What the Whites of your Eyes say about your Health

Abstract:

Medicine is an art. Some thinks that doctors always need modern investigations to diagnose diseases. That is not true. Almost all the diseases can be diagnosed only by taking a proper history and by carrying out a thorough physical examination.

Medicine is an art. Some thinks that doctors always need modern investigations to diagnose diseases. That is not true. Almost all the diseases can be diagnosed only by taking a proper history and by carrying out a thorough physical examination. Not only doctors but also fortune tellers, palm readers and people who tell about people’s lives have the knowledge and ability to gather information from what they see. There are certain parts of the body that give information more than any modern test can give. Your eyes play a leading role in that list.

Eyes of a person tell a lot about him. The eye is composed of several components. Each one of these components is very important to your vision. The white of the eye, also known as the sclera is one such part. The whites of the eyes tell a lot about your health. Most of the time, the color of the sclera is the most apparent change in relation to the underlying disease.

Muddy Sclera

Before going to know about the abnormal presentations of your eyes, you should know about the normal variations. Usually a healthy person has a pure white sclera, but not always. Some people sometimes can have light brown discoloration of their eyes. This is known as muddy sclera. Muddy sclera commonly occurs as a result of repetitive exposure to wind, dust and other physical and chemical insults. That does not indicate any serious underlying illness, but it says that you are carrying out a life that exposes you to a lot of dust, wind and sunlight.

Yellowish Discoloration

Yellowish discoloration of eyes, also known as icterus or jaundice always indicates an underlying disease. The eyes become yellow as a result of increased amount of bilirubin in your blood. Bilirubin is produced by breakdown of red cells. The initial molecules produced immediately after breakdown of red cells are called unconjugated bilirubin. Then these unconjugated bilirubin molecules are carried to the liver and the liver converts them in to conjugated bilirubin and excretes them in the bile. Any illness that increases red cell destruction or interferes with the above mentioned pathway results in increment of serum bilirubin levels. These excess amounts of bilirubin deposits in the sclera and make it look yellow. Some of the commonest causes of yellowish discoloration of eyes are hemolytic anemias (thalassemia, hereditary spherocytosis), hepatitis, Gilbert’s syndrome, Crigler Najjar syndrome, sclerosing cholangitis, carcinoma of bile duct, gall stones, carcinoma of the head of the pancrease etc.
Blue Sclera
Blue sclera is beautiful, but the underlying disease is not. People with diseases such as osteogenesis imperfect have blue sclera. Osteogenesis imperfect usually present at a very early age with recurrent bone fractures. The presence of blue sclera helps the physicians to come to a final diagnosis.
Bitot Spots
Bitots spots are characteristic of vitamin A deficiency. They appear as white or gray triangular or oval spots on the temporal side of the eye. Bitot spots are very rare nowadays because almost every child is given vitamin A supplements to help them maintain their tissue stores.

Scleritis and Episcleritis

Red eyes are sometimes due to scleritis or episcleritis. These two conditions are usually linked with connective tissue disorders such as rheumatoid arthritis. Sometimes they are associated with sero negative arthropathies such as ankylosing spondylitis.

Conjunctivitis

If your eyes have become red, teary and inflamed, you are having conjunctivitis. Conjunctivitis is inflammation of the sclera. It can be allergic conjunctivitis, viral conjunctivitis or bacterial conjunctivitis.

Subconjunctival Hemorrhage

Subconjunctival hemorrhage appears as a spot of bleeding. Sometimes it indicates base of skull fracture. Sometimes it is simply due to local trauma. The presence of posterior margin of the hemorrhage indicate that is only a local condition but if there is no posterior margin, it is most probably due to base of skull fracture.

Above mentioned are only an outline of most common disease conditions that causes changes in the whites of your eyes. There are many other rare disease conditions that give rise to changes in the sclera.

Use of Penicillin during Pregnancy

Abstract:

Before starting the article I would like to say that penicillin is not the ‘only’ safe antibiotic to use during pregnancy, because there are few other drugs that can be considered as safe during pregnancy.    

Before starting the article I would like to say that penicillin is not the ‘only’ safe antibiotic to use during pregnancy, because there are few other drugs that can be considered as safe during pregnancy.

Most drugs are contraindicated during pregnancy. This is because most of the drugs that are taken during pregnancy can cross the placenta and enter the fetus. Most of these drugs can act negatively on the fetus, and cause various abnormalities. They can result in morphological abnormalities, as well as growth and developmental abnormalities. Therefore use of any drug during pregnancy should be done with caution.

Drugs are given in order to cure a disease, but what if the patient is pregnant? She should be given medications. We can not keep her without giving any treatments just because she is pregnant. This is where the few drugs that are safe during pregnancy come in to play.

Antibiotics are a class of drugs that are given to cure various infections. As mentioned above most of the antibiotics too can be hazardous to the fetus, but the patient should be given antibiotics, if she acquires a serious infectious disease during pregnancy.  Otherwise the disease it self could be life threatening to the fetus as well as to the mother.

Penicillin plays a major role among the drugs that are safe during pregnancy. It is used in pregnancy without any fear, because there is no evidence of fetal harm from this drug. It is the treatment of choice if the mother acquires any of the following infectious diseases.

Syphilis – This is a disease cause by Treponema pallidum. Protein penicillin is prescribed for primary, secondary or early latent syphilis. It is given 1.2 MU daily, intramuscularly, for 12 days. It should be given for 21 days for later stages of syphilis. Even though this is considered as safe, it can also have some adverse effects. Penicillin causes the death of organisms. Sometimes these dead organisms can trigger the release of pro-inflammatory cytokines, which leads to a Jarish-Herxheimer reaction. As a result the symptoms can become worsen and fever may rise for about a day after starting the treatment. This can also trigger preterm labour, so the mother is admitted to the hospital before starting the treatment.
Group B streptococcus infections – This is an organism that belongs to the normal flora of the gut and the vagina of 20-40 % of the normal women. It can cause upper genital tract infections that could lead to septicaemia, which is detrimental to the mother. Its infections are fatal to the neonate too. Therefore it should be cured by antibiotics. Fortunately penicillin is a safe and effective drug in treating this condition. Penicillin is given intravenously at the time of delivery, after the diagnosis has been made by culture. It is not given in early pregnancy because of common occurrence of re-colonization.
Gonorrhoea – This is a disease caused by Neisseria gonorrhoeae. It is also treated successfully with penicillin.

Even though there are many incidences of penicillin resistance, it is still widely used because of its high effectiveness and safety.

None of the drugs can be considered as safest, but comparing with other drugs, we can say that penicillin is fairly safe.

Finally I would like to say that penicillin is not the only drug that is safe during pregnancy, as the topic implies. Other antibiotics that are considered as safe during pregnancy are Cephalosporin, Erythromycin, and Nitrofurantoin in first and second trimesters.

How Staphylococcus Aureus in Blood can cause Fatal Infections

Abstract:

The presence of bacteria in the blood is called bacteraemia. Blood is a sterile medium. Therefore there are not any bacteria in the blood under normal circumstances. So, presence of any organism can cause various diseases. Transient bacteraemia ca

The presence of bacteria in the blood is called bacteraemia. Blood is a sterile medium. Therefore there are not any bacteria in the blood under normal circumstances. So, presence of any organism can cause various diseases. Transient bacteraemia can occur in normal individuals after defecation and after brushing teeth. Usually these bacteria are removed from the blood stream by the spleen and liver, but sometimes, some of these bacteria get the chance to stay in organs like the heart, and in the ends of growing bones, and thereby avoid reaching the spleen and liver.

Staphylococcus aureus is one such bacterium that can stay in these organs, and cause serious diseases, which could be fatal if untreated. Infective endocarditis is a potentially fatal disease caused by staphylococcus aureus. It is responsible for 25% - 66.7% of infective endocarditis cases occurring world wide.
Intravenous drug users are at a high risk of developing infective endocarditis, because a lot of Staphylococcus aureus organisms enter the blood when they inject drugs into their body. These bacteria enter the blood stream and establish themselves in the damaged heart valves (especially in prostatic heart valves). They can produce adhesins, dextran and fibronecting binding proteins, which help them to attach to the heart valves.
The organism starts multiplying after attaching to the wall. This leads to attraction of more platelets and deposition of fibrin. So finally the organisms are covered with platelets. These growths are called vegetations and can be of several centimeters in size. Vegetations help organisms to hide from the body’s surveillance system. It takes about five weeks for this process to occur. These vegetations act as foci that continuously introduce bacteria to the blood stream. So these bacteria can spread to various organs and cause diseases in other organs too.

Staphylococcal infective endocarditis could be dangerous in several ways.  The local damage done to the heart valves can give rise to various cardiac problems, which can be life threatening. Sometimes the vegetations can dislodge from their site of origin and travel to different organs in the body. These emboli are septic and can cause serious illnesses throughout the body. There are also immune complexes formations in response to the presence of micro-organisms in the blood. Immune complexes are composed of microorganisms and antibodies and complement proteins. These immune complexes circulate in the blood. They can deposit in organs like kidneys and cause serious problems like kidney failure, which is a life threatening disease.

The patients with infective endocarditis may initially present with pyrexia of unknown origin. Heart murmurs are always detected in patients with this disease. Apart from those main symptoms, the patient may have loss of weight, loss of appetite nausea, vomiting, malaise and night sweats. On examination the doctor may find Osler nodes, splinter haemorrhages in nail beds and petechial lesions in the skin. Earlier this was invariably a fatal disease.  Now with the discovery of antibiotics, staphylococcus aureus infections can be treated successfully if identified earlier.
The disease is diagnosed by doing a blood culture. The condition is treated with antibiotics that are powerful enough to eradicate the organisms from the blood. This may take several weeks. Treating infective endocarditis caused by staphylococcus aureus is very hard, because of the emergence of antibiotics resistance strains, especially when the organism is hospital acquired. Therefore beta lactamase stable penicillin such as cloxacilline is given along with an aminoglycoside, rifampicin or fusidic acid. Vancomycin or teicoplanin is given if the patient is allergic to penicillin. They are also given to treat methicillin resistant staphylococci.

How can Breast Milk Transmit HIV

Abstract:

HIV (Human Immunodeficiency Virus) is a virus belonging to the retrovirus group. It infects cells expressing the CD4 antigen. These cells include T helper cells, monocytes, macrophages, Langerhan’s cells and dendritic cells.

HIV (Human Immunodeficiency Virus) is a virus belonging to the retrovirus group. It infects cells expressing the CD4 antigen. These cells include T helper cells, monocytes, macrophages, Langerhan’s cells and dendritic cells. The immune system gets progressively damaged and the CD4 positive cells count declines steadily. As a result the cells mediated immune response is lost, so the host becomes immuno-compromised. When the CD4+ cell count drops below a critical level, the patient is said to have AIDS (Acquired Immune Deficiency Syndrome). This favors infections with various opportunistic organisms. The AIDS patients die not due to the HI virus, but due to serious infections caused by other organisms.

HIV is transmitted from an infected person to another through body fluids like, blood, semen, vaginal secretions and breast milk, because these body fluids contain the virus. When an HIV infected woman gets pregnant, the next problem she faces is “Will my child also get HIV?” The child can acquire HIV from the mother during second or third trimesters of pregnancy, during delivery, or during breast feeding. There are successful intervention methods that can prevent vertical transmission of HIV during pregnancy and labour, but unfortunately we still do not have an effective way to prevent transmission during breast feeding.

The exact mechanism by which breast milk transmit HIV is not known, but  scientists have found out that the breast milk contains the virus. The breast milk contains both the cell free virus and the cell associated virus, but which of these is important in infecting the child is not known. The plasma virus concentration that is required for it to appear in the breast milk is also yet to be studied.

When the child drinks the mother’s milk, the virus enters the child’s gut, but the mechanism by which they cross the mucosa is not well understood. The virus can penetrate the mucosa especially when there is a breach in the submucosa. Trancytosis through M cells and enterocytes with specific receptors can also occur. Tonsils are the next place where the virus can enter the blood stream. As the frequency and duration of the breast feeding increases, the risk of the child to acquire the infection also increases.

If the mother has mastitis, there is a higher chance for the virus to appear in large numbers in the breast milk. This occurs as a result of vasodilatation of the blood vessels. As a result the child is exposed to a higher number of virus, making him more viable to acquire the infection.

As discussed above HIV infected mothers can transmit the virus to their children during breast feeding. Therefore, reduction of HIV infected females in the reproductory age group in is very essential.  

Sources: Medical Microbiology 2nd edition (Mims)
www.unfpa.org/.../276_filename_HIV_PREV_BF_GUIDE_ENG.pdf