation

If the patient is alert or pulse is present then defibrillation should not be performed as it can lead to cardiac arrest or lethal heart rhythm disturbance. The paddles used in the procedure should not be placed on a woman’s breast or over an internal pacemaker.

Defibrillation treatment outcomes 

Treatment of life threatening arrhythmias through defibrillation is likely to be effective within first 5 minutes, preventing brain injury and death by returning normal rhythm of the heart. Medications are provided to improve cardiac function.

Photograph via sxc.hu

You may also like:

• Medical Procedures – Bypass Surgery
• Knee replacement surgery – About, Risks, Post-Operative Care
• A complete explanation of a well-woman check up

An Introduction to Defibrillation: Procedure, aftercare and risks is a post from: mDhil

What is cyst?

Cyst is defined as “a collection of fluid in a sac lined by epithelium or endothelium”.  Simply put, it is a small bag filled with fluid in the skin of the body. The cyst can be a “true cyst” as well as “false cyst”.True cyst is lined by a layer of cells (epithelium or endothelium) while a false cyst is just the collection of fluid as a result of exudation or degeneration, and it is not lined by epithelium or endothelium. Moreover, true cyst may be lined by connective tissue with tiny blood vessels running in it (granulation tissue). It usually evolves because of underlying infection.

How and where does a dermoid cyst develop?

Dermoid cysts are most commonly formed on the patients’ face, in the skull, on the back and sometimes in the ovaries. They occur when skin structures get trapped within skin during the foetal development. They may also contain other skin structures like sweat glands, hair, teeth and nerves.

How does a dermoid cyst present itself?

Dermoid cyst presents as a round, smooth and movable swelling. It yields to the pressure of the finger and does not slip away as in lipoma. It means when one applies a pressure to the swelling of dermoid cyst, the finger creates a dip in the swelling; the finger does not slip over it.

How can one confirm the swelling of dermoid cyst?

• Dermoid swelling gives positive fluctuation test but negative translucency test. It means when one presses the swelling from one side, the pressure is felt on the opposite side of the swelling. Negative translucency test means it does not allow light to pass through it because of the turbidity of the fluid contained in it.
• It is free from the skin and the deeper structures (not fixed to the skin).
• Dermoid cyst in the scalp may be found fully outside the skull bones, outside the skull but attached to the duramater (one of the three protective layers that cover the brain and spinal cord.) through defect in the skull, partially outside the skull and partly inside, connected with a stalk or fully intracranial lying between the skull and the duramater.

How can dermoid cysts be treated?

Treatment of dermoid cysts is surgical excision. After the surgical excision, antibiotics and analgesics (pain-killers) are advised to the patients.

Photograph by rockbadger via Creative Commons

Dermoid cysts: Causes, symptoms and treatment is a post from: mDhil

Q.  I’m suffering from eczema. It appears on my feet and gets worse when it gets hot in my city. Wearing of shoes is also a problem when my feet  become inflamed. My local dermatologist has put me on a protein free diet, but it doesn’t seem to help. Please advice.

Warda

A. It can be eczema, but I would like to know whether discomfort increases after wear shoes. In some cases, footwear can cause allergy and can give rise to eczema. I would ask you to undergo a patch testing with a standard series and foot wear series to know whether you have any allergies.

Write into webinfo@mdhil.com with your fitness related queries

Dermatology Q&A: What should someone do if they are suffering from eczema is a post from: mDhil