What your face says about your health

Face is one of the most important parts of the human body. People do various things to keep it good as much as possible. They clean it and make it more beautiful. It is the most important part of the human body that is involved in communication. The Face of a person is designed by the nature to express many things. It can reveal physical, psychological and social status of a person. It also gives a lot of information regarding your health.

 Anatomically, the face is composed of 4 basic layers. They are the bones, muscles, fat and the skin. All these layers contribute to the appearance of your face. Some diseases affect one or several of these layers. As a result they produce signs that help to identify various disease conditions. Some of these diseases are minor, but some can be very dangerous.

Your hair plays a major role in giving your face a great look. The amount of hair you have says a lot about your health. There are several diseases that cause hair loss. This condition is called alopecia. Alopecia can be diffuse or scarring. Diffuse alopecia can be due to a thyroid disease. Both hyperthyroidism and hypothyroidism causes alopecia. Another very important disease that causes alopecia is systemic lupus Erythematosis. It is a connective tissue disorder which is more prevalent among women. 

Eyebrows also say a lot about your health. People with hypothyroidism can easily be identified by the amount of hair they have in their eyebrows. Hypothyroidism causes the eyebrows to thin out. Your eyes are capable of giving a lot of information regarding your health. As many of you may have noticed, every physician never forgets to check your eyes when you consult them. Yellowish discolouration of the eyes is very easy to identify. This condition is also called jaundice or icterus. Jaundice can be deep jaundiced or it can be lemon tinge. Jaundice occurs as a result of a defect in billirubin metabolism. There are two types of bilirubin in the body. They are conjugated bilirubin and unconjugated bilirubin. Conditions such as hemolysis increases plasma unconjugated bilirubin level that gives a lemon tinge to the sclera. When there is an obstruction to the bile excretion, the conjugated bilirubin levels increases, giving rise to deep icterus. Pallor can be identified by looking at your eyes as well as your skin. Pallor is caused by anemia. If your have a dark skin, you may not be able to identify pallor by looking at the skin. You have to check your eyes to identify pallor in such cases. Eyes can also say about your serum cholesterol level. If you are having hypercholesterolemia, you may have corneal arcus. Corneal arcus is a whitish band that is present around your iris. Xanthalasma is another sing of hypercholesterolemia. 

Your nose also reveals a lot about your health status. If there is a skin crease on the bridge of your nose, it means that you are suffering from allergic rhinitis. In allergic rhinitis, you tend to rub your nose up whenever your nose is irritated. Your mouth also says a lot about your health. If there are oral ulcers, it means that you are suffering from anemia. It can also be a result of a connective tissue disorder such as SLE. The tongue is also a part of the face. It also says a lot about your health. A smooth tongue indicates anemia or vitamin B 12 deficiency. 

There are many other diseases that can be identified by looking at your face. Only some of them are mentioned above.

How can the Glomerular Filtreation Rate be Increased in Chronic Renal Failure?

Chronic renal failure is defined as gradual deterioration of glomerular filtration rate.. It can occur over a period of time,which can vary from months to years. The severity of renal failure is assessed by the amount of reduction in glomerular filtration rate. The  glomerulat filtration rate (GFR) is usually calculated by using the the creatinine levels of the body. It is calculated by using the following formula. 

GFR = {1.23 * [140 - age (years)] * weight (Kg) }/ plasma creatinine (micro mol/l)

Creatinine is released in to the plasma by muscles. The amount of creatinine released in to the circulation is fairly constant. These creatinine molecules are excreted from the body by the kidneys. Most of them are filtered through the glumeruli and a small amount is secreted from the renal tubules. In chronic kidney disease, when the renal tubules get damaged, the amount of creatinine secreted from the renal tubules can increase. As a result, more creatinine is excreted from the body. Ultimately the plasma creatinine levels reduces despite of existing renal damage. So, the GFR increases when calculated from the above formula. 

Therefore, there should be a more accurate method to calculate GFR. It is done by measuring the clearance of radioactive EDTA or lohexol, a non ionic contrast medium.

Is Jaccoud's arthropathy seen in Systemic Lupus Erythematosus Reversible?

Systemic Lupus Erythematosus is systemic diseases which affects several systems of the body. One of its main systemic effects is arthropathy. Patients with systemic Lupus Erythematosus has a non erosive type of arthropathy. The effects of the disease on the joint can present in various ways. Jaccoud's arthropathy is one such type of presentation.

Jaccoud's arthropathy is a type of deforming arthropathy. The deformities in Jacccoud's arthropathy includes ulnar deviation of second to fifth fingers and subluxation of metacarpophalangeal joint. Toes can also have the same kind of deformity. These deformities are mainly due to laxity of the capsule. Even though the deformity is chronic, it can be reversed.

Are Psychiatric Disorders are Common Amnog Mental Retarded people?

Scientists have found that psychiatric disorders are more common among mentally retarded people. Most of the children with mental retardation are depressed. This can be partly due to the illness itself and partly due to difficulties they face in their life. Mentally retarded children are more prone to get abused. When a child get abused, it impacts his or her mental status very badly. If the child faces these psychological trauma over and over again, development of psychiatric disorders such as depression is inevitable.

Do Mentally Retarded Children Truely Have Poor Memory?

Poor memory of mental retarded children is a common complain doctors hear from their parents. They complain that their child does not remember anything that they teach them, but is it really due to poor memory? The truth is that it is not due to poor memory. The problem in mentally retarded children is difficulty in understanding. Everybody, even a normal person tend to forget things easily when they don't understand them. So, same thing happens to mentally retarded children. When they don't understand, they forget. 

For example, if you tell your child that you will bring him or her a chocolate in the evening, they will remember it and wait till you come in the evening to take the chocolate. That indicated that their memory is very good. So, their memory is good, but their ability to understand is very poor.

Mental Retardation is Changed to Intellectual and Development Disabilities

Mental retardation is used to call people who have learning difficulties. The term has been considered inappropriate. There was a need for an proper word to address these people. Now, according to the ICD 11, the term is replaced by 'intellectual and development disabilities'. This new term addresses and describes people with learning difficulties very well.The new term gives more respect to such people.Even though 'mental retardation' is still been widely used, even among medical professionals, the new term will come in to use in the near future.

Are Hump Nose Vipers (Kunukatuwa) in Sri Lanka Venomous?

Snake bites are very common in Sri Lanka.Hump nosed vipers are usually considered to be mild to moderately venomous snakes.  In central province, the commonest snake bites are caused by the hump nosed viper. They also exists in the dry zone too. Many people who present to Kandy and Peradeniya Hospitals do not show systemic envenomation. But, some of the hump nosed viper bites reported in the dry zone have shown to cause severe systemic reaction. This can be because the venom in snakes in dry zone is more concentrated than that  in snakes in the wet zones.

When a person presented with a history of snake bite, he is examined to identify the fang marks. Presence of fang marks do not always indicate that the venom has been injected to the body. Therefore, the patient is observed for reactions. They are usually given a dose of steroids to reduce inflammation and antibiotics if there is a wound.

The antivenum serum used in Sri Lanka is important from India. It is not effective against hump nosed viper. Therefore, it should not be given. Earlier the standard practice was to give the antivenom serum for hump nosed viper bites too. Bit, they have found out that it causes more harm than benefit. 

How to and where to Inject Insulin?

Many people with diabetes mellitus come to point where they have to inject insulin. In such cases they have inject insulin at least two times a day. That means you will have to prick your skin at least sixty times a month. Pricking the same site of the skin for a long time can damage the skin. Insulin itself acts on the tissues surrounding the injection site and aggravates the tissue damage. Therefore, it is important that you know the correct method and site of insulin injection to minimize tissue trauma.

When injecting insulin, the preferred site of injection is around the umbilicus. You can also inject insulin to the upper outer aspect of the arms and to the outer aspect of the middle one third of the thighs. umbilicus is regarded as the best place to inject insulin. This is because its blood supply is very low. When there is less blood supply, insulin is absorbed in to the circulation very slowly. Therefore, the risk of hypoglycemia is very low. The next preferred place of insulin injection is the arms. Legs have the highest rate of absorption. This causes rapid reduction of blood glucose. Therefore, you can develop hypoglycemia very quickly.

Always follow the following steps when injecting insulin.

1. Check the insulin vial. If you are using soluble insulin, the solution should be clear and colorless. If you are using a suspension, it should be uniformly cloudy. If there is any abnormality, discard the vial and take a new one. Clean the top of the vial with alcohol. Check the insulin pen for the same abnormalities if you are using an insulin pen.
2. Prepare  the site. The site is best prepared by cleaning with alcohol. But, if alcohol is not available, maintaining a good hygiene by cleaning yourself daily is enough.
3.  Draw air in to the syringe. The amount of air drawn is same as the dose you are going to take from the insulin valve. Then inject the air in to the insulin valve. Now you can easily draw out the amount of insulin you want.
4. If you are going to inject insulin to a site around the umbilicus, take a point two finger breadths away from the umbilicus. Likewise go inject subsequent doses around the umbilicus for a month. Then choose another side to inject insulin. For example, the arms. Inject insulin to one arm for a month and then change it to the other arm. Rotating sites like this allows the site to heal.
5. The angle of insulin injection is usually 90 degrees. Bit, if you are a very thin person and going to inject insulin to a place with minimum fat content you can inject in 90 degree angle but, insert only half of the length of the needle. If not, you can insert the needle in a 45 degree angle to avoid going in to deep structures other than the fat tissues. 

Types of canker sores

Canker sores, also known as aphthus ulcers are a type of ulcers that occur in the gutters of the mouth tongue or cheeks. Even though small, they can cause extreme discomfort during talking and eating. Sores usually develop as a result of trauma to the skin, but canker sores can develop as a result of nutrient deficiency and stressful lifestyle. Scientists have found out that certain kinds of foods can also cause canker sores. These ulcers are usually small, oval shaped, shallow and painful. There are two types of canker sores. They are simple canker sores and complex canker sores. Complex canker sores are also known as periadenitis mucosa necrotica.

Simple canker sores usually appear three or four times a year. They initially present as an areas of tenderness. Then they gradually turn in to small red papules. These red papules then quickly turn in to ulcers. The ulcer measures about 2-5 mm. They are usually grey in colour and have a red areola. These ulcers usually present in groups of 2-5 tiny sores. Therefore, they are called herpetiform aphthae. They usually heal within a week or two.

The sites of the complex canker ulcers are the same as simple canker ulcers, but they are more common in the back of the mouth. The sequence of development of the ulcer is also identical to that of simple canker sores. These two types of ulcers differ from each other according to the size of the ulcer and the frequency of presentation. Major canker sores are considered to be larger than 1 cm in size. People who present with complex canker sores commonly have a previous history of similar attack. Complex canker sores can be extremely uncomfortable due to their larger size and the site. Unfortunately these ulcers can persist up to one month. Behcet’s disease can cause confusion in patients with complex canker sores.

Differentiation of two types of canker sores requires thorough examination of the ulcer. Investigations are usually not required because their presentation and the appearance are diagnostic. Even though these ulcers are benign, they can interfere with the day to day activities. Therefore, it is better to prevent these ulcers. Simple measures such as minimizing the trauma during tooth brushing and avoiding stress can be taken to prevent these sores. Application of topical corticosteroid gel at the early stages of the ulcers minimizes the life span of the ulcers.

Is Left Sided Chest Pain is Always Due to Heart Attack

Everybody knows that the heart is situated in the left side of the chest. Therefore, many thick that heart attacks always causes left sided chest pain. But, this is not true in most of the cases. Many people who present with left sided chest pain are finally diagnosed to have some other disease such as gastroesophageal reflux disease, pneumonia, musculoskeletal pain etc. People with heart attacks (ischemic heart disease) usually present with constrictive or tightening type of central chest pain.

Heart is a visceral organ. Therefore, it is supplied by the autonomic nervous system.As a result it gives rise to phenomenon called 'referred pain'. That is why the patients usually complains of radiation of pain to the upper arm, shoulders, neck jaw etc. 

In some instances heart attack can present with no chest pain at all. This is commonly seen in uncontrolled diabetes patients because, their nervous system has been damaged due to hyperglycemia.

Organophosphate Poisoning and Atropine Poisoning

Organophosphate poisoning is a common method of suicide and suicidal attempt, especially in developing countries. Most of these people present to the primary care units of the hospital. Organophosphate inhibits the enzyme acetyle cholinesterase. It is the enzyme responsible to remove excess amounts of acetyle choline from the body. As a result there is increased cholinergic activity throughout the body. Acetyle choline has two types of receptors. They are muscarinic receptors and nicotininc receptors. Organophasphate causes overstimulation of both of these receptors. As a result the person's pulse rate reduces, his pupils become pin point and his air ways begin to accumulate secretion. He also begin to have increased salivation and increased sweating. 

The antidote to treat organophosphate poisoning is atropine. It is a muscarinic receptor antagonist. It is given to everybody who present with symptoms of organophosphate poisoning. The patients are adequetly atropinised until the sings of organophosphate disappear. Sometimes the patients are over atropinised. As a result they show sings and symptoms of atropine poisoning. So, the person becomes tachycardic.

When to Worry About Back Pain

Back pain is a common complain among people. Everybody experiences back pain at some point in their life. But back pain in very young and older people needs special attention. If your age is below 20 years or over 55 years, the back pain can be a result of a serious disease condition. Therefore, if it is persisting and aggravating you should immediately seek for medical attention.If back pain arises suddenly in an elderly person, it too can be due to serious problem.

You should also worry about back pain if it is continuously increasing in intensity and severity. If the back pain persists even in the night, it indicates that it requires immediate medical attention. Lumbar spondylosis is a  common cause for back pain. This can lead to lumbar spondylolysthesis, if it gets worse. In such cases the intervertebral disk can compress the spinal code and the nerve roots and cause serious neurological defects. In such cases the back pain gets worse when lying in the supine position because, it puts more weight on the lumbar spine causes it bulge out.

Another serious cause of back pain is spinal tuberculosis. People with spinal tuberculosis will have night sweats, evening pyrexia, loss of appetite and loss weight in addition to back pain. Bones are common places for secondary tumor deposition which leads to back pain. Breast and prostatic cancers are the ones that are more likely to have secondary bone deposits. Therefore, you should worry about back pain if you have a past history of cancer.

If you have other symptoms such as weakness or numbness of the limbs, the nerves might have also affected. It gives rise to neuropathic pain. Neuropathic pain arises when a nerve is compressed. It is very common in the legs and it  can be differentiated from claudication and venous pain by using the symptoms and signs the person has.People with reduced immunity should also take back pain seriously because they are more prone to infections.

Back pain is a very common condition. Most of the time it disappears on its own. But, especial attention should be payed if it is associated with any of above mentioned risk factors.

Ambulatory Blood Pressur Monitoring and White Coat Hypertension

The blood pressure level is very important in diagnosing hypertension. The type of treatment is also decided according to the level of blood pressure. Therefore, it is very important to measure the blood pressure correctly. The correct measurement of the blood pressure depends on correct selection of blood pressure cuff, the position of the cuff and the patient and the psychological state of the patient. 

The blood pressure of person is determined by the cardiac output and the peripheral resistant. The cardiac out put is determined by the heart rate and the end-diostolic volume. When a person is anxious, his sympathetic nervous system gets activated. The sympathetic output increases the person's heart rate. It also causes constriction of blood vessels. As a result the blood pressure increases.

Some people feel anxious when they are with a doctor. As a result his blood pressure rises. This is called white coat hypertension. If a person with white coat hypertension is diagnosed as a hypertensive person, he will have to spend the rest of their lives taking unnecessary drugs. Prevention of this from happening is very important. This is where the ambulatory blood pressure monitoring comes into play. 

In ambulatory blood pressure monitoring, a device is attached to the patient and the blood pressure is continuously monitored. If the reports show that the person's blood pressure is high only when he is around, it is white coat hypertension, so it doesn't need any treatment. 

Ambulatory blood pressure monitoring can also detect the absence of diurnal variation of the blood pressure. It is a feature of severe hypertension.

Can Blood Pressure in a Hypertensive Lady Fall During Preganacy?

Hypertension is a common illness nowadays. Even though hypertension is known to affect adults, it can also present in young people, especially when they are showing evidence of metabolic syndrome. Therefore, hypertension can present in pregnant women also. Sometimes the blood pressure of known hypertensive patients falls when they become pregnant. It is because the peripheral resistant falls significantly in pregnancy.

If Hypertension is diagnosed in early pregnancy, is it Pregnancy Induced Hypertension

By definition, pregnancy induced hypertension occurs after the 20th week of pregnancy. Pregnancy induced hypertension occurs as a result of abnormal placentation. Placenta is the part that is designed to absorb nutrition from the mother. Placenta acts as the interface which the baby's blood exchange nutrients and waste products with the mother's blood. In the placenta, the baby's blood vessels and the mother's blood vessels form a complex that allows this process. To create this complex, the mother's blood vessels should expand.

What happens in pregnancy induced hypertension is that the mother's blood vessels don't expand properly. As a result, the resistant against which the mother has to pump blood increases. This increases the mother's blood pressure. This expansion of the blood vessels occurs around the 20th week of gestation.

As described above, the blood pressure rise in  pregnancy induced hypertension occurs around 20th week of gestation. Therefore,  if the rise in blood pressure is discovered in early pregnancy, it is unlikely to be pregnancy induced hypertension. In such is cases, the most likely cause is pre-existing hypertension.

What is Chuvasch Polycythemia?

Chuvasc is a congenital autosomal recessive disorder. It associated with mutations of the Hipp-Lindau gene. This is a gene with produces produces proteins which are involved in oxygen sensing erythropoietin pathway production pathway. This results in increased production of erythropoetin.

What are the Genes Associated with Polycythemia Vera

More than 95% of patients with polycythemia Vera are found to have certain gene mutations. These mutations causes alterations of pluripotent progenitor cells. It leads to proliferation of erythroid, myeloid and megakaryotic cells. The mutated gene is Janus kinase 2 (JAK2).

How Long Does it Take to Muscle Wasting to Appear After Lower Motor Neuron Lesion?

Muscle wasting is a significant feature of lower motor neuron lesion. But, muscle wasting takes time. It takes about 2-3 weeks to appear. Muscle wasting can also appear in upper motor neuron lesion but, it is due to disuse atrophy.

How Long Does it Take to Muscle Wasting to Appear After Lower Motor Neuron Lesion?

Muscle wasting is a significant feature of lower motor neuron lesion. But, muscle wasting takes time. It takes about 2-3 weeks to appear. Muscle wasting can also appear in upper motor neuron lesion but, it is due to disuse atrophy.