NOTES ON Osteoarthritis

Osteoarthritis


By: Sue Renfrow, RN, BSN



Osteoarthritis

* A form of Degenerative Joint Disease (DJD) * A common disabling joint disorder (problems with hips, knees, ankles) *Osteoarthritis is the most prevalent activity limitation among the elderly leading to disability *Affects 16- 20 million people in U.S.



Causes

*Idiopathic- Primary *No prior event or disease * Aging *Secondary *Resulting from previous joint or inflammatory disease *Congenital diseases ( Legg-Cave’-Perthes) *Gout *Obesity the more you weigh the harder it is on your joints



Clinical Manifestations

*Pain *Stiffness/ swelling *Functional Impairment/ asymetric *Heberden’s Nodes



Assessment/Diagnostic

*Physical assessment of musculoskeletal system *Location and pattern of pain *X-Rays- Show loss of joint cartilage, narrowing of joint space, osteophytes (bone Spurs) *Labs-ESR, RH-rule out RA (RH 40 or less)



Medical Management

*Decrease weight *Injury prevention *Ergonomic modifications



Conservative:

-heat/cold -avoid overuse -supports for joints -isometric, postural and aerobic exercise -Physical/Occupational therapy



Pharmacological

*Tylenol, Acetaminophen (drug of choice) worry about liver damage





*Salicylates, Aspirin - the “grandfather” *NSAIDS: Ibuprofen, Advil, Motrin & Nuprin (eventually will wind up on NSAIDs) *Cox-2 (Celebrex) worry about GI bleed *Opiates *Corticosteroids *Glucosamine/Chondroiton *Hyaluronic acid (Synivisc) *Topical- Capsain, methylsalicylate



Surgical Management

*Osteotomy-moderate to severe loss of function, may have this (realign joint) *Arthroplasty-surgical repair of the joint p. 1628



Treatment

*GOALS of treatment include: GOALS *decreasing joint pain and stiffness *improving joint mobility and stability *increasing ability to perform ADL’s *optimizing functional ability



Nursing Management:

*Chronic pain related to joint degeneration *Impaired physical mobility related to restricted joint mobility *Body image disturbance related to visible body changes *Self-care deficit related to immobility *Knowledge deficit *Ineffective individual/family coping or compromise



Preventative Measures:

*Joint Protection Joint *Correct body mechanics *Avoid grasping actions that strain finger joints *Spread weight of an object over several joints *Maintain good posture *Use strongest muscles and favor large joints

NOTES ON UPPER LIMB

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LIVING WITH DISEASE

Great peoples and their disease.

.
Albert Einstein
Albert Einstein did not speak until the age of three. Even as an adult Einstein found that searching for words was laborious. He found schoolwork, especially math, difficult and was unable to express himself in writing. He was thought to be simple minded (retarded), until it was realized that he was able to achieve by visualizing rather than by the use of language. He work on relativity, which revolutionized modern physics, was created in his spare time.

Stephen Hawking
Stephen Hawking is a physicist/mathematician who has Lou Gehrigs Disease. He uses a wheelchair for mobility and a computer to speak.

Helen Keller
Helen Keller was suddenly shut off from the world at the age of 19 months by the loss of sight and hearing. Against overwhelming odds, she waged a slow and difficult but successful battle to re-enter the world. A near-savage deaf and blind mute child grew into a woman who wrote, spoke, and labored incessantly for the betterment of others and almost single-handedly destroyed age-old myths about people with disabilities.

John Milton
English Author/poet (1608-1674): He became blind at the age of 43. He went on to create his most famous epic, Paradise Lost.

Leonardo da Vinci
Leonardo da Vinci, an Italian painter, sculptor, writer, scientists, engineer, musician and architect. Renaissance genius. Strephosymbolis (unable to process symbols accurately).

George Washington
George Washington was unable to spell throughout his life and his grammar usage was very poor. His brother suggested that perhaps surveying in the backwoods might be an appropriate career for young George.

NOTES ON SKULL TUTORIAL

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NOTES ON JAUNDICE

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NOTICE

VERY SOON WE ARE GOING TO HAVE MAGAZINE/ARTICLE CORNER IN THIS BLOG IN WHICH WE ARE GOING TO POST  CREATIVE WRITINGS ON ANY TOPICS RELATED AND NOT RELATED TO MEDICAL FIELDS...
THE ARTICLES WILL BE COLLECTED FROM MORE THAN 100 MEDICAL COLLEGES ALL OVER THE WORLD....
TO SUBMIT YOUR ARTICLE MAIL TO :
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PLEASE DO NOT COPY THE ARTICLES FROM OTHER SITE ,,,

Musculoskeletal Pathology:Most know area

Musculoskeletal Pathology:Most know area




Hereditary Disorders



Osteogenesis imperfecta

· Many types

· Mutations of collagen type 1

· Multiple fractures

· Dentinogenesis imperfecta



Achondroplasia

· 20% autosomal dominant; 80% random mutations

· Most common form of inherited dwarfism

· Epiphyseal plates close prematurely

· Cor pulmonale



Osteopetrosis

· Autosomal dominant or recessive

· Osteoclast hypofunction causes very dense bone

· AR: severe, with anemia, nerve entrapment, hydrocephalus, infections, fractures

· AD: milder



Non-Neoplastic Disorders



Fracture

· Inflammatory phase (first week; clot and callus formation)

· Reparative phase (months; callus bridge)

· Remodeling phase (weeks-years; remodeling of callus)



Osteonecrosis

· Ischemic death of bone without infection

· Physical event: trauma, embolism, radiation

· Systemic disease: sickle cell, lupus, gout

· Toxic effect: corticosteroids, alcoholism



Myositis Ossificans

· Reactive bone formation within muscle

· Caused by trauma

· Looks like a neoplasm

· Lower limbs



Osteomyelitis

· Bone inflammation caused by infection

· Staph, Strep, E. coli, N. gonorrhea, H. influenzae, Salmonella

· Results from direct penetration or hematogenous spread

· Sequestrum (necrotic bone fragment) eventually covered by involucrum (new periosteal bone)



Osteoporosis

· Decreased bone mass per unit volume

· Normal ratio of mineral to matrix

· Primary occurs in elderly women (decreased estrogen, less exercise)

· Secondary occurs with corticosteroid use, alcoholism



Paget Disease

· Disorder of bone remodeling

· Three phases (hot, mixed, cold)

· Bones of skull: cotton wool appearance, hypercementosis of jaws

· Tests: alkaline phosphatase, urine hydroxyproline



Fibrous Dysplasia

· Monostotic

· Ground glass appearance on xray

· McCune Albright syndrome

· Jaffe syndrome



Osteoarthritis

· Most common joint disease

· Primary (cartilage defect), secondary (to trauma, crystal deposits, infection)

· Weight-bearing joints (knees, hips, spine) and hands

· Eburnated (very dense, ivory-like) bone, Haberden nodes



Rheumatoid Arthritis

· Chronic, systemic, autoimmune, inflammatory disease

· Symmetrical small-joint involvement

· Starts as synovial disease (hyperplastic synovium, pannus)

· Rice bodies, rheumatoid nodules



Gout

· Increased serum urate leads to urate crystals in joints, kidneys

· Primary or secondary (malignancy, alcoholism)

· Acute gout (podagra), tophaceous gout (tophi in ear, Achilles tendon)

· Histology: Granulomas with needle-shaped crystals





Muscle Disorders



Duchenne Muscular Dystrophy

· X-linked

· Deletion of dystrophin gene

· Degeneration of muscles

· Wheelchair-bound by age 10-15; death from respiratory insufficiency or arrhythmia



Myotonic Dystrophy

· Autosomal dominant

· Atrophy of type I fibers, hypertrophy of type II fibers

· Muscle weakness and sustained muscular contractions

· Gets worse from one generation to next

Asperger's Symptoms :A SYNDROME IN "MY NAME IS KHAN"

Asperger's Symptoms in Children 

Does your toddler have aspergers?

Asperger's Symptoms can be presented in a range of combinations. Both children and adults can exhibit any combination of aspergers behaviours in varying degrees of severity. This means that two children, both with the same diagnosis, can act very differently from one another and have varying skills.

The best way to understand Asperger syndrome is to think of it as a form of autism in smart kids.

10 Most Essential Asperger's Symptoms in Children 

1. Not pick up on social cues and may lack inborn social skills, such as being able to read others' body language, start or maintain a conversation, and take turns talking.

2. Dislike any changes.

3. Lack empathy.

4. Be unable to recognize subtle differences in speech tone, pitch, and accent that alter the meaning of others' speech. Thus, your child may not understand a joke or may take a sarcastic comment literally. Likewise, his or her speech may be flat and difficult to understand because it lacks tone, pitch, and accent.

5. Have a formal style of speaking that is advanced for his or her age. For example, the child may use the word "beckon" instead of "call" or the word "return" instead of "come back."

6. Avoid eye contact or stare at others.

7. Have unusual facial expressions or postures.

8. Be preoccupied with only one or few interests, which he or she may be very knowledgeable about. Many children with Asperger's syndrome are overly interested in parts of a whole or in unusual activities, such as designing houses, drawing highly detailed scenes, or studying astronomy.

9. Talk a lot, usually about a favorite subject. One-sided conversations are common. Internal thoughts are often verbalized.

10. Have delayed motor development. Your child may be late in learning to use a fork or spoon, ride a bike, or catch a ball. He or she may have an awkward walk. Handwriting is often poor.

Source: WeBMD.com

 

How Asperger Syndrome Affects Daily Life 

The syndrome manifests in many ways that can cause difficulties on a daily basis. Here are some examples of what to look for:

- Delayed motor milestones
- Difficulty in conversing
- Extreme shyness
- Mixing with inappropriate company
- Unusual and obsessional interests
- Quoting lists of facts
- Confusion
- Difficulty with multitasking
- Not understanding jokes or social interaction
- Being naive and trusting
- Delighting in fine details such as knobs on a stereo
- Lack of dress sense

Is There A Cure? NO! 

There is currently no known 'cure' for Asperger Syndrome. This does not mean, however, that nothing can be done to help your asperger child.

One of the worst problems is that you can never really understand what is going on inside your child's head.

This makes it so difficult for you to understand their behaviour.

This can leave you feeling emotionally beat up and completely useless as a parent.

You have to cope with crisis on a daily, hourly or even minute by minute basis.

You experience problems when you are at home,...

Is There A Help? YES! 

Although behaviors may change through the years, the problem will not go away. But there are strategies that can improve functioning and help families cope. Early diagnosis, behavior training programs, and careful educational management to help the children reach their maximum potential are well worth the effort.

There are some simple, easy-to-use practical tips and techniques that can save you ALL that stress, worry, physical pain and embarrassment...

The Parenting Aspergers Resource Guide is an excellent resource that I would recommend to any parent who has a child with Aspergers Syndrome.

It is full of really practical and easy-to-use information to help parents with their Aspergers child and also the rest of the family.

Learn effective methods which can have a really positive effect on Asperger Symptoms and Asperger Syndrome Behavior:

Eating broccoli and cabbage can assist in lowering blood pressure

London, July 11: Eating broccoli and cabbage can assist in lowering blood pressure, suggests a latest study.

The probable reason behind this is the presence of glutamic acid in high volume in broccoli and cabbage.
For conducting the latest study, researchers scrutinized the quantity of five amino acids in the diets of 4,680 volunteers, ages between 40 to 59 years, from the U.S., UK, China and Japan.
It was discovered that with an increase in glutamic acid content in their food, their blood pressure dropped down.
Study author Dr Ian Brown, an epidemiologist at Imperial College, London, was quoted as saying, “Glutamic acid may partly explain the link between vegetable protein and lower blood pressure.”
He added, “However there is no ‘magic bullet’ for preventing high blood pressure, and vegetable protein and glutamic acid are individual elements of a broader healthy eating pattern.”
Glutamic acid and its sources
Glutamic acid is one of the most widely found amino acids and forms nearly one-fourth of vegetable protein and one-fifth of the animal protein.
It is found in all types of meats, dairy products, poultry, fish and the seaweed kombu. Rice, soy products, breads, cereals and similar whole grain foods are other excellent sources of glutamic acid.
Researchers recommend that people should not pop up glutamic acid pills, instead they should eat foods containing this acid.
DASH recommended for blood pressure
Experts say that the ‘Dietary Approaches to Stop Hypertension (DASH)’ diet, which reduces blood pressure and is developed by the U.S. National Institutes of Health, should be followed.
The DASH diet is rich in fruits, vegetables, whole grains, lean poultry, nuts and beans.
The new study has been published in Circulation: Journal of the American Heart Association.

THE SPITTING COBRA

 THE SPITTING COBRA

The species of snake called the spitting cobra is very unusual as it not only has a poisonous bite but it also spits venom into the eyes of its prey and aggressors. Contact of this venom with your eyes is very painful and can even blind you temporarily, therefore, if you get cobra venom in your eyes, irrigate them with water at once in order to prevent permanent tissue damage.

The King Cobra (Ophiophagus hannah) is also remarkable in this large family of snakes (elapidae) because it feeds almost entirely on other snakes with mice and small birds also falling prey to its poison.

The King Cobra is also a record-holder because of its size – it can reach almost twenty feet (585 cms) in length, which makes it the largest poisonous snake in the world. The most recent discovery of a new species of cobra was made in 2003 as part of an illegal shipment of exotic pets at London Zoo.

DNA studies revealed that this new species of snake is similar to the red spitting cobra but has different genes. It seems to originate from an area between Sudan and Egypt and it has been called the ‘Nubian Spitting Cobra’.

Though highly dangerous when it is threatened cobras will not attack if you leave them alone, although the spit is very accurate for about two meters. Compared to the strike of a rattlesnake, the cobra is fairly slow in its attack and furthermore, many bites prove to be blank, that is without venom.

Statistics of a study conducted on Malaysian cobra snake victims indicate that only 55% of the bites involved poison release and the same statistics indicate a mortality rate of only 10% for people bitten, since the poisons injected into the blood of the prey destroy the nerves (neurotoxins), which induces respiratory failure approximately half an hour after being bitten, so you have 30 minutes to seek help.

The colouration is variable from light green-grey to black, while juveniles are yellow and black banded. This snake can find a habitat all over south-eastern Asia.

Use Google as a calculator.

Use Google as a calculator.


Google has a built-in calculator — try entering a calculation like 110 * (654/8 + 3). Yes, your computer also has a calculator, but if you spend most of your day inside a browser, typing your calculation into the browser’s search box is quicker than firing up your calculator app.

Liver, Pancreas, and Gallbladder Anatomy-Histology Correlate

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NOTES ON MUSCLE CONTRACTION

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NOTES ON MUSCLE PHYSIOLOGY

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QUIZ ON GASTROINTESTINAL PHYSIOLOGY

Gastrointestinal System Quiz - II

1. Which of the following listed diagnostic tests to be performed at the last?
A. Gall bladde series
B. Barium enema
C. Barium swallow
D. Oral choleycystogram

Answer Key

2. What type of diet should be provided to the patient sheduled for oral choleycystogram on the evening before the test?
A. Low-protein
B. High-carbohydrate
C. Fat-free
D. Liquid
Answer Key

3. What type of diet is indicated for a patient with colostomy for the first 4 to 6 weeks foolowing the surgery?
A. High-protein
B. High-carbohydrate
C. Low-calorie
D. Low-residue

Answer Key

4. Which is the appropriate mode of suction pressure and control indicated for stomuch decompression?
A. Low and continous
B. High and intermittent
C. low and intermittent
D. High and continous

5. Gastric juice contains:
A. Pepsin, lipase and renin
B. Trypsin, lipase and rennin
C. Trypsin, lipase and lipase
D. Trypsin, pepsin and rennin
Answer Key

6. Succus entericus is the name given to:
A. Intestinal juice
B. Junction between ileum and large intestine
C.Swelling in the gut
D. Appendix
Answer Key

7. Glycogen is:
A. Synthesised in liver, source of energy, forming bile and lipase
B. Disacharide stored in liver, reacts with amonia to form protein
C. Synthesied in blood, stored in liver, and muscle to provide glucose.
D. Polysacharide synthesised and stored in liver
Answer Key

8. Which ones are absorbed in the alimentary tract without any breakdown?
A. Proteins
B. Polysacharides
C. fat soluble vitamins
D. Albumin of egg
Answer Key

9. pH suitable for ptylin action is:
A. 6.8
B. 7.8
C. 3.2
D. 9.3
Answer Key

10. Choose the correct pair
A. Rennin-Casein
B. Protein-Amylase
C. Carbohydrate-Lipase
D. Maltase-Lactose
Answer Key

10. What is common among amylase, rennin and lipase?
A. All proteins
B. Proteolytic enzymes
C. Produced in stomuch
D. Act at pH lower than 7.
Answer Key

11. Which is a spcific gastric hormone?
A. secretin
B. Srotonin
C. Amphetamine
D. Trypsin
Answer Key

12. secretion of cholecystokinin is for:
A. Controlling blood pressure
B. Inducing peristalsis
C. Bile functions
D. Release of insulin
Answer Key

13. Average human live weighs:
A. 6. 0 kg
B. 5.0 kg
C. 0.5 kg
D. 1.5 kg
Answer Key

14. Digesive juice contains catalytic agents called:
A. Vitamins
B. Hormones
C. Enzymes
D. Nitrates
Answer Key

15. Human digestive juice lacks:
A. Lactase
B. Cellulase
C. Amylase
D. Sucrase
Answer Key


16. Cobalamine is required for the formation of:
A. Platelets
B. Leucocytes
C. Lymph
D. Erythrocytes
Answer Key

17. Digestive hormones secretin and cholecystokinin are secreted by:
A. Oesophagus
B. Stomuch
C. Ileum
D. Duodenum
Answer Key

18. Number of milk teeth in an toddler is:
A. 12
B. 20.
C. 32
D. 46
Answer Key

19. Which is NOT correctly matched?
A. Vit B12 -- Pernicious anaemia
B. Vit B6 -- Loss of appetite
C. Vit B1 -- Beri-beri
D. Vit B2 -- Pellagra

Answer Key

20. Glisson's capule is associated with:
A. Liver
B. Pancreas
C. Lung
D. Kidney
Answer Key

Answer Key
1. C 2. C 3. D 4. C 5. A


6. A 7. D 8. C 9. A 10. B


11. A 12. C 13. C 14. C 15.B


16. D 17. D 18. B 19. D 20. A

MY PROFILE

MY PROFILE



MY PROFILE

NOTES ON SHOULDER JOINT

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NOTES ON KNEE JOINT

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vinay kumar (PATHOLOGIST)

Vinay Kumar, MBBS, MD, FRCPath
Alice Hogge & Arthur Baer Professor

Chairman, Department of Pathology

Executive Vice Dean, Division of Biological Sciences

Contact

* visit U of C Directory *

Department of Pathology
The University of Chicago
MC 3083, S329
5841 S. Maryland Avenue
Chicago, IL 60637
Phone: 773.702.0647
Fax: 773.702.9379
vkumar@bsd.uchicago.edu
Research Interests


Our laboratory is interested in the cellular and molecular biology of murine natural killer (NK) cells. These cells are believed to act as the first line of defense against tumors and viral infections. In addition they secrete a variety of cytokines including 1FN-g and GM-CSF that can influence the inflammatory response. Two aspects of NK cell biology are of particular interest to us: the development of NK cells from multipotent progenitor cells, and the identification of NK cell receptors and their ligands. Textbook Publications


Kumar V, Abbas AK, Fausto N, Aster JA. "Pathologic Basis of Disease." 8th edition, W.B. Saunders Co., 2009 in press (with translations into Spanish, Portuguese, Italian, German, Turkish and Arabic).

Kumar V, Mitchell RM, Abbas AK, Fausto N. "Basic Pathology." 8th edition, W.B. Saunders, 2007 (with translations into Spanish, Portuguese, Italian, Chinese, Japanese, Hungarian and Croatian).

Mitchell R, Kumar V, Abbas A, Fausto N. "Pocket Companion to Robbins and Cotran Pathologic Basis of Disease." 7th Edition, Elsevier Saunders, 2006.

Klatt E, Kumar V. "Robbins and Cotran Review of Pathology." 2nd Edition, Elsevier Saunders, 2005.

Kumar V, Fausto N, Abbas A. "Robbins and Cotran Pathologic Basis of Disease." 7th edition, Elsevier Saunders, 2004.

How to perform better in exams

How to perform better in exams

Tests and exams are an inevitable part of learning. They’re not there to trip you up, but to measure how well you have understood the subject. Even if you know the content well, there are ways to help yourself perform better on the day.







Before the exam


During the exam


After the exam



Some people thrive on exams, others aren’t so fortunate. A disciplined approach will make your task easier, and - hopefully - improve your results



Before the exam



Your success starts before you even sit down for the exam.



Look at previous tests, and analyse how well you did, and where there could be room for improvement

Always arrive early for an exam. Arriving late will just add to your stress levels

Arrive with a good attitude: be positive, smile, and be confident

If you suffer from exam anxiety, read our article on how to manage exam stress.






--------------------------------------------------------------------------------



During the exam



Read the directions carefully, and slowly. You don’t want to make a careless mistake

Read through the whole exam before answering, to give an overall picture of your task

Answer easy questions first; that way you won’t get stuck on a tricky question and run out of time

Look for the key words in the question: there are usually one or two that will give you a clue

Don’t leave when you’re finished; review all your answers and double-check you’ve answered all questions correctly

Double-check your spelling, punctuation and grammar.






--------------------------------------------------------------------------------



After the exam



Be positive: think about those tasks you know you did well on

Avoid a ‘post mortem’. Discussing with other students how well you and they did, or didn’t do, will only drag you down

After the exam, don’t go back to study or work right away: give yourself some time off to relax doing something you enjoy.







--------------------------------------------------------------------------------

FIRST YEAR MBBS RESULT

CHECK OUT THE MBBS RESULT OF FIRST YEAR

NOTES ON HYMENOLEPIS NANA (dwarf tapeworm) by BIVEK SINGH

HYMENOLEPIS NANA (dwarf tapeworm)




• smallest tapeworm infecting man

• only human tapeworm which can complete its entire life cycle in a single host

• does not require an obligatory intermediate host

• man can harbor both adult and larval stages of parasite



DISTRIBUTION



• worldwide among children



DISEASES



• hymenolepiasis



MORPHOLOGY



1. Adult Worm

- found in the ileum

- delicate strobila that measures 25 to 45 mm x 1 mm (lw)

- Scolex

o Subglobular

o 4 cup-shaped suckers

o retractable rostellum with a single row of 20 to 30 y-shaped hooklets

- Neck

o long and slender

- Proglottids

o Anterior = short

o Posterior = broader

o Measures 0.15 to 0.3 mm x 0.8 to 1.0 mm (lw)

o Mature proglottids : contain 3 ovoid testes and one ovary

o Gravid proglottids :

 testes and ovary disappear

 uterus hollows out and becomes filled with eggs

 segments are separated from the strobila and disintegrate as they pass out of the intestines, releasing eggs in stool

- Segments

o 175 to 220 segments

o genital pores found along the side of segments



2. Eggs





- Shape : spherical or subspherical

- Measures 30 to 47 um in diameter

- Oncosphere

o thin outer membrane

o thick inner membrane with conspicuous bipolar thickenings

 4 to 8 hair-like polar filaments arise

 filaments are embedded in the inner membrane





H. nana cysticercoid



LIFE CYCLE



- Dual pathway



1. Direct

• host ingests eggs which hatch in the duodenum

• liberated embryos penetrate mucosal villi

• develop into infective cysticercoid larvae

• larvae break out of villi and attaches to intestinal mucosa 4 to 5 days later

• develop into adults



2. Indirect

• infection is usually via accidental ingestion of infected arthropod intermediate hosts like rice and flour beetles (Tenebrio sp.)

• cysticercoid larvae are released and will eventually develop into adult tapeworms in the intestines of the host

- takes 20 to 30 days from time of ingestion for eggs to appear in the feces

- eggs are viable immediately after discharge from bowel

- autoinfection can occur through the fecal-oral route or w/in the small bowel

- oncospheres from eggs are released and they invade the host villi to start new generation



PATHOGENESIS AND CLINICAL MANIFESTATION



• symptoms are produced because of patient’s immunological response to the presence of the parasite

• asymptomatic – light worm burden

• clinical manifestations:

o headache

o dizziness

o anorexia

o pruritus of nose and anus

o diarrhea

o abdominal pain

o pallor

• infected children

o restless

o irritable

o exhibit sleep disturbances

o convulsions (rare)

• Heavy infections

o Enteritis due to necrosis and desquamation of the intestinal epithelial cells

• Regulatory immunity

o (time) clears H. nana spontaneously.



DIAGNOSIS



• specific diagnosis = demonstration of characteristic eggs in stool

• light infections = need to concentrate stool specimens

• proglottids are not recovered because they undergo degeneration prior to passage with stools



TREATMENT



• *Praziquantel = 25mg/kg single dose

o causes vacuolization and disruption of tegument in the neck region

o dosage for hymenolepiasis is higher than for taeniasis because of relative resistant cysticercoids in the intestinal tissue

• examine stool after 2 weeks

o repeat treatment to cover for the worms emerging from remaining viable cysticercoids





EPIDEMIOLOGY



• found in warm countries

o Southern USA

o Latin America

o Mediterranean

o East Asia

o Philippines

• Transmission : poor sanitation, overcrowding, poor personal hygiene

• Direct contact plays an important role because eggs cannot survive long outside host

• Familial and institutional infection

• Found in mice and rats



PREVENTION AND CONTROL



• involves a single host and transmission is direct

• personal hygiene and environmental sanitation

• rodent control

• prevent food from infections by grain beetles



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BIVEK SINGH

Gallstones

Bile contains cholesterol, bile pigments and phospholipids - if concentrations vary stones can form

Pigment stones - small, friable and irregular, caused by haemolysis

Cholesterol - large, often solitary. Associated with F, age and obesity

Occur in 8% over 40, 90% are asymptomatic.

Risks for becoming symptomatic - smoking, parity

Stones may cause;



Acute or chronic cholecystitis

Bilary colic

Pancreatitis

Obstructive jaundice

Acute cholecystitis



Follows stone or sludge impaction in the neck of the gallbladder

May cause continuous epigastric or RUQ pain (referred to right shoulder), vomiting, fever, local peritonism or a GB mass

The main difference from biliary colic is the inflammatory component - local peritonism, fever, raised WCC

If the stone moves to the CBD, obstructive jaundice and cholangitis may result

Murphy’s sign positive - place fingers over RUQ and get patient to breath in, then repeat on the LUQ

Tests - raised WCC, ultrasound - thick walled, shrunken GB, pericholestatic fluid, stones? CBD - dilated >6cm? AXR only shows up 10% of stones

Treatment

NBM, analgesics, IV fluids and antibiotics e.g. cefuroxime

Cholecystectomy

Chronic cholecystitis



Stones causing chronic inflammation and colic

Vague abdo pain, distension, nausea, flatulence and fat intolerance

US used to check for stones and CBD dilation

Treatment - cholecystectomy

Biliary colic



Occurs when gallstones become symptomatic with cystic duct obstruction or by passing into the CBD

Give RUQ pain, radiating to back plus jaundice

Give morphine plus an antiemetic

Elective cholecystectomy





Other presentations



Obstructive jaundice with CBD stones

Cholangitis - bile duct infection

Gallstone ileus - a stone perforates the GB entering the duodenum where it may obstruct the terminal ileum. Duodenal obstruction is rarer - Bouveret’s syndrome

Pancreatitis

Empyema

Complications of gallstones;



In the gallbladder;

Biliary colic

Acute and chronic cholecystitis

Empyema

Mucocoele

Carcinoma

In the bile duct

Obstructive jaundice

Pancreatitis

Cholangitis

In the gut;

Gallstone ileus

High-risk profession: Suicide rate of U.S. doctors is one per day

More than a quarter of primary care doctors reported being "burnt out," in part due to worsening time pressures and a chaotic work pace, which were "strongly associated with low physician satisfaction."

300-400 doctors in the United States kill themselves every year, or roughly 1 per day. Male doctors have suicide rates 1.4 times that of the general population, while female doctors have twice the rate of depression and 2.3 times the suicide rate when compared with women who are not physicians.

References:

Help for Today's Tense, Frustrated Doctors. Medscape, 2009.

http://www.medscape.com/viewarticle/710904

Image source: Vincent van Gogh's 1890 painting At Eternity's Gate. Wikipedia, public domain.

Eating chocolate with high flavanol levels can protect the skin from UV light

Cocoa beans fresh from the tree are exceptionally rich in flavanols. Unfortunately, during conventional chocolate making, this high antioxidant capacity is greatly reduced due to manufacturing processes.

The researchers evaluated the photoprotective potential of chocolate consumption, comparing:

- conventional dark chocolate

- specially produced chocolate with preserved high flavanol (HF) levels.

A double-blind in vivo study in 30 healthy subjects was conducted, 15 subjects were randomly assigned to either a high flavanol (HF) or low flavanol (LF) chocolate group and consumed a 20 g portion of their allocated chocolate daily.

The minimal erythema dose (MED) was assessed at baseline and after 12 weeks.



In the high flavanol (HF) chocolate group the mean MED more than doubled after 12 weeks of chocolate consumption, while in the LF chocolate group, the MED remained without significant change.



The authors concluded that regular consumption of a chocolate rich in flavanols confers significant photoprotection and can thus be effective at protecting human skin from harmful UV effects. However, conventional chocolate has no such effect.

Can a Midday Nap Make You Smarter? Adults Who Nap for 90-minutes at 2 PM Learn and Perform Better at Tests

According to a new study, if you devote your lunch hour to a nap, you may perform and learn better in the afternoon.


Napping at midday, when the brain's ability to learn may have deteriorated, may clear the brain's memory "storage area" and make room for new information.



In the study, the nap group was given the chance for a 90-minute siesta at 2 p.m.; the no-nap group was asked to stay awake.



People in the group which didn't nap had a 10% reduction in their learning capacity. The people who had a nap improved their ability to learn by 10% (not much).





References:

Can a Mid-Day Nap Make You Smarter? WebMD.



Image source: Sleeping kitten. Wikipedia, Tilman Piesk, public domain.

B-BLOCKER BLOOD PRESSURE PILLS HAVE BEEN USED FOR STAGE FRIGHT BUT MAKE SOME DEPRESSED AND SLOW HEART RATE

Some people are so nervous that they are anxious about their anxiety. "A blood pressure pill could help people forget bad memories, according to a Dutch study published Sunday". I am not sure if this is exactly news because beta blockers in small doses have been profferred as a treatment for some kinds of anxiety for quite a long time. According to the interesting musician's web site below "Beta blockers have been called "the musicians underground drug." Often musicians form their opinions, and may risk their health, based on locker-room-type information". But like almost everything in medicine different people react differently to the same drug. Some people actually get more depressed on beta blockers.




Beta blockers are a class of heart cardiovascular and blood pressure pills that have the effect of slowing the heart beat. They work on the so called beta receptors. They can be dangerous in certain conditions such as when a person already has a slow heart rate and they can worsen diabetes and increase asthma problems.
"The generic beta-blocker propranolol weakened a person's fearful memories of spiders in the test group, making it a possible treatment for individuals with anxiety disorders and phobias.We could show that the fear response went away, which suggests the memory was weakened," said Merel Kindt, a psychologist at the University of Amsterdam, who led the study".

What Does Monty Python Have to do with the Heart?

I went to a cardiologist yesterday and he told me to go watch the movie Ferris Bueller's Day Off or Monthy Python... Actually that didn't happen but it could have. Watching a funny movie could be good for your heart. "Laughing may be important to maintain a healthy endothelium, and reduce the risk of cardiovascular disease,” says principal investigator Michael Miller, M.D., director of preventive cardiology at the University of Maryland Medical Center". Using laughter-provoking movies to gauge the effect of emotions on cardiovascular health, researchers at the school suggest that laughter is linked to healthy function of blood vessels. The endothelium is the inner lining of the blood vessels. You may not know it but the blood vessels can dilate (become wider). One of the signs of good cardiovascular function is the flexibility of the blood vessels to dilate. Interestingly, drugs like Viagra improve the dilation qualities of blood vessels. That is how it was discovered when scientists were looking for new heart medicines. Too much dilation can cause low blood pressure and thus the warnings about these drugs in some people, but I digress.