What happens right before a C-section?

Cesarean section is the surgical procedure designed to deliver the fetus through the abdomen. It is the only way to deliver a baby when it cannot be delivered through the vagina. Anything that prevents vaginal delivery leads to cesarean section. Conditions such as contracted pelvis, large baby, anatomical abnormalities of the birth passage and obstructed labor prevent safe delivery of the fetus vaginally. These abnormalities leave cesarean section as the only hope to deliver the baby safe without damaging the mother as much as possible.

The preparations for the cesarean section are carried out from the moment the obstetrician decides to deliver the baby by a cesarean section. Then the mother is managed accordingly and a date for the C-section will be booked. The preparations for a C-section are started from the day before the surgery. You will be advised to stay without eating anything. The duration should be not less than 6 hours. This is done to keep your stomach empty at the time of the surgery to prevent regurgitation and aspiration of stomach contents. On the night before the C-section, you will be also given some other medications. These medications include an anxiolitic to ease your anxiety and an anti-emtic to prevent vomiting during the surgery. These medications will help you to sleep well at night.  

Usually an elective cesarean section is done in the morning. They will give you another dose of anxiolytic and anti-emetic. Before you are sent to the operation theatre, the doctor will check you to see how you and your baby are doing. He will check everything you need to undergo a surgery is present. For example, the presence of crossed matched blood is checked. C-section is a surgery that can lose a lot of blood. Therefore, blood should be preserved to give to the mother if such thing happens. He will also explain the procedure and answer any questions that you have. Then you will be sent to the operation theatre.

After you arrive to the theatre, the surgery will not be started right away. Still there are some procedures that you will have to undergo just before the surgery. The obstetrician and the anaesthetist will double check your medical records. Then you will be taken to the anaethetic room where you will be given anaesthesia. An intravenous cannula will be inserted and you will be connected to a saline drip. Usually, C-sections are performed under spinal anesthesia. Spinal anesthesia only anesthetizes the body below the waist line. Then you will be taken to the operating theatre. During this whole time you and your baby’s vital signs will be checked to see whether you two are doing fine. Just before the surgery a urinary catheter will be inserted and the perineal area will be shaved. Meanwhile, you will be connected to various machines to monitor your vital signs throughout the procedure.

C-section is a surgical procedure designed to deliver the baby abdominally when it cannot be done through the vagina. Sometimes the procedure is done when the parents specifically request to deliver the baby by a C-section. Like any other medical procedure, C-section also has some complications. Above mentioned pre-operative preparations are carried out thoroughly to minimize these complications. 

Medical conditions that can lead to a reduction in appetite

Reduction of appetite is an important symptom in medical practice. It is paid more attention because it can indicate an underlying serious illness. Most of these illnesses have treatment at their initial stages. Therefore, it is important to identify them before they advance. Any disease can give rise to reduction of appetite, but a significant reduction of appetite is a characteristic feature for some diseases.

Physicians consider several parameters when analyzing reduction of appetite. The duration is one among them. As mentioned earlier, any illness can result in reduction of appetite, but it is considered serious when it becomes significant. If you are having reduction of appetite for weeks or months, it is considered significant. Your physician will also inquire regarding the type of foods that you have reduced appetite for. The amount of food that you take for a meal is also inquired. Through this information, the physician will confirm the presence of reduction of appetite and the extent of the condition. Reduction of appetite and reduction of weight go hand in hand. So, it is important that you keep track of your weight to help the diagnostic process.

There are several illnesses that can give rise to reduction in appetite. Not only physical illnesses but also psychological illnesses can result in loss of appetite. It is a typical symptom of malignancies and tuberculosis. Loss of appetite is a diagnostic criterion for depression as well.

Malignancies

Reduction of appetite, loss of weight, fatigue and lethargy are characteristic features of malignancies. These symptoms are known as constitutional symptoms. The reason for most of these non-specific symptoms including reduction of appetite is the loss of balance between endogenous cytokines and their natural antagonists. 

Reduction of appetite is subjective, but loss of weight can be measured objectively. Therefore, physicians use the amount of weight lost during a certain period of time to quantify the severity of reduction in appetite.

Even though cancers are generally considered to cause loss of appetite, some cancers do not give rise to this characteristic feature. For example esophageal carcinoma is a malignancy with preserved appetite. This feature is also used for the diagnostic process of cancer. For example, both esophageal carcinoma and stomach carcinoma can give rise to difficulty in swallowing, but physicians can differentiate the two by the presence of reduction of appetite. As mentioned earlier, if the patient is having an esophageal cancer, there will be no reduction in appetite. On the other hand, gastric carcinoma is a well known malignancy to cause significant reduction in appetite.

Tuberculosis

Reduction in appetite is a characteristic feature of tuberculosis. Tuberculosis is a common disease in the developing world. The initial symptoms of tuberculosis can be very non specific. Therefore, there should be a high degree of suspicion to diagnose tuberculosis based on these non specific symptoms. Loss of appetite is a common symptom among them. It is usually associated with other constitutional symptoms such as loss of weight, fever, night sweats, etc.

Depression

Not only medical conditions, but also psychological conditions can cause reduction in appetite. Depression is one such psychological disorder. It is one of the diagnostic criteria of depression according to the ICD 10 classification.

Apart from malignancies, tuberculosis and depression there are many other diseases that can give rise to reduction in appetite. Even simple viral fever, cold, gastroenteritis can have reduction of appetite. So, it is an important symptom that can be used to identify many illnesses. 

Possible causes of genetic mutations in animals

Genes carry tons of information regarding structure and function of the animals. Almost everything in animals’ body is controlled by the genes. The skin color, the height and even the emotions are primarily controlled by the genes. Genes are situated in almost all the cells of animals. Each cell has a copy of genetic materials. Most of the genetic material is contained within the nuclei of the cells, but a very little amount is contained within the mitochondria.  These genes express proteins that finally control the function of those cells. Genes are the main control centre of a cell.

Any change in the structure of the genome is called a mutation. The genome is composed of nucleotides. Information is stored according to the nucleotide sequences. A single change in arrangement of these nucleotides results in a mutation. As a result, a defective protein is made instead of a correct one. The structure or the function of the cell is changed according to the gene involved. Most of these mutations give rise to abnormal animals, but some has contributed to the evolution of present animals. Therefore, mutations can be harmful or helpful according to the outcome of the mutation.

As mentioned earlier, a single change in nucleotide sequence can give rise to a mutation. These changes can occur at any time during life. Some mutations occur when the cell is replicating (dividing). Some mutations occur as a result of an outside force. As mentioned earlier, even a change in one nucleotide can result in a mutation. Therefore, even a very little force from outside can change the genome. There are many such causes of genetic mutations in animals.

Mutations Occurring During Cell Replication

Cell replication results in production of two identical cells. In order to achieve this task, a copy of each and every part of the cell should be synthesized, so they can be equally divided among the two daughter cells. This involves the synthesis of genetic materials as well. Anything that interferes with this process gives rise to a mutation.

Ultraviolet Light

Ultraviolet light may be the commonest cause of mutations in animals. The rays of the sun contain light. Some part of sun light is composed of ultraviolet light. Ultraviolet light has the ability to act on animal cells and change the structure of genetic materials. Skin is widely opened to the sun light. Therefore, it is at a high risk of developing mutations. This is why people are advised to use sun cream when they are going out.

Nuclear Radiation

It is a well known fact that nuclear radiation gives rise to mutations. This is proven by the deformities seen among the victims of nuclear bomb explosions (E.g.: People of Hiroshima). Radiation is also used in medicine for various purposes. It is used in radiology for imaging. It is also used as a therapeutic material to kill cancer. Unwanted exposure to any of these procedures can result in mutation.

 Chemicals

Chemicals can also cause genetic mutations. Chemicals can enter the cells and directly damage the genome. This finally results in mutations. Examples of chemicals that can cause mutations are hydroxylamine, alkylating agents, base analogues etc. Oxidants can also cause mutations. That is why people are advised to eat fruits with anti-oxidant. Vitamin C and E contained within fruits act as antioxidants and prevent formation of mutations.

Mutations usually results in deformities, but rarely, they are helpful for development of new structures or functions of an animal that helps in evolution of animals. Knowing the causes of mutations is important to understand the behavior of genes. 

How to support a loved one that is quitting smoking

Quitting smoking is not an easy task. The smokers need help when they are quitting. This is where family members’ and friends’ roles become very important. The first thing that you should have before you support a loved one quit smoking is empathy towards the person. Empathy is the capacity to recognize emotions that are being experience by another person. To develop empathy towards a person who is addicted to smoking requires proper understanding about the pathology of addiction.

The general idea towards a smoker is that he is not quitting smoking because he doesn’t want to. The will does play a major role in quitting smoking, but sometimes the smoker may not succeed in quitting smoking because they are strongly addicted to it. When a person is addicted something, it is very hard to get rid of it. When a person takes an addictive substance, the chemicals in the brain change. With time, the brain cells loose the ability to stay without that addictive substance. When the concentration of that substance in the brain reduces, the person experience unpleasant feeling and sensations which leads them back to taking the substance. The same thing happens to a smoker also. Therefore, the first thing you should understand is that difficulty in quitting smoking is not entirely their fault.

Encouraging the person to quit smoking is very important. When your loved one is try to quit smoking you must do everything you can to admire his decision. Frequent admiration, encouragements and reminding of the benefits of quitting smoking make it easy for a person to quit smoking. If you keep on reminding him, it will be a great help for him to get over overwhelming feelings of smoking.

People, who are quitting smoking, get the idea of smoking again more frequently. They always get the desire to smoke again. They have got used to keeping something in their fingers and in their mouth for a long time. Therefore, if you can provide your loved one to find things that he can keep in his hands and something to put in his mouth, it will be a great help. You can provide him some hard candy. You can also prepare some fruits or vegetables (carrots) that he can put in to his mouth whenever he wants.

Smokers who are trying the quit often gets the idea to smoke again, especially when they are free and along. At such times, the person is at very high risk of smoking again. The best way to prevent this is by keeping the person busy throughout the day. Always try to stay with the person. Always try to find something for him to work on, so he doesn’t have much time to think about smoking.

Reducing other stressful situations in the person’s life is very important. Quitting smoking itself is a very stressful situation. Therefore, your loved one must be in real stress. They must have got used to smoking especially when they are under stress. Therefore, by removing other stressful situations from his life, you can make the process of quitting smoking much easier. Never forget to reward your loved one. Rewarding the person for taking this life changing decision encourages him to hang on to quitting. It will help him to get over the feelings of smoking again.

Quitting smoking is not easy. It requires the help of loved ones. Understanding the pathology behind smoking and about the way the brain works helps to understand the situation/

How to Identify the Cords of Brachial Plexus in a dissected Specimen

brachial plexus supplies nerves to the upper limb. The books describe the cord of the brachial plexus nicely in relation to the axilllary artery. The cord lateral to the artery is the lateral cord. The cord medial to the artery is the medial cord. The cord posterior to the artery is the posterior cord. But, when it comes to dissected specimen of brachial plexus, at ones it might look like a total mess. Therefore, the students usually find it confusing to identify each cord and its branches. 

First start with simple things. Then you can read more and go in to details. First the way to identify the main 3 cords, their terminal branches and their main branches will be described. When you are given a dissected specimen of brachial plexus, first try to find out the muscularcutaneous nerve. Muscularcutaneous nerve passes laterally in to a muscle in the arm. You will see this nerve piercing through the muscle. This muscle is called coracobrachialis. Once you identify this nerve, the rest is easy. 

Now trace the nerve backwards towards the plexus. The you will find the cord which the nerve arise from. This is the lateral cord. Now you will see that there is another branch arising from the medial aspect of the lateral cord. That is the lateral root of the median nerve. This branch goes downwards and units with another short branch coming from the medial side. That is the medial root of the median nerve. The nerve formed by the union of these two roots is the median nerve.

Now trace the medial root of the median nerve up to find the medial cord. You will see that the medial cord continues downwards along the medial aspect of the arm. That is the ulnar nerve. Now that you have identified the medial and lateral cords, median nerve and the ulnar nerve, the remaining cord posterior to the artery is the posterior cord. Now isolate the posterior cord and look carefully. You will see that the cord goes through the muscles of the upper arm. that is the radial nerve. Higher up in the posterior cord, you will find a branch arising. This branch goes through muscles of the arm. That is the axillary nerve. Now that you have identified the 3 cords and their main and terminal branches, it will be easier to find out the rest. 

Veins Without Valves

Generally veins have valves. This is to prevent the backward flow of blood within veins. Arteries carry blood from the heart to peripheral tissues. At tissue levels, the arteries branch out and finally give rise to capillaries. The capillaries then unit and forms the veins. Veins carry blood from peripheral tissues to the heart. As the vessels branch out in the above manner, the pressure within those vessels gradually decline. When it comes to the capillaries, the pressure is very low compared to that of major vessels such as the aorta. The pressure within the veins is even more less. Therefore, there is less force to pump blood back to the heart. 

Usually, the body takes the help of muscle contraction to pump blood up the veins. So, when the muscles contract, they squeeze blood up in the veins. When this happens, there should be mechanism to prevent blood from going back. This is where the valves come in to play. They prevent backward flow of blood. 

Not all the veins in the body contain valves. There are some veins that do not have veins. They are,

• The pulmonary veins
• Superior vena cave
• Left and right bracheocephalic trunks
• Azygos system of veins

Revolution in Ophthalmology : Discovery of New Corneal Layer

Harminder Dua, a professor at the University of Nottingham has conducted a research to find out the number of layers in human cornea. Up to now it was believed that human cornea was made of only five layers, but with the findings of the Professor Harminder Dua, the anatomical description of the cornea has changed. 

The professor and his team have used cornea that were donated for research purposes. Then they have injected air into these cornea to separate and visualize the layers easily. They have scanned each and every layer through an electron microscope. Through this technique they were able to find a new layer. They have named the new layer as 'Dua's Layer'.

They have also stated that the reason for corneal hydrops is tear of Dua's layer. They have also pointed out the association of this layer with many other diseases of the cornea. Therefore, the discovery of this layer will take the field of ophthalmology in to a whole new level.  

How is Chlamydia treated during pregnancy?

There is a wide variety of genital tract infections. Some of them are sexually transmitted.  Treatment of these infections is important to prevent complications. Chlamydia is one such infections requiring immediate medical attention. It is also a sexually transmitted disease.  Chlamydia is an obligate intracellular organism. That means that the organism lives in side the cells. The pathogen chooses only the noncilliated columnar, transitional and cuboidalcells to live in. These are the cells found in the upper genital tract and urethra.

Unlike many other sexually transmitted diseases, Chlamydia infection gives rise to few symptoms. The patients will be completely normal until they develop complications. The complications are more when the infections occur during pregnancy. In pregnancy, not only the mother but also the baby can get affected by the infections. Chlamydia infection during pregnancy can lead to preterm birth, preterm prematue rupture of membranes and choriamnionitis. Usually, Chlamydia infection in non-pregnant women can be treated with several antibiotics. These antibiotics include azythromycine, doxycycline, erythromycin, levofloxacin and orfloxacin, some of these antibiotics cannot be used during pregnancy. That is because they can cross the placenta and can give rise to adverse effects in the baby. Therefore, the drug should be chosen carefully.

The antibiotic of choice in pregnancy is tetracycline, usually doxycycline. Out if these two, tetracycline binds to the developing bones and teeth of the fetus during second and third trimester. This results in brown colored teeth and dysplastic bones. Therefore, it should be avoided in the second and third trimesters. Erythromycin 500 mg twice a day for two weeks is the treatment of Chlamydia infection during pregnancy.

Erythromycin is usually a drug with many gastrointestinal side effects. Once ingested, the mother can get nausea and vomiting. As a result, the drug might not get absorbed properly. The pharmacokinetics of the drug during pregnancy can also get altered and the efficacy of the treatment is doubtful. Therefore, pregnant mothers who are treated with erythromycin should be tested later for presence of infection 2 weeks after the completion of antibiotic therapy. For women who cannot tolerate erythromycin, azythromycin as a single 1g dose is given. Scientists have found that Co-amoxyclave have a protective effect against neonatal infection. Therefore, it can also be used to treat Chlamydia infection during pregnancy.

As mentioned earlier, Chlamydia is a sexually transmitted infection. Therefore, not only the pregnant mother, but also her partner should be tested for the presence of infection. If the male partner is also found to have the infection, he should also be treated before resumption of sexual intercourse. If the mother is found to have infected with Chlamydia after delivery, she should be given tetracycline as definitive treatment. Breast feeding can be continued while on treatment.

Sometimes, Chlamydia infection goes unnoticed during pregnancy. In such cases the first presentation could be eye infection of the neonate. This is called ophthalmia neonatarum. If the baby develops ophthalmia neonatarum, it should be treated with tetracycline eye oinements. They should be also given erythromycin syrup for two weeks. This is to reduce the risk of neonatal pneumonia.

As described earlier, treatment of Chlamydia infection is very important to prevent its complications. The treatment of the mother as well as her sexual partner and the baby after birth is very important. 

Causes for Loss of Motor and Sensory Functions of Limbs

Loss of motor and sensory functions of limbs is a common neurolgical disorder. Both young and old can get this condition. Peripheral neuropathy is the commonest cause for this disease. If a patient has difficulty in moving his limbs or abnormal sensation, then he might be suffering from peripheral neuropathy. This is a disease that requires immediate medical attention because some can progress rapidly.

Following are some common causes of peripheral neuropathy. it can be easily remembered by the mnemonic STAGLAND.

1. Sarcoidosis
2. Thyroid
3. Amyloidosis
4. Guillian Barre
5. Lead
6. Alcohol
7. Nutritional
8. Drugs/ Diabetes

Can Adults Form New Brain Cells?

Some human organs have the ability to grow until death (e.g: hair, skin), but some stop growing at very young age (e.g: neurons) . It is believed that the development of the brain is completed at very young age. Scientists believed that after that certain age, the human brain does not grow. But, according to the latest research findings, human brain cells grow even at adult age.

Kirsty Spalding, a molecular biologist at the Karolinska Institute in Stockholm, Frisén, and colleagues have done a research to find out the ability of brain cells to divide even at adult age. For this research they have used brains of deceased humans who were exposed to above-ground nuclear weapon testing 50 years ago. During these nuclear weapon testing Carbon 14 were released in to the atmosphere. These Carbon 14 were incorporated in to DNA of cells of people who were exposed. They have found out a way to test the amount of Carbon 14 with in DNA of these cells. In their study they have extracted hippocampi of 55 deceased people who had given their consent to use their brains for research purposes. They have found out that every day about 1400 cells in hypoccampal region are being replaced. 

According to this research, it is confirmed that the brain cells have the ability to regenerate even in adult age. The results of this research will help the development of many aspects of science, especially the field of medicine.

Treatment of Supraventricular Tachycardia

Tachycardia is defined as heart rate of more than 100 beats per minute. The heart beats as a result of electrical activity that spread throughout the myocardium (heart muscle). This electrical activity normally originates at sinu-atrial node, a focus in right atrium. Tachycardia occurs as result of increased frequency of electrical discharge from the sinu-atrial node (SA node) or from another focus. When this focus in situated in the atrium, it is called supra-ventricular tachycardia. 

Atrial fibrillation, atrial flutter also leads to supraventricular tachycardia. Supraventricular tachycardia can lead to reduced cardiac output and embolisation. When there is tachycardia, the diastolic time reduces. Diastole is the time period where the heart is relaxed. During this period, the atria and ventricles get filled with blood. When there is tachycardia, the amount of blood coming to fill the atria reduces significantly. As a result, the cardiac output reduces. Arrhythmias such as atrial fibrillation creates a turbulent flow. Turbulence results in blood clot formation. These blood clots can shoot in to the systemic circulation and block small blood vessels and give rise to strokes, myocardial infarction etc. Therefore, it is important to treat supraventricular tachycardia.

Medical treatment of supreventricular tachycardia includes several drugs and manures. They can be remembered by the mnemonic ABCDE.

• A - Adenosin

Adenosin is an alpha 1 receptor blocker. It acts on the atrio-ventricular node (AV node). AV node transmits impulses from atrium to the ventricle. When the drug is given intravenously, it blocks excessive impulses passing to the ventricles. As a result the ventricular rate reduces. 

• Beta Blocker

Beta blockers also reduce the heart rate.

• Calcium Channel Blocker

• Digoxin

Digoxin is a cardiac glycoside. It inhibits sodium potasium ATPase pump. As a result the heart rate reduces. It also has a positive inotropic effect (increases myocardial contractility) on the myocardium. Its effect on AV node, prevent excessive impulses passing in to the ventricles. 

• Excitation

Excitation includes manueurs used to stimulate vagal activity. These manuers include carotid massage, sprinkling cold water on to the face etc.

Above medications helps to keep the heart rate down and prevent clot formation. 

Nipple Discharge? Is it breast Cancer?

Nipple discharge can be a scary experience for all men and for women who are not breast feeding. The biggest concern when a person experience nipple discharge is the possibility of carcinoma. Even though breast carcinomas often present with nipple discharge, all nipple discharges are not due to breast cancer. If you are experiencing nipple discharge, the following information will help you to find out the cause for the nipple discharge. 

So, you are experiencing nipple discharge. The first thing you should clarify when you are having nipple discharge is whether it is from one nipple or from the both. If you have discharges form both your nipples, it is most probably due to a systemic disease more than a local disease, such as carcinoma. 

• Bilateral Nipple Discharge 

If you are having bilateral nipple discharge, you are having one of the following conditions. Bilateral nipple discharge does not indicate breast cancer unless the cancer has spread to the both breasts.

• Lactation
• Pituitary tumor

Out of these, pituitary  tumor should take immediate attention because they should be ablated. Some people with pituitary tumor experience some specific symptoms which can be used as diagnostic tools. Pituitary tumors enlarge  in size and increases the intracranial pressure. As a result, the person experiences early morning headache, nausea and vomiting. The visual pathway runs close to the pituitary gland. Tumors arising from the gland compress the visual pathway. As a result, the affected person looses vision of his both temporal sides. This is called bitemporal hemianopia. If you are having bitemporal hemianopia, when you are looking at something, you will feel like you are looking through a tunnel. This is called tunnel vision. 

• Unilateral Nipple Discharge 

If you are having discharge only from one breast, it is due to a local pathology affecting only that breast. You should also consider your age because carcinomas are very rare in younger ages. If you are in your twenties or early thirties and there is no family history of breast cancer among first degree relatives, there is very low chances for you to develop breast cancer. If you are very young there is nothing to worry about. If you are still anxious, you can consult a doctor. He will also reassure you after doing the triple assesment. Consulting a doctor is important because he can analyse your data decide on the possibility of cancer. 

The next thing you can do to know whether it is due to cancer or not is by looking for a lump. To do this you will have to carry out a self breast examination. A careful self breast examination can detect most of the lumps in the breast, but some breast cancers are very small and therefore, cannot be palpated. If you are more than 40 years of age and have a family history of breast cancer, you should immediately see a doctor even you do not feel any lump.

Then the next thing you should focus on is the color of the discharge. The color of the discharge gives diagnostic clues. As mentioned earlier, breast cancers can give rise to nipple discharge, but not all discharges are due to cancer. There are many benign conditions that can give rise to nipple discharge. These benign conditions are,

• Duct ectasia
• Papilloma of the duct 
• Mammory dyslasia
• Fibrocystic disease (fibroadenosis)
• Infection
• Hypothyroidism
• Pituitary tumor

The nature of the secretion is very important in differentiating each of these condition. Blood stained discharge is suggestive of cancer, but benign conditions such as duct ectasia, papilloma of the duct, fibrocystic disease can also give rise to blood stained nipple discharge. 

The commonest form of nipple discharge is serous discharge. This is commonly physiological and sometimes due to duct papilloma, duct ectasia, mammory dysplasia or fibrocystic disease.

If the discharge is black or green, it is due to duct ectasia. This is a benign condition which does not progress to breast cancer. If the discharge is purulent (pus), it is due to an infection. In infection,   in addition to the discharge you may also experience pain, fever, warmth of the breast. 

Milky discharge is due to lactation, hyperthyroidism or pituitary tumor. One of the commonest pituitary tumors are prolacting secreting tumors. Prolactin stimulates milk production and gives rise to galactorrhea. 

Above mentioned are the possible causes of nipple discharge. According to these information it is vivid that nipple discharge is not always due to breast cancer. There are many benign diseases that can cause nipple discharge. 

Hemifacial Spasms

Are you experiencing spasms in one side of your face? You might be having the disorder called hemifacial spasms. You must know that each and every spasms that occur in your face is not always due to hemifacial spasms. 

Hemifacial spasms is a rare disorder most commonly seen among middle aged females. It is characterized by sudden irregular clonic spasms of the facial muscles. The severity of the spasms can vary from very mild to severe. People with very severe spasms may usually find it very distressing and disfiguring. 

What is the cause for hemifacial spasms? There are several causes, but most of the time it is idiopathic. It means that there are no identifiable cause. Following are some well identified causes for hemifacial spasms.

1. Following Bell's palsy - Bell's palsy is a disorder characterized by sudden onset of facial muscle weakness. People can develop hemifacial spasms after recovering from Bell's palsy. 
2. Acaustic neuroma - Acaustic neuroma is a type of tumor involving the eighth nerve that can also have its effects on the facial nerve as well. As a result, the muscles of the face supplied by the affected nerve can start aving spasms. 
3. Paget's disease withing the skull base
4. Pressure from the vessels in the cerebellopontine angle.

The disorder is treated according to the severity  Mild cases do not require any treatment. Severe disease is managed with botulinum toxin injection. Decompression of the facial nerve at the cerebellopontine angle can also be done. 

What is the difference between isometric and isotonic exercise?

Exercises keep you healthy and strong. Regular exercises increases your circulation and helps to burn excess fat. People engage in exercises for various reasons. Some do it to lose weight. Some do it to stay healthy. Athletes are obligated to do exercises every day. Some do it just for fun. There are many types of exercises. The type of exercises differs according to your goals. Therefore, it is important that you clarify and set your goals before starting exercising. Then you should choose the type of exercise you need. Therefore, it is important to have a basic understanding about the types of exercises.

Exercises are divided into many categories. Strength training exercises are one such category. Strength training exercises are divided in to two. They are isometric exercises and isotonic exercises. Strength training exercises are designed to increase muscle strength. This is achieved by combining both isotonic and isometric exercises. The effects of the exercise are more when it is done against resistance. When the resistance is more the tension within each muscle fiber increases. As a result, with time the muscles become bulkier and stronger.

How to differentiate isometric exercises from isotonic exercises?

The main difference between these two is the movement at the involved joint. Isometric exercises keep the joint immobile while the isotonic exercises involve all the movements of the joint. Now you might wonder how to exercise without moving anything. The following explanation will answer your question.

Isometric Exercises

As mentioned above, isometric exercises do not involve movements at joints. These kinds of exercises increase muscle strength by increasing the tension of the muscle while keeping the muscles at a static level of contraction. How can you do this? It is done by keeping your body in a static posture for a long time. It might seem that staying at the same posture does not require any muscle activity, but it is not true. Maintaining posture involve contraction of opposing muscle groups at an equal intensity. Maintaining the same posture requires a lot of energy. Examples of isometric exercises include pushing or pulling against an immobile object and yoga exercises that maintains a posture for a long time. The disadvantage in this type of exercise is that one should use many postures in order to strengthen each muscel group in the body.

Isotonic Exercises

Unlike isometric exercises, isotonic exercises involves joint movements. The muscles are made to lengthen as well as shorten, but the tone of the muscles is kept static throughout the range of motion. Isotonic exercises include pushups, running, jumping, curls and climbing.

Both isotonic and isometric exercises increase muscle strength as well as endurance. To achieve maximum benefit from your exercise program, you should combine both of these types of exercises.  

How Obesity Gives Rise to Hernia

Obesity is major health threat that gives rise to various health problems. It is associated with many systemic illnesses such as dyslipidemia, hypertension, diabetes mellitus etc. Apart from that, obesity can cause many other surgical problems as well. One such problem is formation of hernia.

Hernia and obesity usually go hand in hand. Hernia is defined as protrusion of an organ from its containing cavity. This is either due to weakened coverings of the cavity or due to increased pressure inside the cavity. Obesity causes hernia by both of these mechanisms. Obese people have fat not only in the skin but also inside the abdomen, within the mesenteries. As a result the intra-abdominal pressure increases. Fat also deposits within the muscle fibers.  They separate each muscle fiber from one another and make them weak. Fat also deposits within the aponeurosis and weakens it too. As a result, para-umbilical, direct inguinal and hiatus hernia occurs. 

Is hernia repair is enough to cure hernia?

Is hernia repair is enough to cure a hernia? The answer is no. If you have a hernia, you might think that everything will be OK after getting it operated, but this is not true. There are a lot of things that you have to do. The surgeon can only repair the hernia. It is up to you to make sure it does not come back. 

So, what are the things you should do to prevent hernia from coming back? The first thing you should do is to identify the cause for hernia. Everybody do not get hernia. So, what went wrong in your case? One of the commonest cause of herniae is smoking. Smoking causes collagen deficiency. As a result, the strength of the abdominal wall reduces and predisposes for  formation of hernia. Therefore, if you want to prevent recurrent hernia, you should stop smoking. 

The next most commonest predisposing factor for hernia is chronically raised intra-abdominal pressure. Several things can lead to raised intra-abdominal pressure. They are chronic cough, straining during urination as well as straining during defecation. 

In conclusion, hernia repair is not enough to cure hernia. It also requires elimination of predisposing factors. Therefore, if you have a hernia, first think whether you have any of above mentioned predisposing factors. If you do, you must take necessary steps to eliminate them. It might require consulting a doctor and taking appropriate steps. 

Most of the time your doctor will inquire about these factors and refer you to take necessary treatments. Therefore, you don't have to worry too much about it. But, you should pay more attention to eliminate these predisposing factors by following the medical instructions correctly.

How can a strangulated hernia get reduced on its own after taking pain killers?

Hernia is a common surgical problem. Hernia can be complicated with many things. Strangulation is one such thing. A hernia gets strangulated when the contents of the abdomen comes out and twists. As a result the vessels supplying the hernial contents get crushed and the blood supply is cut off. If your hernia has got strangulated, you will feel colicky abdominal pain, with nausea, vomiting, abdominal distention and constipation. This is a surgical emergency that requires immediate attention. Unless, the contents can become gangrenous and rupture. 

If you have a strangulated hernia, the doctors will advice you to have strict bed rest and elevate the foot end of the bed. They will also prescribe you analgesics. Surprisingly, some people improve with the provision of pain killers. This occurs as a result of relaxation of the muscles surrounding the neck of the hernia. Analgesics can relax the muscles. The same thing happens when your are taken to the theater and anaesthesia. Anasthetics are also muscle relaxants. Sometimes the muscles can get too loose and the hernial contents can get back in to the abdominal cavity. This can be an disadvantage, because the surgeon might have to open into the abdominal cavity, in order to find the strangulated bowel loops and look for possible perforation.