Wednesday, April 29, 2009

Nail as a diagnostic tool PART 2

Splinter hemorrhage under the nail may result from trauma,psoriasis,rheumatoid arthritis other collagen vascular diseases and bacterial endocarditis. Bacterial endocarditis is the most common systemic disease associated with splinter hemorrhages. These hemorrhages are more common in subacute variety rather than acute variety.Although splinter hemorrhages in subacute bacterial endocarditis have been described as proximally located,no suitable evidence available to confirm this

Leukonychia. These marks are common, nonuniform, white lines found in differing spots on one or more nails. It should not be confused with Mees line(due to arsenic poisoning)and Muehrcke's line which are parallel to the lanula across the entire nail bed and occur in more than one nail.

Beau's lines. This condition presents as a transverse depressions in the nail that result from trauma, exposure to cold, Raynaud's disease, or any episodic disease condition serious enough to disrupt the normal nail growth

Raynauds phenomenon can lead to thinning and longitudinal ridging of nail plate

Muehrcke's line demonstrates as a transverse white bands parallel to the lanula. These bands usually occur in pairs and extend all the way across the nail.

Half and half nail with a white proximal and red or brown distal half is occasionally seen in patient with chronic renal failure

Whitening of nail plates may be related to hypoalbuminaemia as in cirrhosis of the liver

Nail fold erythema is a useful physical sign in dermatomyositis, systemic sclerosis and SLE

References :

Huchisons clinical method

Davidson’s Principles and practice of medicine

Nail disorder index


Sunday, April 26, 2009

Vaccine for Diabetes ???

Scientists discovered a link between family of viruses and diabetes.A team in Britain found proof that type I diabetes is caused by a virus after they spotted traces of an infection more than 60 % of sufferers.They have claimed that ,they will identify the exact virus involved and subsequently a vaccine to prevent the disease.

Finding:In their study ,the scientist tested the pancreas of 72 young diabetes patients who died of type 1 diabetes over the past 20 years.The findings showed that 60% of cases ,the children’s organ contained evidence of infection by enteroviruses.


Friday, April 24, 2009

Nail as a diagnostic tool PART 1

The appearence of the fingernails and toenails may suggest an underlying systemic disease. Some diseases are very frequently accompagnied with nail problems. Examples of these high frequency nail disease problems are psoriatic arthritis, rheumatioid arthritis, psoriasis, and diabetes. In general nail disorders are frequently observed in cardiovascular diseases,circulatory problems, gastrointestinal diseases, endocrine disorders and viral or bacterial diseases.

In Clubbing, nail itself loses its longitudinal ridges and become convex above downwards as well as side to side.Clubbing occurs in patients with neoplasm of lung and pleura. It may also accompany with other pulmonary diseases like bronchiectasis, lung abscess, empyema, pulmonary fibrosis, and cystic fibrosis.It may also occur in patients with cirrhosis,celiac diseases, congenital heart diseases,arterio-venous malformation or fistulas and endocarditis.

Discoloration of nails may be seen with the effect of certain drugs like antimalarials,antibiotics, and phenothizines.Discolouration and deformity, hypertrophy and abnormal brittleness may result in fungal infection.

Koilonychia are soft, thin brittle and spoon shaped nails commonly seen in iron deficiency anaemia.This abnormality is sometimes a normal nail variant in infants, but it usually corrects itself within the first few years of life.Koilonychia may result from trauma, constant occupational exposure of the hands to petroleum based solvents.In case of spooning of nail without an obvious associated illness, physicians should obtain a complete blood count and ferritin level to rule out iron deficiency and hemochromatosis.

Pitting is caused by defective layering of superficial nailplate.Pitting may be caused by variety of systemic diseases , Reiter's syndrome ,connective tissue disorders, sarcoidosis, pemphigus, and alopecia areata.Moreover any localized growth that distrupts the orderly growth also cause pitting.

Onycholysis occurs by the separation of nail plate from nail bed results in white discoloration of the affected area.Onycholysis may also result from hyperthyroidism(plummer’s nails),warts(periungual warts) ,trauma and onychomycosis.Hyperthyroidism also can cause brown discoloration of nails.

References :

Huchisons clinical method

Davidson’s Principles and practice of medicine

The journal of family practice- Nail disorders and systemic disease: What the nails tell us

Glossary of nail conditions

Thursday, April 23, 2009

happy earth day

Lets make mother earth a better place for our children to live!

Wednesday, April 22, 2009

Quick references to the clinical presentation of cranial nerve lesions.

Olfactory Nerve- Anosmia,(loss of sense of smell) may result from head injuries in which cribriform plate of ethmoid bone is fractured.

Optic nerve:Visual field defects and loss of visual acuity may result from fractures in the orbit, lesion along the visual pathway and diseases of nervous system.

Oculomotor nerve:A lesion in the nerve causes strabismus ,ptosis of upper eyelid ,pupil dilatation,the movement of eye ball downward and outward on the damaged side,loss of accommodation for near vision and diplopia.

Trochlear nerve:In trochlear nerve paralysis,diplopia and strabismus occur.

Trigeminal nerve:Injury results in paralysis of muscles of mastication and loss of sensation of touch and temperature.Neuralgia of one or more branches of trigeminal nerve is called trigeminal neuralgia.(Tic douloureux)

Abducens nerve: With the damage to this nerve, the affected eyeball move laterally beyond the midpoint and the eye is usually directed medially.

Facial nerve:Injury produces paralysis of facial muscles called bell’s palsy,loss of taste and loss of ability to close the eyes even during sleep.

Vestibulocochlear nerve:Injury to the cochlear branch may cause tinnitus or deafness.Injury to the vestibular branch may cause vertigo,ataxia, and nystagmus.

Glossopharyngeal nerve:Injury results in difficulty during swallowing,reduced secretion of saliva,loss of sensation in the throat and loss of taste.

Vagus nerve:Damage to this nerve in the upper body interfere with swallowing,paralyses the vocal cords,and interrupts the sensation from many organs.

Acessory nerve:Damage to this nerve results in paralysis of sternocleido mastoid and trapezius muscle present with inability to raise the shoulder and turning the head.

Hypoglossal Nerve.Injury results in difficulty in chewing ,speaking and swallowing. The tongue when protruded turn towards the affected side and the affected side become atrophied,shrunken,and deeply furrowed.

Further reading

Cranial nerve examination

Sunday, April 19, 2009

LINKS for Medical professionals

Resources for Homoeopaths.....

Homoeopathy resources on internet Illustrates Philosophy and Utility of Miasm,Miasmatic Diagnostic Classifications,Miasmatic Diagnosis of Clinical Classifications,Miasmatic Ancestral Tips,Miasmatic Repertory,Miasmatic Weightage of Medicines by Bengal allen institute

Similima,the largest portal on homoeopathy, designed by post graduate homoeopaths,it includes, latest information on homoeopathy,research articles ,study materials , and educational materials for exam preperation by Dr.Mansoor ali and team

hpathy- A Portal for Homeopathic Medicine, Homeopathy Remedies, Cures, Treatment, Books, Information about Software & Doctors

Modern homoeopathy-An evidence based Homoeopathy site includes Online Treatment, Articles, Cured Cases, Online Journal by Dr. Pawan S Chandak.

Homoeopathic forum by abchomoeopathy

Resources for all Medical professionals.......

Enjoy the animated graphics and extensive discussions of topics in
cardiology. -featuring image library,endoscopic piture archieves,endoscopic learning center,links to gastrointestinal websites and much more…

List of sites offering links to audible examples of normal and abnormal Breath Sounds on loop recordings that you may listen to on your computer.

Flash video of cardiac cycle:

Dermatology atlas database:

MARTINDALE'S The virtual medical centre includes interactive patient education programs that use illustrations and animations to simplify concepts, narration to read the text, and questions to verify understanding.

Updated monthly............

Friday, April 17, 2009

Cardiovascular fitness against Aerobic fitness

Cardio vascular fitness

It is the efficiency of the heart, lungs, and vascular system in delivering oxygen to the working muscle tissues so that prolonged physical activity can be maintained. Cardiovascular fitness is good for the health , heart and the rest of your body

To achieve this, exercise 15-30 minutes/ four times a week without worrying about your heart rate(unlike aerobic fitness). Someone who exercises regularly may have a resting heart rate of 55 or 60 beats per minute. A person who does no regular exercise may have a resting rate of 70 or more beats a minute. The heart of a fit person with a resting rate of 50, beats nine million less each year than an average person’s heart with a resting heart rate of 70,there by reducing the work load of your heart

Aerobic fitness

It gives everyone, the ability to sustain significant activity for a longer period of time. Though it is a necessity for athletes, everyone can follow it as a good health practise.

The American Heart Association recommends that you do exercise that increases your heart rate between 50 and 75% of your maximum heart rate ( maximum heart rate is 220 beats per minute minus your age. For eg.Consider a person of 40 yrs., his maximum heart rate = 180.(220-40) )

So by Involving in an exercise which will raise the heart rates to 50-75% of your maximum heart rate will definitely improve your fitness. However a beginner may not be able to attain this range in the initial phase. During the first few days, do exercise for 10-15 minutes/day. Gradually set the duration as 30-60 minutes/ 4-5 times a week.You should "warm up" and "cool down" for about 5 minutes before and after your exercise. If the exercise is walking or jogging, walk slowly as a warm up. Stretching is an excellent way to warm up and cool down.


Excercise for health

Heart rate and excercise

Cardiovascular fitness

Wednesday, April 15, 2009

Essentials of Endocrinology Part ii

Following symptom may suggest some of the common endocrinal/metabolic disorders.

NAUSEA:Most common manifestation of thyrotoxicosis is loose stool but occasionally it may be associated with nausea and vomitting.If a patient present with constant nausea and vomitting in the absence of significant structural diseases ,then we can consider the following endocrinal disorders as a differential diagnosis.They are adrenal insufficiency(nausea maximum in the morning associated with vomitting.)and hypercalcaemia.

CONSTIPATION/DIARRHOEA: Hypothyroidism or pan hypopitutarism may present with constipation and abdominal distension. Diarrhoea may occur as a part of autonomic neuropathy involving the gut in diabetes mellitus. Peptic ulceration may occur in zollinger Ellison syndrome.

SKIN CHANGES: In hyperthyroidism the skin is dry and hot, whereas in hypothyroidism skin appears pale sallow or slight yellow and thinning of scalp and lateral eye brow hair. Vitelligo, a common feature of autoimmune hyperthyroiditis and vitamin B12 deficiency. Excessive pigmentation is a feature of Cushing syndrome with increased sebum production causing greasy skin and acne on the face and shoulders. Violaceous cyanosis like skin discoloration may be a feature of carcinoid tumors of gut or lung (because of increased 5 hydroxy indole acetic acid 5HIAA). In hypoadrenalism, there is a pallor with pigmentation of conjunctival membrane beneath the lids, inside the mouth and axilla

MENSES :Regular menstration is a good indication against the androgen excess.,In such cases ,hirsuitism (Excess hair growth) can be considered as constitutional than Pathological.Pathological causes of excess hair growth include polycystic ovarian syndrome,late presentation of congenital adrenal hyperplasia,androgen secreting ovarian tumors.Moreover an increased libido suggests an increased androgen secretion

RENAL STONE: Renal stone may present due to primary hyperparathyroidism or it occur as a part of the syndrome multiple endocrine neoplasia.(MEN Type 1) or else it may run in families as an isolated disorder.

CRAMPS and paraesthesiae:If it is bilateral,it is due to hypoparathyroidism (decreased circulating ionized calcium level) or it may be associated with metabolic/respiratory alkalosis. Refractory cramping after correction of hypocalcaemia due to associated hypomagnesaemia.

Part 1

Source and links

Hutchison's clinical method and endocrineweb

Monday, April 13, 2009

Common method used for the estimation of LDL cholesterol

Even though the 'Direct Estimation Methods' are more accurate and precise than the conventional methods,(ie Precipitation method for HDL-Cholesterol & Friedewald's formula for LDL-Cholesterol.)the direct methods are not commonly used by clinical laboratories because it is expensive, time consuming, and it requires equipment not commonly available in the clinical lab.

Friedwald’s Formula:It is the conventional method for the estimation of LDL-cholesterol in fasting specimen

The formula

LDL-cholesterol = Total cholesterol - HDL cholesterol - VLDL


Limitation of Friedwald's formula

Friedewald formula is unreliable in the presence of chylomicronemia ,hypertriglyceridemia (when plasma triglyceride concentration exceeds 400 mg/dL or 4.52 mmol/L) and in patients with dysbetalipoproteinemia (type III hyperlipoproteinemia).

Further reading

Friday, April 10, 2009

World Homoeopathy Day

salutations to the master of homoeopathy on his birthday which is celebrated worldwide as world homoeopathy day.In recent times, the growing awareness of adverse side-effects of allopathy medicine is creating an increasing interest in alternative systems, especially Homoeopathy. It is a unique system of rational healing having no known harmful effects, based on natural laws and even considered as a link between orthodox medicine and holistic approach. Dr. Christian Freidrich Samuel Hahnemann discovered homoeopathy stating that the high and only mission of a physician is to restore the sick to healt in a rapid and gentle way.
Try homoeopathy ,it is safe!

Thursday, April 9, 2009

Essentials of Endocrinology -part 1

Muscle weakness in the absence of neurological diseases, is a feature of severe metabolic disorders like cushing syndrome,thyrotoxicosis,and vitamin D deficiency. Almost all cases of metabolic myopathies can have proximal muscle weakness especially the shoulder and hip girdle musculature. Symptomatically it is presented as difficulty in climbing stairs or rising from sitting posture. Out of all these conditions, vitamin D deficiency ,osteomalacia and hypothyroidism are painful myopathies.

Hyperhydrosis (increased sweating) may present as a constitutional abnormality. More recent increase in sweat secretion may be an early indication of thyroid overactivity. One must also consider Pheochromocytoma, a rare cause of hyperhydrosis.In autonomic dysfunction,there is an intermittent sweating pattern after meals(gustatory hyperhydrosis).Growth hormone excess(Acromegaly) can also have increase sweating.A case of hyperhydrosis has to be differentiated from flushing which is a common feature in menopausal age group.Flushing may be a presenting symptom in Seratonin secreting carcinoid tumors of gut .

Tremor:In Anxiety, the pattern of tremor is coarse and irregular with cold peripherals whereas in thyrotoxicosis, it is fine rapid resting tremor (with warm skin). Tremor in neurological diseases may present at rest with greater amplitude and slower rate.It may either present at rest(parkinson’s diseases) or in motion(cerebellar intention tremor)

Dizziness or postural unsteadiness on standing: Postural hypotension (a fall of diastolic blood volume on standing occurs with reduced blood volume.) may be the reason for majority of cases.But, in the absence of bleeding or gastrointestinal fluid loss adrenal insufficiency may be the common possibility. In long standing diabetis mellitus, postural hypotension may occur due to autonomic neuropathy.Moreover, it can also occur as a common complication of any hypertensive drug for essential hypertension.

Weight loss is the single most differentiating feature of insulin dependent diabetis from non insulin dependent diabetis.Thyroid over activity is always associated with a combination of increased appetite and weight loss in which the appetite may be stimulated more. Another common cause of weight loss in young little girls is anorexia nervosa where there is a peculiar history of low body weight in the absence of other features of illhealth.

Weight gain occurs as a result of reduced metabolic rate. So, it is a common feature of primary hypothyroidism.In Cushing syndrome,the pattern is truncal obesity and paradoxical thinning of the limbs.Occasionaly increased body weight can be a feature of hypothalamic lesions

Cold intolerance: A feature of hypothyroidism which has to differentiated from Raynauds diseases which is due to localized vasomotor symptoms(Vasospasm)

Source and links: Hutchison's clinical method,endocrineweb

Tuesday, April 7, 2009

World Health Day 2009

Save lives. Make hospitals safe in emergencies
World Health Day 2009 focuses on the safety of health facilities and the readiness of health workers who treat those affected by emergencies. Health centres and staff are critical lifelines for vulnerable people in disasters - treating injuries, preventing illnesses and caring for people's health needs. Often, already fragile health systems are unable to keep functioning through a disaster, with immediate and future public health consequences.This year, WHO and international partners are underscoring the importance of investing in health infrastructure that can withstand hazards and serve people in immediate need. They are also urging health facilities to implement systems to respond to internal emergencies, such as fires, and ensure the continuity of care

Monday, April 6, 2009

New study on Inflammatory Bowel Disease and folic acid

According to a new study led by researchers at the University of California, San Francisco and UC Berkeley. Chidren with newly diagnosed cases of IBD have higher concentration of folate in their blood than individuals without IBD.This new finding questions already existing theory that patients with IBD are prone to folate deficiency .(The only difference is that previous theory refered to adult IBD where as latest research refered to paediatric IBD)How ever it would certainly opens the way for additional research into the role of folic acid . Follic acid, A water soluble vitamin B helps to produce and maintain new cells, moreover it has shown to prevent changes to DNA that may lead to cancer and birth defects,

IBD refers to illnesses that cause chronic inflammation in the intestines, including ulcerative colitis, which manifests itself in the colon, and Crohn's disease, which can arise anywhere in the intestinal tract.IBD occurs in children of all ages and can cause abdominal pain, diarrhea, fever, bleeding and nutritional deficiencies.

SOURCE and links

The study appears in "American Journal of Clinical Nutrition"

Difference between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS)?'

Saturday, April 4, 2009


Dear doctors,
We are very happy to inform that, IHMA is celebrating its 5 th anniversary on 4th april,2009. IHMA, a premier organization, got transformed from KHMGA(Kerala homoeopathic medical graduates association) which had been in the forefront for many years. Through our organization, we could bring forth some remarkable changes in the field of development of Homoeopathy. Our stand in cetain burning issues regarding homoeopathic eduction/practice were received wide appreciation. .On this occasion we express our gratitude to to all members of our national working committee and chapter office bearers for their valuable support to this organization..We expect, wholehearted cooperation from all enthusiastic homoeopaths around the world to lead this organization to great heights.

Thanking you

Yours in homoeopathy,
Ihma karunagappally chapter.




Wednesday, April 1, 2009

Why waist to hip ratio is a better indicator than body mass index?

Body mass index (BMI) is a simple way to measure body fat using your height and weight as a basis for the calculation. BMI measurements have long been considered the standard indicator to determine if someone is overweight.BMI works best when used to study a large segment of the population.

BMI Classification

Below 18.5 Underweight

18.5 - 24.9 Normal weight

25.0 - 29.9 Overweight

30.0 and above Obese

But it has so many disadvantages.BMI does not differentiate between muscle and fat and will therefore underestimate in some and overestimate for others. For the same reason BMI can give a false result for body builders and other athletes with a muscular build. These people have extra weight due to the large amounts of muscle mass on their bodies. It can underestimate the results for elderly people because older people have lost so much muscle mass.

Waist to hip ratio is the ratio of the circumference of the waist and the circumference of the hips to measure body fat. This method is considered a better measurement because it considers the amount of belly fat. It serves as a better indicator of cardiac status than BMI..Waist-to-hip ratio shows a graded and highly significant association with myocardial infarction risk worldwide.

· Waist circumference: It is measured by putting an unstretched tape measure around the narrowest level of your waist

· Hip circumference: It is measured by putting a tape around the widest part of your hip area over minimal clothing.

Waist - hip ratio -For females the normal WHR is about 0.80, while for men it is 0.95


Waist-to-hip ratio, body mass index, and subsequent kidney disease and death.

Waist-to-hip ratio versus BMI as predictors of cardiac risk in obese adult women

Waist-to-Hip Ratio vs BMI may Be More Accurate Predictor of CV Risk

Research shows that “apple-shaped” bodies (with more weight around the waist) face more health risks than those with “pear-shaped” bodies who carry more weight around the hip. Waist-to-hip ratio Calculator