WHAT IS THE REASON FOR CLUBBING ?

Clubbing of the fingers or toes (also called acropachy) refers to certain changes in  fingernails or toenails that occur due to an underlying condition. These changes can include:

• softening of the nail beds, which makes the nails seem to float instead of being attached
• an increase in the angle between the cuticle and the nail
• enlarging or bulging of the tip of the finger, which may also be red and warm
• downward curving of the nail

CLUBBING MAY BE HEREDITARY OR CAUSED DUE TO CERTAIN ACQUIRED CONDITIONS.

IT MAY BE UNILATERAL OR BILATERAL OR OCCUR IN ONE FINGER OR ALL FINGERS.

DIFFERENT PATTERN OF CLUBBING TELLS US ABOUT DIFFERENT UNDERLYING CONDITIONS,

EG. UNILATERAL CLUBBING IS MOSTLY CAUSED BECAUSE OF ANEURYSM OF AORTA.

UNDERLYING CAUSES OF CLUBBING:

• lung cancer
• heart defects at birth
• chronic lung infections
• heart chamber and heart valve infections
• celiac disease (an autoimmune disease of the small intestine that prevents it from absorbing gluten from food)
• cirrhosis of the liver
• Graves’ disease (an autoimmune disease that causes the thyroid gland to overproduce hormones)
• several types of cancer, including liver and gastrointestinal cancers

copied from http://www.healthline.com/symptom/finger-clubbing

BUT WHY DOES THE ABOVE CONDITION LEAD TO CLUBBING ?

Clubbing occurs because of increase in soft tissue mass under the nail plate. This occurs due to decreased amount of oxygen in blood. Exact mechanism of how decreased blood oxygen causes clubbing is unknown. 

BUT HERE ARE THE PROPOSED HYPOTHESIS

Shneerson (1981) reviews the four most likely mechanisms underlying clubbing. They include a circulating vasodilator, tissue hypoxia, a neurocirculatory reflex, and genetic factors. For acquired clubbing, the most likely mechanism postulates a neurocirculatory reflex, leading to increased blood flow through multiple arteriovenous shunts in the distal phalanges. Increased blood flow then leads to tissue hypertrophy and hyperplasia on a nutritional basis. The evidence for this mechanism is threefold: (1) clubbing may resolve after vagotomy; (2) disturbances of the vasculature such as arteriovenous fistulae and aneurysms are associated with its development; and (3) Racoceanu (1971) and others have demonstrated increased blood flow to digitial capillaries in acquired clubbing.

Flavell (1956) first proposed the neurocirculatory reflex theory to explain hypertrophic osteoarthropathy, after he observed that severing the vagus nerve could reverse it even when the underlying lung cancer was unresectable. According to this theory, there is a reflex in which afferent impulses travel by the vagus nerve from the inciting focus (such as a lung tumor) to the central nervous system. The efferent limb of the proposed reflex is unknown, but presumably some humoral substance or neural impulse mediates the vascular changes, leading to hypertrophy of the fibroconnective tissues. Others have supported such a mechanism by observations that the visceral organs in which associated diseases occur are all innervated by the glossopharyngeal or vagus nerves.

Strong support for this theory has also come from a study by Gold and colleagues (1979). They studied a unique case of unilateral clubbing secondary to a posttraumatic aneurysm of the ulnar artery, which resolved after resection of the aneurysm. Using the contralateral hand of the otherwise healthy patient, they conducted detailed studies of the microcirculation by Doppler flow recordings, differential pulse pressure measurements, angiography, measurements of reactive hyperemia, and differential capillary blood gas determinations. They interpreted their findings of increased blood flow, decreased peripheral resistance, and increased oxygenation to support the neurocirculatory reflex mechanism. They postulated that the efferent limb of the reflex was cholinergic fibers of the autonomic sympathetic innervation of digital arteriovenous shunts.

However, different mechanisms may cause acquired and hereditary clubbing. Some workers have found that digital capillary blood flow, measured by washout of krypton-85 solution, is increased in acquired clubbing but normal in hereditary clubbing. An alternative explanation for this finding may be that in hereditary clubbing the condition has been studied only after the condition has stopped progressing; the physiologic findings might be similar in the active phase

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Management of an open fracture in an emergency department?

A Patient comes to Emergency after a road traffic accident.
He is 21 year old and is hit by a bus while riding a bike.
He has an open fracture on his right leg. How would you manage the case if you are working in an average facilitied ER in developed country?

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RHYTHMS IN HUMAN BODY

                    RHYTHMS IN HUMAN BODY

                              
What is rhythm?

Rhythm simply means repetition of a feature. If we analyze we will know that everything in this universe has rhythm. Be it music or dance or other entities of universe they all have rhythm. If we observe our daily life it too has rhythm. Even matter which appears still is vibrating in its own rhythm. Matter is composed of energy and can be annihilated into energy and this energy is simply rhythms and therefore it can be concluded that everything is rhythm. Since it is a medical magazine here we are going to discuss rhythm in context of some very interesting features of human body.

 INTRODUCTION TO RHYTHMS OF HUMAN BODY:

"Although it may not be apparent to a layperson, the human body is largely run by “biological rhythms.” All organs, systems and cells are controlled by exact, cyclic patterns of rest and activity, which we can aptly call the “universal laws of life.” ", Andreas Moritz in naturalnews.com

There are activities in our body which happen rhythmically (that happens in only certain time of day and repeats itself in a particular pattern). we observe some of them, some of them are observed but not analyzed and some of them are observed only through detail studies of human body and not observable by general population.

       Few Examples of such activities
      
GENERALLY OBSERVED FACTS
        1.)1. Body temperature is lowest before waking up in the morning, and highest in the late afternoon.

        2.) The large bowel is most active and efficient during the early morning hours i.e. the urge to purge is most during early morning than other time of day.
        3.) Births peak in the morning and early afternoon and so do suicides.
        4.) People have sexual urge more at night just before going to bed than other any time of the day.
        5.) If we have a very good routine we will observe that we do same type of thing at same time of day and generally have same type of mood at same time.

FACTS OBSERVABLE ONLY BY DETAILED STUDIES
        1.) Doctors often prescribe taking medicines at certain times of day. This is because  drugs give more efficacy and minimum toxicity at particular time.  
        2.)The liver is more active during the night than it is during the day.
        3.)Red bone marrow produces more blood cells during the night.
        4.)Most digestive enzymes are secreted during the day.
        5.)Different types of cells have different life spans and are turned over at specific intervals.
       6.) Bile secretions peak at midday.


Apart from the fact mentioned above there are many other activities that occurs rhythmically.
so what is responsible for maintaining this rhythm in our body ?


CAUSE OF BIOLOGICAL RHYTHM 


CIRCADIAN RHYTHM "A circadian rhythm is any biological process that displays an endogenous, entrainable oscillation of about 24 hours. ", wikipedia

The rhythm is not only observed in humans but widely in many plants, animals and microorganisms. A circadian rhythm is built in and adjustable to environment.

FOUR CRITERIA OF BIOLOGICAL RHYTHM TO BECOME CIRCADIAN RHYTHM
1.)The rhythms repeat once a day.
2.)The rhythms persist in the absence of external cues.
3.)The rhythms can be adjusted to match the local time.
4.)The rhythms maintain circadian periodicity over a range of physiological temperatures; they exhibit temperature compensation. 
     
  

 

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PERNICOUS ANAEMIA- TYPE OF MEGALOBLASTIC ANAEMIA

                                            PERNICIOUS ANAEMIA


Pernicious anaemia is a type of megaloblastic anaemia due inablity to secrete intrinsic factor that helps in absorption of vitamin B12.

                                                        PERNICIOUS ANAEMIA 
                                                        BLOOD PICTURE


      a.) WHAT CAUSES PERNICIOUS ANAEMIA ?
      ans:->Pernicious anaemia occurs as a complication of rheumatoid gastritis.

                                                    GROSS: RHEUMATOID GASTRITIS

Rheumatoid gastritis leads to damage of parietal  cell of fundic mucousa which is responsible for     secretion of intrinsic factor. Therefore depletion of parietal cells leads to lack of intrinsic factor.           Intrinsic factor is responsible for absorption of vitamin B12 . So lack of intrinsic factor leads to             anaemia.
   
     

  b.) WHAT DOES THE WORD PERNICIOUS MEAN ? 
      ans:-> The word 'PERNICIOUS' means 'DESTRUCTIVE'. In medical term it is used to denote               diseaseof severe charracter and usually fatal without appropriate treatment.  

since there is no treatment or cure for pernicious anaemia after it's clinical signs are seen and
since it is a very severe type of megaloblastic anaemia the term pernicious is appropriate.



  c.) CAN ALL CASES OF VITAMIN B12 DEFICIENCY BE                              CALLED PERNICIOUS ANAEMIA ? 
    ans:-> NO. 
Only the vitamin B12 deficiency due to deficieny of intrinsic factor can be called as pernicious anaemia.


  d.) WHY DOES VITAMIN B12 DEFICIENCY LEAD TO                                  ANAEMIA ?
     ans:-> Vitamin B12 is important factor for DNA synthesis during erythropoesis. Deficiency of vitamin B12 leads to impairment of DNA synthesis that leads to distinctive morphologicchanges and abnormally large erythroid precursors and red cells which are inappropriate for normal RBC function and there fore leads to anaemia.
The large erythroid precusrsors are called megaloblasts and therefore the anaemia is called           megaloblastic anaemia. 

                                    MEGALOBLASTS SURROUNDED BY GAINT BANDS
      
     


       e.) ARE ALL MEGALOBLASTIC ANAEMIA CAUSED                                  ONLY DUE TO FOLATE DEFICIENCY ?    
         ans:-> NO. Megaloblastic naaemia can be either due to folate deficiency or vitamin B12                          deficiency.

 PERNICIOUS ANAEMIA IS DUE TO FOLATE DEFICIENCY.          


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PAST AND FUTURE OF MEDICINE

MEDS TMIELINE

1500 BC         HERE TAKE THIS HERB
1000 BC         THAT HERB IS HEATHEN, DRINK THIS POTION
100   AD         THAT POTION IS SMOKE OIL, SAY THIS PRAYER
2000 AD         PRAYER DON'T WORK,TAKE THIS PILL
2015 AD         PILLS DON'T WORK, EAT THIS HERB
2050 AD         ANTIBIOTICS HAVE SIDE EFFECTS, TAKE THIS HERB

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STROKE - A MEDICAL EMERGENCY

Stroke,previously known as cardiovascular accident, is the rapidly developing loss of brain function due to disturbance in blood supply in the brain. This can be due to ischemia caused by blockage hemorrage.
It is a medical emergency  and can lead to permanent neurological damage, complication and lead to death.

Two types of stroke
1.)Ischemic stroke
-80% cases
-due to cerebral infracts
2.)Hemorragic stroke
-due to rupture of artery within brain(intra cerebral hemorrage)
-due to rupture of an aneurysm(eg. subarachnoid hemorrage)

KNOWING STROKES

-first cause of asquired disablity worldwide.
-second cause of death worldwide.


Risk factors
High BP, overweight, high cholesterole, diabetes, lack of exercise

CONSEQUENCES
Brain cell die resulting in damage or loss of neurons.
Physical disablites such as partial loss of movement , hemiplegia, sensory loss, language disorders, visual disorders and even memory loss.

SIGNS AND SYMPTOMS

 

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TASTE THE MEDICINAL VALUES OF GINGER

Traditionally ginger is used to relive cold and stomach pain .
It is rich in inflamation fighting compound such as gingerols,which some experts belive  may hold some promise in fighting some cancer and reducing arthritis pain.
  
People who took ginger capsule daily for 11 days reported 25% less muscle pain when they perform exercises designed to stress muscle(compared to a similiar group of placebo capsules)(recent studies)

Another studies  found that helped to relive pain in the knee.

Acts as stomach soother.

Ginger extracts can help reduce nausea caused by morning sickness or following surgery or chemotherapy.
 But it is less effective for morning sickness.

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