Size of smile matters

Seen by many,known by few.

Medical Facts


1.Your tongue has a unique print similar to your fingerprints.
2.Your brain is more active at night than during the day.
3.If you squeezed out all of the bacteria from your intestines, you could almost fill up a coffee mug.
4.Undertakers report that human bodies do not deteriorate as quickly as they used to. The reason, they believe, is that the modern diet contains so many preservatives that these chemicals tend to prevent the body from decomposition too rapidly after death.
5.Facial hair grows faster than any other hair on the human body, which explains the 5 o clock shadow that men get.
6.The storage capacity of human brain exceeds 4 Terabytes.
7.The acid in your stomach, that which helps digest your food, is strong enough to dissolve razor blades.
8.Women’s hearts beat faster than men’s due to having a smaller area to pump blood to.
9.Your stomach lining replaces itself every three to four days. If it did not do this your stomach would digest itself.
10.A scientist  discovered this weird medical fact – the left lung is smaller than the right lung to make room for the heart.
11.During your lifetime you will produce enough saliva to full up two swimming pools.
12.Every time you sneeze it reaches speeds of over 100mph, which is why people struggle to keep their eyes open when they sneeze.
13.This random medical fact is one for the ladies – women have a better sense of smell than men and continue to have a better sense of smell throughout their lives.
14.Everyone has a unique smell, except for identical twins.
15.The attachment of the human skin to muscles is what causes dimples.
16.In 1972, a group of scientists reported that you could cure the common cold by freezing the big toe.
17.The number one cause of blindness in the United States is diabetes.
18.People who laugh a lot are much healthier than those who don't. Dr. Lee Berk at the Loma Linda School of Public Health in California found that laughing lowers levels of stress hormones, and strengthens the immune system. Six-year-olds have it best - they laugh an average of 300 times a day. Adults only laugh 15 to 100 times a day.
19.In 1815 French chemist Michael Eugene Chevreul realized the first link between diabetes and sugar metabolism when he discovered that the urine of a diabetic was identical to grape sugar.
20,The first Band-Aid Brand Adhesive Bandages were three inches wide and eighteen inches long. You made your own bandage by cutting off as much as you needed.
21.According to the Centers for Disease Control and Prevention (CDC), 18 million courses of antibiotics are prescribed for the common cold in the United States per year. Research shows that colds are caused by viruses. 50 million unnecessary antibiotics are prescribed for viral respiratory infections.
22.It takes an interaction of 72 different muscles to produce human speech.
23.The first known heart medicine was discovered in an English garden. In 1799, physician John Ferriar noted the effect of dried leaves of the common plant, digitalis purpurea, on heart action. Still used in heart medications, digitalis slows the pulse and increases the force of heart contractions and the amount of blood pumped per heartbeat.
24. The lungs contain over 300,000 million capillaries (tiny blood vessels). If they were laid end to end, they would stretch 2400km (1500 miles).
25.. A mans testicles manufacture 10 million new sperm cells each day – enough that he could repopulate the entire planet in only 6 months.
26. Human bone is as strong as granite in supporting weight. A block of bone the size of a matchbox can support 9 tonnes – that is four times as much as concrete can support.
27. Each finger and toenail takes six months to grow from base to tip.
28.The largest organ in the body is the skin. In an adult man it covers about 1.9m2 (20sq ft). The skin constantly flakes away – in a lifetime each person sheds around 18kg (40 lb) of skin.
29. When you sleep, you grow by about 8mm (0.3in). The next day you shrink back to your former height. The reason is that your cartilage discs are squeezed like sponges by the force of gravity when you stand or sit.
30. The average person in the West eats 50 tonnes of food and drinks 50,000 liters (11,000 gallons) of liquid during his life.
31.. Each kidney contains 1 million individual filters. They filter an average of around 1.3 liters (2.2 pints) of blood per minute, and expel up to 1.4 liters (2.5 pints) a day of urine.
32.. The focusing muscles of the eyes move around 100,000 times a day. To give your leg muscles the same workout, you would need to walk 80km (50 miles) every day.
33. In 30 minutes, the average body gives off enough heat (combined) to bring a half gallon of water to boil.
34. A single human blood cell takes only 60 seconds to make a complete circuit of the body.
35. A foreskin, the size of a postage stamp, from circumcised babies take only 21 days to grow skin that can cover three (3) basketball courts. Amazing isn’t it. Thanks to science. The laboratory-grown skin is used in treating burn patients.
35.The eyes receive approximately 90 percent of all our information, making us basically visual creatures.
36. The female ovaries contain nearly half-a-million egg cells, yet only 400 or so will ever get the opportunity to create a new life.
Sources: Reader’s Digest Book of Facts
Hope all the facts are true. ;)

Glasgow Coma Scale


The Glasgow Coma Scale  is a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment.

The scale is composed of three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).

Eye response (E)
There are four grades starting with the most severe:

1.No eye opening
2.Eye opening in response to pain stimulus. (a peripheral pain stimulus, such as squeezing the lunula area of the patient's fingernail is more effective than a central stimulus such as a trapezius squeeze, due to a grimacing effect).
3.Eye opening to speech. (Not to be confused with the awakening of a sleeping person; such patients receive a score of 4, not 3.)
4.Eyes opening spontaneously

Verbal response (V)
There are five grades starting with the most severe:

1.No verbal response
2.Incomprehensible sounds. (Moaning but no words.)
3.Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange. Speaks words but no sentences.)
4.Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
5.Oriented. (Patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month, etc.)

Motor response (M)
There are six grades:

1.No motor response
2.Decerebrate posturing accentuated by pain (extensor response: adduction of arm, internal rotation of shoulder, pronation of forearm and extension at elbow, flexion of wrist and fingers, leg extension, plantarflexion of foot)
3.Decorticate posturing accentuated by pain (flexor response: internal rotation of shoulder, flexion of forearm and wrist with clenched fist, leg extension, plantarflexion of foot)
4.Withdrawal from pain (Absence of abnormal posturing; unable to lift hand past chin with supra-orbital pain but does pull away when nailbed is pinched)
5.Localizes to pain (Purposeful movements towards painful stimuli; e.g., brings hand up beyond chin when supra-orbital pressure applied.)
6.Obeys commands (The patient does simple things as asked.)


Interpretation

Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form "GCS 9 = E2 V4 M3 at 07:35".

Generally, brain injury is classified as:

Severe, with GCS < 8-9
Moderate, GCS 8 or 9–12
Minor, GCS ≥ 13.
Generally when a patient is in a decline of their GCS score, the nurse or medical staff should assess the cranial nerves and determine which of the twelve have been affected.

Holiday Package

At last, I'm back home..It was a tiring journey but I do love traveling alone  for the first time..
Let me share some of the pictures..



My study table..a night before I left..still couldn't finish clean it.. 


Was thinking how I'm going to bring all this back one day..It's only half of the collection.. 







Chittagong airport..International departure..



















KLIA2 (domestic departure area)






















to penang..








penang 2nd bridge 



a gift from my sis..maybe it's to early to call me dr..let wait and see whether I really make it or not..




Lakdhes

Menstrual disturbances

Menstrual disturbances

1.Menorrhagia-cyclic bleeding coming monthly, lasting for longer time  or excessive amount. (Disturbance usually in uterus).

2.Polymenorrhoea-cyclic bleeding coming too frequently and lasting for normal duration (problem usually in ovaries).

3.Polymenorrhagia-cyclic bleeding coming too frequently and too excessive.

4.Metrorrhgia-acyclic bleeding having no menstrual pattern. 

Appendicitis

Appendicectomy



is the surgical removal of the vermiform appendix. This procedure is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis. In the absence of surgical facilities, intravenous antibiotics are used to delay or prevent the onset of sepsis.

Indications: Acute appendicitis, recurrent appendicitis

Acute appendicitis
is the  inflammation of the appendix .

Symptoms:
Pain first, vomiting next and fever last has been described as the classic presentation of acute appendicitis. Since the innervation of the appendix enters the spinal cord at the same level as the umbilicus ), the pain begins stomach-high. Later, as the appendix becomes more swollen and irritates the adjoining abdominal wall, it tends to localize over several hours into the right lower quadrant, except in children under three years. This pain can be elicited through various signs and can be severe. Signs include localized findings in the right iliac fossa. The abdominal wall becomes very sensitive to gentle pressure (palpation). Also, there is severe pain on sudden release of deep pressure in the lower abdomen (rebound tenderness). In case of a retrocecal appendix (appendix localized behind the cecum), however, even deep pressure in the right lower quadrant may fail to elicit tenderness (silent appendix) because the cecum, distended with gas, protects the inflamed appendix from pressure. Similarly, if the appendix lies entirely within the pelvis, there is usually complete absence of abdominal rigidity. In such cases, a digital rectal examination elicits tenderness in the rectovesical pouch. Coughing causes point tenderness in this area (McBurney's point).


Procedure:
Incision:
Types:
1.Grid iron incision
2.Lanz incision
3.Rigth paramedian incision

McBurney point
an imaginary line joining anterior superior iliac spine and umbilical.The point is at 1/3 lateral and 2/3 medially

McBurney's grid incision is the most popular incision. it is right angles to the spino-umbilical line placed at Mcburney's point.It is about 6-8cm in length.
Lanz incision are cosmetically better than McBurney's.
Right paramedian incision is made when diagnosis is in doubt as a part of exploratomy laparotomy.



Layers opened:
1.skin
2.two layers of subcutaneous tissue: Camper's, Scampa's.
external oblique aponeurosis running downwards and medially.it is incised in the direction of the fibres
3.Internal and transverse abdominal muscles are split
4.Peritoneum.

Surgical procedure:
1.Antibiotics are given immediately if there are signs of sepsis; otherwise, a single dose of prophylactic intravenous antibiotics is given immediately before surgery.
2.General anaesthesia is induced, with endotracheal intubation and full muscle relaxation, and the patient is positioned supine.
3.The abdomen is prepared and draped and is examined under anesthesia.
4.If a mass is present, the incision is made over the mass; otherwise, the incision is made over McBurney's point.(this represents the position of the base of the appendix .The position of the tip is variable).
5.The various layers of the abdominal wall are opened.

6.Appendix is gently held at mesoappendix by using Babcock's forceps and blood vessels in the mesoappendix are divided.These include appendicular artery, branch of ileocolic artery.Once the appendix is freed upto the base (caecum), a purse string suture is applied all round appendix, taking bites from caecum , using 2-0 atraumatic silk.
Appendix is crushed at the base and is held 1cm above the crush. A tight silk ligature is applied at the crushed site and appendix is cut in between.Stump is cleaned with spirit.invaginated and purse string is tightened.This is called burial of the stump.Perfect haemostasis is obtained.

Closure
1.Peritoneum -continous 2-0 catgut/vicryl
2.Split muscles -sutured together by a few interrupted suteres using chromic catgut/vicryl
3.External oblique is sutured with silk
4.Subcutaneous fat is sutured with vicryl 
5.Skin with interrupted silk .Instead of catgut, 2-0 silk , 2-0 vicryl is being used more often nowadays.
6.The wound is dressed.

7.The patient is brought to the recovery room.
Corrugated red rubber drain is not kept routinely unless there is gangrenous appendicitis or a lot of pus in the peritoneal cavity. 

Recovery


Recovery time from the operation varies from person to person. Some will take up to three weeks before being completely active; for others it can be a matter of days. In the case of a laparoscopic operation, the patient will have three stapled scars of about an inch in length, between the navel and pubic hair line. When an open appendectomy has been performed the patient will have a 2–3 inch scar, which will initially be heavily bruise.

by Lakdhes

Urinary Tract Infection

Urinary Tract Infection



A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a simple cystitis (a bladder infection) and when it affects the upper urinary tract it is known as pyelonephritis (a kidney infection).

Causes of UTI:

1.Bacteria:


-E.coli
-Pseudomonas
-Proteus 
-streptococci
-staphylococcus epidermidis and saprophyticus

2.Virus
-adeno virus

3.Fungus
-candida albicans

4.Parasites:
-schistosoma haematobium
-wuchereria bancrofti

Predisposing factor for UTI
1.incomplete bladder emptying 
-bladder outflow obstruction
-neurological problem such as multiple sclerosis ,diabetic neuropathy )
-gynaecological abnormalities such as uterine prolapse.
-vesico ureteric reflux

2.Foreign bodies
-urethral catheter or uterine stent

3.Loss of host defences
-atrophic urethritis and vaginitis in post menopausal women
-diabetes mellitus

Spectrum of presentation of urinary tract infection
-asymptomatic bacteriuria
-symptomatic acute urethritis and cystitis
-acute pyelonephritis
acute prostatitis
-septicaemia

Typical features of UTI
-abrupt onset of frequency of micturition 
-scalding pain in the urethra during micturition 
-suprapubic pain during and after voiding
-intense desire to pass more urine after micturition 
-urine may appear cloudy and unpleasant odour
-visible haematuria



Antibiotics used in case of UTI
1.Upper UTI 
Trimethoprim
nitrofurantoin
co amoxiclav
ciprofloxacin
norfloxacin
gentamicin

2.Lower UTI
Trimethoprim 
ciprofloxacin
norfloxacin

3.Prophylactic 
Trimethoprim
co amoxiclav 
cefalexin 

And before I end my post, let me share why UTI is more common in females..
1.the distance between urethra and the anus is near
2.female urethra is shorter than male
3.female dont have bactericidal prostatic secretions. 


by Lakdhes

Diabetic lipoatrophy

Diabetic lipoatrophy:


Localised atrophy of subcutaneous fat due to repeated injection of pork insulin.

Treatment:
Injection of pure human insulin at the margin and centre of the affected area which results in restoration of normal contour.

by Lakdhes

Carotid Massage

Carotid Massage




Simplify version:
1.First auscultate over the carotids for any bruit, which is produced by atheromatous plaque, which may dislodge and causes stroke if massage if given.
2.If no bruit, give massage over the carotid area so that the carotid body gets compressed over vertebral body.Give the massage for 5 sec and ask pt to do valsalva maneuver at the same time and stop both suddenly at the same time.Give massage on the other sides for 2-3 times.

Carotid Massage

Proper Explanation:

Carotid sinus massage involves rubbing the large part of the arterial wall at the point where the common carotid artery, located in the neck, divides into its two main branches(dilated area superior to the bifurcation of the common carotid at the level of the superior border of thyroid cartilage).

Carotid sinus massage will slow the heart rate during episodes of atrial flutter, fibrillation, and some tachycardias. It has been known to stop the arrhythmia completely. If the procedure is being done to help diagnose angina pectoris, massaging the carotid sinus may make the discomfort go away.

The patient will be asked to lie down, with the neck fully extended and the head turned away from the side being massaged. While watching an electrocardiogram monitor, the doctor will gently touch the carotid sinus. If there is no change in the heart rate on the monitor, the pressure is applied more firmly with a gentle rotating motion. After massaging one side of the neck, the massage will be repeated on the other side. Both sides of the neck are never massaged at the same time.
Doctor must be sure there is no evidence of blockage in the carotid artery before performing the procedure. Massage in a blocked area might cause a clot to break loose and cause a stroke.


Absolute contraindications to carotid sinus massage include myocardial infarction, transient ischemic attack or stroke within the preceding three months. A history of ventricular fibrillation or tachycardia, or a previous adverse reaction to carotid sinus massage are also absolute contraindications. A relative contraindication is the presence of carotid bruits, which should be evaluated by Doppler ultrasonography before proceeding with massage. If the ultrasound shows stenosis or atheroma, the patient should understand the risks and benefits of the procedure.

Carotid sinus massage should be discontinued immediately if the ECG shows asystole for more than three seconds. If asystole is prolonged, a chest blow should be administered. If neurologic complications occur, the procedure should be stopped, aspirin should be given if not contraindicated, and the patient should be closely observed. Symptoms of pre-syncope or syncope should be recorded and compared with the original symptoms for which the patient is being evaluated. The procedure is then repeated on the left side with the patient in the supine position, and then on both sides with the patient in the erect position. The diagnostic rate increases when the carotid sinus massage is repeated in the upright position. The baseline values should return before the next step of the procedure is begun. After the procedure, the patient should be observed in the supine position for at least 10 minutes before discharge.



Valsalva Maneuver


The Valsalva  manoeuvre is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one's mouth, pinching one's nose shut while pressing out as if blowing up a balloon. Variations of the maneuver can be used either in medical examination as a test of cardiac function and autonomic nervous control of the heart, or to clear the ears and sinuses by equalize pressure between them when ambient pressure changes, as in diving, hyperbaric oxygen therapy, or air travel.

By Lakdhes. 

Smoking Cessation



I'm blogging after sometime..Hope the grammar is readable.Today i would like to write about smoking cessation.Many try to stop smoking but eventually failed after sometime.It's not your fault solely..It's due to the real  culprit,nicotine.

Bupropion is a drug primarily used as an 
atypical antidepressant and smoking cessation aid. 
also widely used to reduce nicotine cravings by people who are trying to quit smoking.It used  an aid for smoking cessation where it reduces the severity of nicotine cravings and withdrawal symptoms.

A typical bupropion treatment course lasts for seven to twelve weeks, with the patient halting the use of tobacco about ten days into the course. Bupropion approximately doubles the chance of quitting smoking successfully after three months. One year after treatment, the odds of sustaining smoking cessation are still 1.5 times higher in the bupropion group than in the placebo group.

The evidence is clear that bupropion is effective at reducing nicotine cravings. Whether it is more effective than other treatments is not as clear, due to a limited number of studies.Other than bupropion,Varenicline also can be used for smoking cessation but it has a greater amount of side effects.

Other than drug therapy ,Nicotine replacement therapy  is the remedial administration of nicotine to the body by means other than tobacco, usually as part of smoking cessation. Common forms of nicotine replacement therapy are nicotine patches(which transdermally administers nicotine) and nicotine gum (which orally administers nicotine). 

The primary benefit of nicotine replacement therapy is that it prevents cravings in a smoker whilst allowing him to abstain from tobacco—and thus avoid the harmful effects of smoking. Nicotine replacement therapy enables the easier overcoming of nicotine addiction because it reduces the craving to smoke.
The use of nicotine replacement therapy increases the success of initially quitting smoking by 50 to 70%. So before trying any of those,see a doctor and do as directed by the physician.


Thank you.
by Lakdhes..

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