Acute appendicitis

One of the commonest surgical emergencies.


Sudden appearance of signs n symptoms of appendicitis called acute appendicitis.
Appendicitis- inflammation of the appendix..a vestigial organ.

Aetiology –

• Racial and dietary factors-  common in white races, young males affected more often. Diet rich in meat and low in fibre precipitates the condition.


• Familial susceptibility- related to having a long retrocaecal appendix, in which blood supply diminished to thedistal portion hence precipitates appendicitis.


• Socioeconomic status- common in middle class and rich people.


• Obstructive theory- obstructiob due to faecoliths, worms, ova , cysts.


• Non-obstructive theory- due to bacteria such as e.coli , enterococci, proteus, pseudomonas etc.

Symptoms-

• Pain- severe,colicky initially felt in umbilical region due to distension of appendix. Shifting pain of acute appendicitis present.
• Vomiting.
• Fever low grade.
• Haematuria
• Constipation.

Signs-

• Cough tenderness.
• Tenderness and rebound tenderness at mc burney’s point.
• Guarding and rigidity in right iliac fossa.
• Palpation of left liac region of abdomen produces pain in the right iliac region.
• Features of generalized peritonitis present only when there is perforation.
• Tenderness in right rectal wall in rectal examination.

CT scan is the investigation of choice.

Other investigations-

• Total wbc count
• Plain x-ray abdomen erect.
• Abdominal ultrasound.

Treatment-

• Emergency appendicectomy.
• Laparoscopic appendicectomy.

Complications of acute appendicitis-

• Rupture of appendix.
• Appendicular mass.
• Appendicular abcess.




There is no prevention from this disease few steps which can help in prevention from complications from acute appendicitis are-


• Take a high fiber diet.
• Look after the symptoms earlier and consult a doctor immediately so that the condition can be prevented from being worse.

VITAMIN B3 FOR SKIN

How Vitamin B3 Acts On Your Skin?

There are 2 important enzymes (NADH and NADPH) that contribute to the production of cellular energy and lipids (responsible for cell growth). With a sufficient supply of both enzymes, your skin creates an effective barrier to external factors that influence the aging process. However, the levels of both NADH and NADPH decline as we grow older.

 When applied topically, vitamin B3 seems to reduce their rate of decline.

Because topical application of niacinamide can help preserve levels of NADH and NADPH, it contributes to the support of the skin’s barrier against pollutants and other irritants.

 Therefore, many skin conditions, such as acne, the redness associated with rosacea, and other inflammatory signs can be actively managed. Also, vitamin B3 has shown to be useful for encouraging the production of natural emollients that can help the skin remain hydrated. It also helps in lightening the complexion of your skin.

Foods rich in vitamin B3-

Eggs

Fortified bread and cereals

Beets

Red fish 

Peanuts

Bran

Yeast extract spread.

Tuna

Salmon

Lamb

Mushrooms

Halibut

Roasted turkey breast.

Vitamin b3 is now being used as a potent ingredient in a variety of cosmetic products. Hence, while buying any skin care product look out for the ingredient list and select a product which contains vitamin B3 for a perfect healthy complexion :) :)

FOODS FOR LOWERING CHOLESTEROL.

High cholesterol levels in the body can lead to ATHEROSCLEROSIS i.e  thickening of the arterial wall due to the accumulation of fatty acids. atherosclerosis can lead to various conditions such as -

• coronary heart disease.
• high blood pressure.
• angina.
• heart attack.
• stroke.
• heart arrythmia.
• peripheral artery disease.

for the functions of cholesterol and its normal limits click here

Here I am listing some foods which can lower cholesterol in the body -

• Oatmeal, oat bran and other high fiber foods.

Oatmeal contains soluble fiber which reduces low density lipoproteins (LDL). Other foods containing soluble fiber – kidney beans, apples, pears, barley and prunes, eggplant and okra.

Soluble fiber reduces absorption of cholesterol into blood stream.

• Fatty Fish and omega 3 fatty acids.

It reduces blood pressure and risk of developing blood clots.

Highest levels of omega acid are found in- mackerel, lake trout, salmon, halibut etc…

One should take grilled or baked fish in order to avoid unhealthy fats.

Other sources of omega 3 fatty acids- ground flaxseed ( called alsi in hindi) or canola oil (white mustard oil).

• Walnuts, almonds & other nuts.

Handful of some dry nuts are beneficial in reducing cholesterol level in blood.

• Olive oil.

Contains a potent mix of antioxidants that lowers bad cholesterol (LDL) & leave good cholesterol (HDL) untouched. Extra virgin olive oil is best for this purpose. Minimum 2 tblspn of olive oil is sufficient daily.

• Foods with added plants and sterols.

They help in blocking absorption of cholesterol. Margarines, orange juice and yogurt drinks with added plant sterols can help reduce LDL cholesterol by more than 10 percent.

• Eating the fruits and vegetables raw in the form of salads and drinking soup is a good way of warding off the evils of high cholesterol. Leafy vegetables and green salads are a good way to start the day. Citrus fruits contain lots of vitamin C, folic acid and soluble fibre.

• Eating soyabeans, soy milk can also rduce cholesterol.

• Eating dark chocolate has been found to improve the cholesterol levels. For best results eat raw chocolate without added dairy products or artificial sweeteners.

• Garlic contains allicin which prevents the body from retaining LDL.

• Sesame seeds are rich in phytosterols which lowers LDL.

• Safflower  also reduce cholesterol levels in the body.

ETIOLOGY OF SOME SKIN DISORDERS

• Pyoderma gangrenosum - It's often associated with inflammatory conditions, such as ulcerative colitis and Crohn's disease. If you have pyoderma gangrenosum, new skin trauma, such as a cut or puncture wound, may result in the formation of new ulcers. This tendency of new ulcers to form from trauma, including surgery, is known as pathergy. ulcerative colitis., rheumatoid arthritis, and multiple myeloma (MM) sufferes have the condition.

• Erythema nodosum- Erythema nodosum may occur as an isolated condition or in association with other conditions. Conditions that are associated with erythema nodosum include medications (sulfa-related drugs,birth control pills, estrogen), strep throat,cat scratch disease, fungal diseases,infectious mononucleosis,sarcoidosis, behchet's disease, inflammatory bowel diseases (crohn's disease and ulcerative collitis), and normal pregnancy.

 Erythema nodosum is presumed to be a hypersensitivity reaction and may occur in association with several systemic diseases or drug therapies, or it may be idiopathic.

• Ecthyma gangrenosum - Pseudomonas aeruginosa bacteremia. EG usually occurs in patients who are critically ill and immunocompromised and is almost always a sign of pseudomonal sepsis. The characteristic lesions of EG are hemorrhagic pustules or infracted-appearing areas with surrounding erythema that evolve into necrotic ulcers surrounded by erythema.

• Erythroderma- Most published series reveal that the majority of patients are diagnosed with psoriasis, spongiotic dermatitis, drug reactions or cutaneous T cell lymphoma (CTCL). 

• Ichthyosis vulgaris -This buildup is a result of your skin's natural shedding process being slowed or inhibited.

Ichthyosis vulgaris is most often caused by a genetic mutation, inherited in an autosomal dominant pattern. That means a child has to inherit only one copy of the affected gene to develop the disease. Children with the inherited form of the disorder usually have normal skin at birth, but develop scaling and roughness during the first few years of life. At times, ichthyosis vulgaris may disappear during the adult years, only to return later.

Ichthyosis not caused by genetic abnormalities, referred to as acquired ichthyosis, is rare. This type usually shows up in adulthood. It's usually associated with other diseases, such as cancer, thyroid disease or chronic renal failure.

BENEFITS OF DRINKING GREEN TEA

Green tea is made solely from the leaves of Camellia sinensis that have undergone minimal oxidation during processing. Green tea originates from China and has become associated with many cultures throughout Asia. a person can have 2-3 cups daily. Intake should  not be exceeded more than 3 cups everyday.

Green tea is the key to longer and healthier life. The benefits are as follows -

• Cancer-  Clinical studies have proven that green tea helps prevent many types of cancers. Researches support that polyphenols found in green tea may actually kill cancer cells and arrests their growth. Breast, colorectal, lung, pancreatic, prostate, skin and stomach cancers have all shown to be positively affected by green tea.
• It also helps in preventing tooth decay.

• Improves the ratio of good and bad cholesterol  i.e it decreases LDL and maintains HDL in the body.
• It is also helpful for reducing weight. Green tea helps in boosting the body’s metabolism and polyphenols helps in burning fat.
• Green tea serves as a powerful antioxidant and prevents from free radical damage.
• Also treat the impaired immune function of the body. Makes body resistant to certain infections.
• Polyphenols helps in protecting the heart from oxidative stress, as well as maintain good left ventricular function after ischemic arrest. It also protects the heart by preventing hypertension.
• Improves cognition. Green tea may protect the brain from forming plaque deposits found in alzheimer’s disease and reduce memory loss.
• Green tea consumption may improve glucose tolerance and insulin sensitivity in individuals with diabetes. 

CHOLESTEROL

Cholesterol is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an important component for the manufacture of bile acids, vit. D and steroid hormones. Cholesterol is the principal sterol synthesized by animals; however, small quantities can be synthesized in other eukaryotes such as plants and fungi. It is almost completely absent among prokaryotes, i.e. bacteria. Although cholesterol is important and necessary for mammals, high levels of cholesterol in the blood have been linked to damage to arteries and are potentially linked to diseases such as those associated with the cardiovascular system (heart disease).

Normal levels -  according to some books its between 150-240 mg/dl but the actual criteria for total cholesterol is given below -

Total Cholesterol (mg/dl)
<200	Desirable level
200-239	Borderline
>=240	High risk

We have heard about the side effects of  cholesterol in the body, but the fact is that our body needs a typical amount of it, in order to maintain a lot of functions maintained by it. Some of them are listed below :-

• It provides stability to the cell membranes to enable them to selectively regulate vital substances needed for our survival to enter and exit the cell.
• Maintains the structure of the vessels.
• Low cholesterol levels suppress the immune system, making you susceptible to disease and illness.
• It produces hormones which assist with healing the body from injuries and infections.
• Act as an insulator around the nerves and protects your nervous system from diseases.
• Helps in synthesis of vit. D.
• It's influential on your memory capacity.
• Serotonin receptors in the brain needs cholesterol to function properly.
• It’s important for steroid hormone production.
• Strengthens intestinal walls.
• Insulin hormone is made from cholesterol.
• Lower than normal limits  may accelerate signs of aging.
• People with kidney dysfunction are at an increased to risk to succumb if they have low cholesterol levels.

Therefore, cholesterol is needed for the proper functioning of the body. Attempts to reduce cholesterol from its normal limit is dangerous for health.

MOLLUSCUM CONTAGIOSUM

What is molluscum contagiosum ?

It is a viral infection of skin and occasionally of mucous membranes  that is caused by a DNA poxvirus called molluscum contagiosum virus (MCV).  There are 4 types of MCV, MCV-1, MCV-2, MCV-3 & MCV-4.  MCV-2 is most commonly seen in adults. MCV has higher incidence in children, sexually active adults and those who are immunodeficient.

Mostly seen in children of 1-10 years of age.

Parts of the body affected.

It can affect any area of the skin but the most common sites are- trunk, arms and legs. face is also affected in many cases.

How does the virus spread ?

Commonly through skin to skin contact, direct contact or shared items such as clothing and towels.

Communicable period-

It is contagious until the bumps are gone, which if untreated may last upto 6 months or longer.

 Incubation period-

2-7 weeks.

Symptoms .

Molluscum contagiosum lesions are flesh-colored, dome-shaped, and pearly in appearance. They are often 1–5 millimeters in diameter, with a dimpled center. They are generally not painful, but they may itch or become irritated. Picking or scratching the bumps may lead to further infection or scarring. In about 10% of the cases, eczema develops around the lesions.

Complications.

Complications of molluscum contagiosum include irritation, inflammation, and secondary infections. Lesions on eyelids may be associated with follicular or papillary conjunctivitis. Bacterial superinfection may occur but is seldom of clinical significance.

Cellulitis is an unusual complication of molluscum contagiosum in patients who are HIV infected. Secondary infection with Staphylococcus aureus has resulted in abscess formation, whereas Pseudomonas aeruginosa can cause necrotizing cellulitis.

Treatment.

Individual molluscum lesions may go away on their own and are reported as lasting generally from 6 to 8 weeks, to 2 or 3 months. However via autoinoculation, the disease may propagate and so an outbreak generally lasts longer with mean durations variously reported as 8 months, to about 18 months,and with a range of durations from 6 months to 5 years.

Most importantly the treatment includes- ( just a brief view of names of therapies used )

• Cryotherapy.
• Application of astringents such as potassium hydrochloride and cantharidin.
• Benzoyl peroxide.
• Tea tree oil 

Systemic treatments.

• Cimetidine
• Griseofulvin
• Methisazone.

Surgical- cryosurgery

Laser-  pulse dye laser therapy.

These treatments are only to be taken under medical supervision, because the drugs as well as surgical or laser treatment vary for individuals and the severity of the disease. So, instead of trying things on your own one should always consult a doctor for proper treatment.