Happy Doctor's Day

Doctor's day,a tribute to Dr.B.C ROY ( It is the birth day of famous physician of India Dr.B.C.Roy) and the entire medical profession. It is a great occasion for the doctors to dedicate themselves to this noble profession.For the public, it is an opportunity to honour the efforts and skills of committed doctors. The official symbol of Doctor's Day is the red carnation, which symbolizes love, charity, sacrifice, bravery and courage.

Doctor’s day is celebrated in the west on march 30- the day when Dr Crawford W. Long, became the first physician to use ether anesthesia in surgery

Influence of vitamins in thyroid related illness

There is a correlation between levels of thyroid hormones and levels of specific micronutrients such as selenium, zinc, retinol, and alpha-tocopherol. Several studies are being conducted to assess the impact of vitamin intake on thyroid related problems.

Patients with thyroid disease should take supplements containing molecules with anti-oxidant properties, such as vitamin C, vitamin E, and coenzyme Q10. (Vitamin C and B-complex vitamins are very important.) Induction of B1 is supposed to be the best for helping thyroid to function properly in views of some doctors. B1 is mainly found in brewer’s yeast and germinated wheat. For non-vegetarians source of this vitamin is liver part of meat.

Patients suffering from thyroid diseases mostly suffer from the following symptoms and disorders, they should take the vitamins in the form of food products or even can take pills of the mentioned vitamins on the advice of a physician.

Vitamins recommended in thyroid related diseases and symptoms

A- Kidney stone

C-Arthritis

E-Menses

B1-Appetite, constipation, fatigue,

B1 and B2 –skin problems

B6-Emotional disturbance, gall bladder stone.

B6 and D-Anaemia, weakness

B12-Pernicious anemia

LINKS AND REFERENCES

Vitamin D deficiency and thyroid diseases

Vitamins and suppliments improve thyroid patients

Remedial measures for Monsoon ailments

Though Monsoon brings so much of relief from the heat of summer, it makes man more succeptible to variety of illness. Diseases that are spread during monsoon may be water borne, air-borne or vector-borne.

General and specific management for the most common monsoon related diseases.

Cholera

Patient must be kept at rest as warm as possible,no solid food whatever should be given, water may be given as desired.Milk is the best food if it is tolerated.(according to J..H Clark ‘The Prescriber’)

Homoeopathic management: Ver alb, Camphor, Jatropha, cupmet, ars, podo, elaterium, arg nit

Influenza

Rest in bed, warmth,plenty of fluid intake, support with nourishment in a digestible form, as long as the symptoms are acute. There is a modified form of the disease, which requires care, but not necessarily either rest in bed or confinement to the house.

Homoeopathic management: ars alb, baptisia, Influenzinum, eupatorium p, gelsemium, bryonia, rhus tox

Post influenzal cough- sangunaria, sticta

Jaundice

The patient must fed on the lightest diet barley water, thin gruel, skim-milk. If there is much itching, sponging with vinegar and hot water (one pint in six) is agreeable.

Homoeopathic management: merc sol, bryonia, china, hepar sulph, chamomilla.


Dysentery

When dysentery appears make sure that water is good.If not use boiled and filtered water to drink.House must be carefully disinfected.Unripe fruit must be avoided.the diet must be confined to gruel and farinaceous food with as much as cold water as patient likes.

Homoeopathic management:merc cor, colocynth, ipecac, aloes,

Asthma

General management :Try to avoid all triggering factors like dust,pollen,animal danders etc.Practise Breathing exercises.

Homoeopathic management:nat sulph, dulcamera, kali carb, aur, china, ipecac

Rheumatic/rheumatoid complaints

Gen management: Patient should be advised to wear woolen clothes since the woolen garments retain the heat and let the perspiration escape. Presence of lactic acid in the system gives rise to most of the symptoms. So modify the dietary pattern according to that.Grain foods are the best choice. (Oats, barely, wheat etc)

Dietery restrictions include meat, take milk but sparingly, avoid sweets ,watery fruits and vegetables. Grain foods are the best choice.(oats,barely,wheat etc)

Homoeopathic management:Rhus tox, bryonia, colchicum, dulcamara, kalmia, Calc phos, kali bich.

Links and references

The prescriber-JH CLARK

Hompath /therapeutics

Administation of camphor in cholera from the book'Cure and Prevention of the Asiatic Cholera - (1831)'

Swine flu formally declared as pandemic by WHO

The world health organization announced its members nations on june 11 2009 that it was declaring a swine flu pandemic ,the first global flu epidemic in 41 years. Moreover it has decided to raise the pandemic warning level from phase 5 to phase 6 ,its highest alert after holding meeting with experts.

Swine flu- Our earlier post

Links

http://news.yahoo.com/s/ap/20090611/ap_on_he_me/un_un_swine_flu

http://www.who.int/csr/disease/swineflu/en/

cell phone elbow

Harmful effects from mobile phones are never ending.Earlier it was repetitive strain injury from texting,then came the recall impairment and subsequent brain damge from ring tones.Now the latest menace is cellphone elbow or medically known as cubital tunnel syndome.

How it happens?

Health experts say that those who are holding the phone near the ear for a prolonged period are at a risk of developing painful condition of arm. By bending their elbow too tightly and for too long could damage the ulnar nerve.

Dr. Benson, a professor of orthopedic surgery at Northwestern University School of Medicine, explains” The more you bend it, for example when using a phone, the more it stretches. It diminishes the blood supply, and the blood is not flowing through the nerves.”

Symptoms

Sufferers can present with numbness and tingling from the elbow to the fingers. More than that they find it difficult to perform their day to day activities.In order to resolve this condition up to some extent, experts suggest mobile users to switch the handset from hand to hand so often.

Links and references

http://www.cnn.com/2009/HEALTH/06/02/cell.phone.elbow/

http://www.medicalnewstoday.com/articles/152526.php

http://www.nlm.nih.gov/medlineplus/news/fullstory_85085.html

Are pictorial warnings against tobacco effective?

Nowadays pictorial warnings are used by majority of the countries, since it created better awareness among tobacco users.Canada was the first country to introduce pictorial warning in 2001.Brazil implemented in the next year. Singapore introduced it in 2004. According to WHO, shocking and fear arousing pictures are the best ones for such purposes

India made it mandatory to put pictorial warning on all tobacco products from may 31.

Previous Studies

Studies conducted in various countries that have introduced pictorial warning on cigarette packets have found that they can be extremely cost effective public health measure for the government .It is shown that in Brazil 67 % of smokers wanted to quit smoking as a result of pictorial warning .In Canada nearly half the number of smokers pointed out that the warning had increased their motivation to quit .Similar response were seen from other countries too.

Advantages of pictorial warnings

They attract the attention of common man and make it difficult to ignore the harmful effects of tobacco. Smokers knew more about the health effects from smoking as a result of pictorial warning.

Links

http://www.thaindian.com/newsportal/india-news/pictorial-warning-to-be-displayed-on-cigarette-tobacco-products-from-may-31_100188933.html

http://www.tobaccoplusindia.com/book.php?p_id=40

http://ibnlive.in.com/news/pictorial-warning-on-tobacco-products-from-today/93814-17.html

Utility chart for the probable diagnosis of thyroid disorders

Click on the image for larger view..............

Compiled from the study materials supplied in connection with the IHMA zonal conferences.

M.D.entrance coaching programme

Indian Homoeopathic Medical Association ( IHMA ) is conducting classes for post graduate medical entrance examinations for the year 2009- 2010

classes conducted in three centers all over kerala-thiruvananthapuram , kollam , kozhikode

• eminent faculty- all are post graduates or lecturers in various homoeopathic colleges in kerala
• well prepared study materials
• all together 14 classes( sundays) and two model exams
• very high success raste in previous years

centre - venue - date of commencement
trivandrum - IVA Hall, dharmalayam road, tvm 1 - May 24
kollam - Govt PWD Rest house, chinnakada, kollam - May 31
kozhikode - Pullians arcade, behind MCC bank, Calicut 1 - May 17

for further detalis contact

Dr.Abhilash.M - 9446072887
Dr Nidhin dev.S - 9446541238

Tribute to DR.J.T KENT ON HIS DEATH ANNIVERSARY

Dr.James Tyler Kent (1849-1916)

IHMA Karunagappally pays floral tributes and salutations to the great man without whom the world of modern repertory and homoeopathic practice would have been a void.

• "True some men do some good work without the repertory, but they also do poor work, more than they would do with it"- Dr.Kent .J.T
• "The mechanical use of the repertory never leads to artistic prescribing nor to remarkable results" - Dr.Kent .J.T
• Which is the best repertory ?
  The best is that which one makes oneself _ Dr.Kent .J.T
  

JUNE 5 WORLD ENVIRONMENT DAY - WED

IHMA karunagappally wishes all its members and non members to be part of the world campaign to create a better place for our children to live and to abide by this years WED slogan- Your Planet Needs You - UNite to Combat Climate Change

World Environment Day (WED) was established by the UN General Assembly in 1972 to mark the opening of the Stockholm Conference on the Human Environment.

Commemorated yearly on 5 June, WED is one of the principal vehicles through which the United Nations stimulates worldwide awareness of the environment and enhances political attention and action. The day's agenda is to:

1.Give a human face to environmental issues;

2.Empower people to become active agents of sustainable and equitable development;

3.Promote an understanding that communities are pivotal to changing attitudes towards environmental issues;

4.Advocate partnership which will ensure all nations and peoples enjoy a safer and more prosperous future.

The theme for WED 2009 is 'Your Planet Needs You-UNite to Combat Climate Change'. It reflects the urgency for nations to agree on a new deal at the crucial climate convention meeting in Copenhagen some 180 days later in the year, and the links with overcoming poverty and improved management of forests.

This year’s host is Mexico which reflects the growing role of the Latin American country in the fight against climate change, including its growing participation in the carbon markets.

Mexico is also a leading partner in UNEP's Billion Tree Campaign. The country, with the support of its President and people, has spearheaded the pledging and planting of some 25 per cent of the trees under the campaign. Accounting for around 1.5 per cent of global greenhouse gas emissions, the country is demonstrating its commitment to climate change on several fronts.

Mexican President Felipe Calderon states that the WED celebration will “further underline Mexico's determination to manage natural resources and deal with the most demanding challenge of the 21st century – climate change.”

People around the world will unite for the planet on 5 June for World Environment Day 2009, with a strong call for environmental action just six months before the crucial United Nations climate change talks in Copenhagen.

This year's theme is 'Your Planet needs You! Unite to combat climate change' - a topic that reflects everyone's individual responsibility to protect the planet, as well as the urgency for nations to agree on a new climate change deal in December.

World Environment Day is truly a People's Day: it is the chance for everyone, young and old, with their community or with close friends, to show that they care for the planet.

This year's host is Mexico, reflecting the country's growing role in the fight against climate change - with its increasingly strong participation in global carbon markets, its massive tree planting campaigns and its natural resource management.

United Nations Secretary-General Ban Ki-moon said: "On this World Environment Day. I encourage all people to take concrete steps toward making the planet greener and cleaner. Switch off the lights. Take public transportation. Recycle. Plant a tree. Clean up your local park. Hold corporations responsible for their environmental practices. And urge your government representatives to Seal the Deal in Copenhagen."

Achim Steiner, UN Under-Secretary-General and Executive Director of the United Nations Environment Programme, said: "I am delighted that Mexico and its people will be the 2009 global hosts of the annual United Nations celebrations on 5 June under the theme 'Your Planet Needs You! Unite to Combat Climate Change'. Mexico is among a group of nations showing real leadership on the challenges of our age - from climate change to bringing environmental goods and services into the mainstream of national and international economics."

World Environment Day is a truly global event, and as such it will be celebrated on every continent - from remote villages to sprawling capitals. Here are some of the highlights of this year's celebration.

Utility of barium swallow and barium meal in various abdominal conditions.

Barium is a naturally occurring element, which is radio opaque. Barium swallow and barium meal test involve swallowing a liquid suspension of barium sulphate. When swallowed, barium coats the walls of the digestive tract, which allows the shape of upper digestive tract to be outlined on an X-ray. Then the investigator will take a series of x-rays of gastrointestinal tract in various positions.

Utility

A Barium swallow test may be suggested if you are having difficulty in swallowing, or if you have chest pain or reflux oesophagitis(backflow of stomach juices into the lower part of the oesophagus).

Observation of passage of a radio opaque barium solution through the pharynx and esophagus in to the stomach remains an important investigation of dysphagia. In addition to structural abnormalities such as stricture or neoplasia, disorders of motor functions can be detected through barium swallow. In a patient with dysphagia, lack of progress of barium through the lower esophageal sphincter on swallowing, indicates the presence of achlasia cardia.

Barium meal x-ray is useful in the disease condition of stomach, small intestine and appendix. Barium meal test may also be suggested if you are having unexplained vomiting, pain in your abdomen, severe indigestion or blood in your stool.

If any residue of barium meal is seen at the dependent part of stomach after 6 hours, it may be due to pylorospasm or hypotonia. If the residue is after 24 hours, a diagnosis of organic pyloric stenosis is certain.

Projecting bud of barium meal from smooth outline usually on the lesser curvature of the stomach is a direct sign of ulcer.

Carcinoma of stomach may present as a persistent filling defect which must be constant in all films.

In carcinoma of head of pancreas barium filled duodenum is widened. In case carcinoma in ampulla of vater, a filling defect is seen which may give the duodenum an appearance of a reversed 3.

Links

barium swallow and barium meal tests

Barium swallow image

Health Benefits of insoluble and soluble dietary fibers.

Dietary fiber, also known as roughage or bulk, includes all parts of plant foods that your body can't digest or absorb unlike other food components such as fats, proteins or carbohydrates.

People who use fiber rich diet, unrefined diet may reduce the risk of developing obesity, diabetes, atherosclerosis, gallstones, haemorrhoids, diverticulosis, appendicitis, and colon cancer.

Fibers may be classified as insoluble and soluble fiber.

Insoluble fiber includes the woody or structural parts of plant such as fruits and vegetables and bran coating around the wheat. This kind of fiber is responsible in alleviating irregular bowel movement and constipation. It helps to protect against colon cancer.

How it acts?
Insoluble fiber pass through the GI tract largely unchanged and speeds up the passage of materials through the tract.

Soluble fiber found in abundance in beans, oats, barely, broccoli, apples, prunes and citrus fruits. It has the consistency of gel and tends to slow the passage of materials through the tract. It is responsible for easy elimination of your bowel and it is also a great help in reducing your cholesterol and blood sugar levels.

How it acts?

-One possible explanation for the relationship of soluble fiber to cholesterol level is that the fiber binds bile salts (cholesterol is a precursor to bile salt formation) and prevents their reabsorption.


-Fiber, particularly soluble fiber, can slow down the absorption of sugar, which for people with diabetes, can help to improve blood sugar levels. A high-fiber diet may also reduce the risk of developing type 2 diabetes.


Links

how fiber protects you from various disease conditions

All about dietary fiber

Interesting human body statistics

Brain-It makes up only 2% of the body weight, but uses 20% of the oxygen and blood supply. Human brain stores information equal to 500,000 sets of encyclopedia Britannica. At a time our brain can retain 7 facts in the short-term memory. Neurons are the longest cells in our body.

Heart –The hollow muscle pumps enough blood in an average lifetime to fill the fuel tanks of 56 moon rockets. Its involuntary contractions begin 4 weeks after conception, before nerve cells are formed and continue to pulse even out of the body in saline solution. Muscle cells of the heart generate a total electric current of about 2 watts that commands the fibers to contract.

Lungs-Adult human lung have an internal area of 93 m2, which is 40 times the external surface of human body.

Stomach –It produces 2 litres of hydrochloric acid daily.5 lakhs cells of stomach’s inner walls are replaced every minute so that the acid doesn’t damage the walls.

Muscles-There are 639 muscles, which account for 40% of the total body weight. It takes 17 muscles to smile and 42 to stare.

Tongue-The tongue contains more than 10,000 taste buds, which are renewed weekly. It can distinguish 500 different tastes.

Eyes-We spends 30 minutes everyday, being blind. (The time taken for blinking)

Ear- Our ear can detect 1500 different tunes and 350db of loudness.

Various approaches to kidney stone diet

Kidney stones form when the urine becomes so saturated with a certain mineral that no more of it can dissolve into the urine. The undissolved portion of the mineral forms crystals that then clump together and grow into hard stones. This condition is medically known as urolithiasis or nephrolithiasis. It is important for the physician to determine the stone's mineral content and to identify any medical conditions that may have contributed to stone formation. About 80% of all kidney stones are composed of calcium and other minerals, usually a combination of calcium and oxalate.

• Doctors used to prescribe a low calcium diet for preventing kidney stones. Changing the amount of calcium in the diet causes very little change in the blood level of calcium. Blood calcium level kept steady by balancing the absorption of calcium from diet and taking calcium from bones when it is needed. The kidney filters substances from the blood; so changing the dietary intake of calcium does not change the amount of calcium that is filtered by the kidneys.

• Citric acid can protect against kidney stone formation. Citric acid in its natural form, such as from citrus fruits, citric acid does not alkalinize the urine as citrate does. It prevents small stones from becoming “problem stones” by coating them and preventing other material from attaching and building onto the stones. Moreover it inhibits stone formation and breaks up small stones that are beginning to form. It is for this reason, that citrus fruit, especially lemons should be plentiful on the kidney stone diet. The exception to this rule is grapefruit juice.

• Another approach to prevent kidney stones in adults is to eat calcium rich foods and avoid foods rich in oxalates. Calcium and oxalate always have a tendency to bind in the intestine). If oxalate rich foods (Chocolate Tea Spinach Beet tops Peanuts Almonds) are restricted in the diet, taht can bve solved and chances of formation of stones can be reduced.
  

• Insoluble fiber (found in wheat, rye, barley, and rice) that may help to reduce calcium in the urine. It combines with calcium in the intestines, so the calcium is excreted with the stool instead of through the kidneys. Moreover insoluble fiber also speeds up movement of substances through the intestine, so there will be less time for calcium to be absorbed.

• Potassium reduces urinary calcium excretion, which in turn lowers the risk of kidney stone formation. So foods rich in potassium should be included in the diet.

• Protein rich foods increase urinary calcium and should be reduced in the kidney stone diet.

• It is believed that sugar can increase urinary oxalate and urinary calcium.

References

kidney stone diet

http://www.medindia.net/patients/patientinfo/diet-kidney-stones.htm

Citric acid and kidney stones

Physical characteristics and abnormal constituents of urine part1

Appearance: Small quantity of blood in urine is often undetectable by inspection, but it gives the urine a smoky appearance. Large quantities of blood make the urine brownish or red. Colour variation from dark red -brown-black occurs due to presence of large amount of heamoglobin from lysed red blood cells, after mismatched blood transfusion or in black water fever. Drugs like tetracyclines, anthraquinonepurgatives, desferrioxamine, pheninedione, nitrofurantoin and nitridazole rifampacin, may discolour urine. Cloudiness of urine may be due to the presence of red or white blood cells, pus from bladder or kidney infection, bacteria, mucous and chyle. Phosphates and pus make freshly passed urine cloudy.

Odour: Foul smelling urine is a common symptom of urinary tract infection. Fruity odour is associated with diabetes mellitus, starvation, dehydration or ketone body formation. Patients with maple syrup urine diseases and phenyl ketonuria may present with distinctive odour of the urine.

Specific gravity: Low specific gravity (below 1.005) associated with diabetes insipidus, acute tubular necrosis, nephrogenic diabetes insipidus and pyelonephritis. High specific gravity (above 1.035) occurs in patients who are in shock or who suffer from nephritic syndrome, dehydration, and acute glomerulo nephritis.

PH: Ranges between 4.6 -8.0.High protein diets increase the acidity of urine; vegetarian diets increase the alkalinity. (Normal fresh urine is nearly always slightly acidic, except after a meal.) Value greater than 7 may be due to metabolic/ respiratory alkalosis, Fanconi’s syndrome. Ph value below 7 may be due to fever, phenyl ketonurea, alkaptonurea and acidosis.

Blood and tissue cells: Red blood cells in the urine can be due to vigorous exercise or exposure to toxic chemicals. High number of white blood cells in the urine is usually a symptom of urinary tract infection. Certain other causes of haematurea are bacterial infections, parasitic infections including malaria, obstructions in the urinary tract, scurvy, sub acute bacterial endocarditis, traumatic injuries, and tumors. A large number of cells from tissue lining can indicate damage to the small tubes that carry material into and out of the kidneys.(In females, one should make sure that the urine sample was not contaminated with menstrual blood from vagina.)

Casts: They are small fibrous objects that are formed when protein and other materials settle in the kidney tubules and collecting ducts. Large number of casts in urine specimen is a sign of kidney disease.

Sources

Hutchison’s clinical method

Davidson's Principles and practice of medicine

Haematurea

Medical inventions and Discoveries

Stethoscope - Laennec (1819)

Chemotherapy - Ehrlich (1909)

Pace maker - Zoll (1952)

Hearing aid - Sonotone Corporation, USA (1952).

Heart –lung machine - Dr. John H. Gibbon. (1953)

Artificial heart - Willem kolff (1957)

LASER - Gould (1957)

MRI -Damadian (1971)

Cloning DNA - Boyer, Cohen (1973)

CT Scan - Hounsfield (1973)

HIV -M.Cockerell. (1984)

Microscope

Compound - Z.Janssen (1590)

Electron -Ruska knoll (1931)

Hepatitis markers and its usual significance

• HBsAg

Virus is present.

• Anti-HBs (surface antibody)

Virus is usually cleared and Patient is immune.

(Presence of hepatitis B surface antigen (HBsAg) signifies the infection with the virus.It doesnot give the information regarding infectivity and the ongoing liver damage.When the virus is cleared from the infected person,antibody to hepatitis B surface antigen (anti-HBs)develops.It gives immunity to further virus infection.)

• HBeAg*

Active viral replication ,ongoing liver disease ,patient infectious.

• Anti-HBe*

Viral replication reduced ,inactive liver disease (usually),Less infectious.

(HBeAg usually represents that , there is an active viral replication. The disappearance of HBeAg and appearance of anti Hbe usually means that the level of viral replication and the associated liver disease has lessened.The individual is less capable of infecting others.)

• HBV-DNA
  

Active viral replication and on going liver disease,patient infectious.

(HBeAg and/or HBV-DNA should be measured , if active viral replication is present.)

• HBcAg

Never detectable in serum

• Anti-HBc (core antibody)

(Hepatitis B core antigen (HbcAg) never appears freely in blood. The corresponding antibody (anti-HBc) appears in the blood at about the same time as HBsAg and usually remains for life.It implies that Patient has come into contact with hepatitis B and may or may not still be infected with the virus. Anti HBc does not signify immunity)

IgM anti-HBc Signifies recent contact with hepatitis B

* except for pre-core mutant strains of HBV(the mutant strain of HBV (pre-core mutant) in which the virus cannot manufacture HBeAg and thus the only marker for the presence of the virus core is HBV-DNA.)

Links

Approach to the management of incidentally detected HBsAg carrier

hepatitis markers

Concept of Polypill and the criticism

A polypill is a medication, which contains a combination of five life-saving drugs called “polypill” that promises to reduce the risk of heart attack and stroke in healthy people. It was actually conceived, developed and clinically tested in Bangalore,India.

The pill is a result of a three-year study conducted by three doctors from St. John’s Medical College, Bangalore along with a team of experts from McMaster University, Hamilton, Canada.

The combination

The "polypill" would contain 3 blood pressure medications at low dose:

a diuretic, such as bendroflumethiazide,a beta-blocker such as atenolol,
an ACE inhibitor such as enalapril.

This is combined with

a statin such as simvastatin,aspirin at a dose of 75 mg and

Follic acid(Follic acid has been shown to reduce the level of homocysteine in the blood which is another risk factor for heart disease).

The criticism

Although several group of physicians accept the rational combination of proven life-saving drugs in easily administered and cost-saving formulations, especially for the secondary prevention of Cardio vascular diseases, they expresses their concern over, proclaiming polypill as the principal pathway to primary prevention of Cardio vascular disease.

Several scientific questions currently remain, especially with respect to primary prevention. How will this drug combination alter with behaviour change involving healthy diets, regular exercise, and smoking cessation?

Critics also worry that the promised protection of a polypill may work against people giving up unhealthy habits like smoking or bad diet.

Another criticism is that,a person would be subjected to different drugs unnecessarily even if he had one ailment.


Links

Can polypill replace poly-policy for heart health

SWINE FLU

Swine influenza (also swine flu) refers to influenza caused by any strain of the influenza virus endemic in pigs (swine). Swine influenza is known to be caused by influenza A subtypes H1N1, H1N2, H3N1, H3N2, H2N3.

Epidemiology: Earlier,many cases in swine (2007 Philippines) & in humans(The "Spanish" influenza pandemic of 1918–19 infected one third of the world's population and US outbreak in 1976)were reported.

The new strain of influenza involved in the 2009 swine flu outbreak is a combination of several strains of influenza A virus subtype H1N1 that are separately endemic in humans and in swine.

In response to the intensifying outbreak, the World Health Organization raised the worldwide pandemic alert level to Phase 4alert.

Who are at risk? Swine flu is common in swine and rare in humans. People who work with swine, people with intense exposures ,are at risk of catching swine influenza. Rarely these strains are able to pass from human to human.Swine flu cannot be spread by pork products, since the virus is not transmitted through food.

Infectivity: The swine flu in humans is most contagious during the first five days of the illness.Although some people, most commonly children, can remain contagious for up to ten days.

Clinical features: In humans, the symptoms of swine flu are similar to those of influenza.Symptoms include ,chills, fever, sore throat, muscle pains, severe headache, coughing, weakness and general discomfort. According to Centers for Disease Control and Prevention (CDC) advised physicians to "consider swine influenza infection in the differential diagnosis of patients with acute febrile respiratory illness who have either been in contact with persons with confirmed swine flu, or who were in one of the five U.S. states that have reported swine flu cases or in Mexico during the 7 days preceding their illness onset."

Diagnosis: A diagnosis of confirmed swine flu requires laboratory testing of a respiratory sample (a simple nose and throat swab)

Prevention:Experts agree that hand-washing can help to prevent viral infections, a surprisingly effective way to prevent all sorts of diseases, including ordinary influenza and the new swine flu virus.Frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in public.Anyone with flu-like symptoms such as a sudden fever, cough or muscle aches should stay away from work or public transportation and should see a doctor to be tested.

Further reading: Swine flu

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

PART 1

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.

READ DETAILS.....

http://www.nhs.uk/news/2009/03March/Pages/DiabetesVirusLink.aspx

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

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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

LINKS for Medical professionals

Resources for Homoeopaths.....

Homoeopathy resources on internet
http://www.shirleys-wellness-cafe.com/homeopathy-resources.htm

http://www.homoeopathy-course.com/appr-p-2.htm 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 http://abchomeopathy.com/forums.php

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

Enjoy the animated graphics and extensive discussions of topics in
cardiology. http://www.heartpoint.com/gallery.html

gatrolab.net -featuring image library,endoscopic piture archieves,endoscopic learning center,links to gastrointestinal websites and much more…

http://www.gastrolab.net/index.htm

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.
http://medzoom.net/breathsounds.html

Flash video of cardiac cycle: http://library.med.utah.edu/kw/pharm/hyper_heart1.html

Dermatology atlas database: http://tray.dermatology.uiowa.edu/DermImag.htm


MARTINDALE'S The virtual medical centre

http://www.martindalecenter.com/MedicalClinical_Exams.html#EXAMS-ALL

X-Plain.net- 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............

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.

links

Excercise for health

Heart rate and excercise

Cardiovascular fitness

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

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

VLDL=TRIGLYCERIDES /5


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

http://www.clinchem.org/cgi/content/full/43/11/2183