Slide show: Back exercises in 15 minutes a day

Source: http://www.mayoclinic.org/healthy-living/adult-health/multimedia/back-pain/sls-20076265

Altitude Sickness - how to treat

How is it treated?

The best treatment for altitude sickness is to go to a lower altitude. But if you have mild symptoms, you may be able to stay at that altitude and let your body get used to it. Symptoms often occur if you have just arrived at a mountain resort from a lower altitude.

You may also be able to use oxygen or a specially designed pressure chamber to treat altitude sickness.

If you stay at a high altitude, rest. You can explore the area, but take it easy. Limit any walking or activity. Drink plenty of water, but do not drink alcohol. Do not go to a higher altitude until your symptoms go away. This may take from 12 hours to 3 or 4 days.

For the headache, you can take an over-the-counter medicine, such as ibuprofen(Advil, Motrin) or naproxen (Aleve). Do not give aspirin to anyone younger than 20. Aspirin has been linked to Reye syndrome, a serious illness. You may also use medicine to reduce feeling sick to your stomach or other symptoms.

A doctor can give you acetazolamide (Diamox). This speeds up how fast your body gets used to the higher altitude. Nifedipine (Procardia) and dexamethasone are also used for altitude sickness. You may also be able to use oxygen or a specially designed pressure chamber to treat altitude sickness.

Go to a lower altitude if your symptoms are moderate to severe, they get worse, or medicine or oxygen treatment does not help. Go down at least 1500 ft (457 m). Go to a lower altitude as fast as you can or get emergency help if someone with you has severe symptoms such as being confused or not being able to walk straight. Go with the person. Never let someone with severe altitude sickness go down alone.

Can you prevent altitude sickness?

You may be able to prevent altitude sickness by taking your time when you go to high altitudes, using medicine in advance, and eating certain foods.

• If you are going to altitudes higher than 8000 ft (2438 m), try to spend a night at a medium altitude before going higher. For example, in the United States, spend a night in Denver before going to the Rocky Mountains.
• Do not fly into high-altitude cities. If this is not possible, avoid large meals, alcohol, and being very active after you arrive. Rest, and drink plenty of liquids. If you have symptoms, do not go higher until they have gone away. Examples of high-altitude cities include Cuzco, Peru; La Paz, Bolivia; and Lhasa, Tibet.
• Sleep at an altitude that is lower than the altitude you were at during the day. For example, if you ski at 9500 ft (2896 m) during the day, sleep the night before and the night after at 8000 ft (2438 m). "Climb high, sleep low" is standard practice for those who spend time at high altitudes.
• One study showed that starting to take ibuprofen 6 hours before climbing to high elevations and then taking it every 6 hours while climbing may help prevent altitude sickness.1 Ibuprofen may also reduce the symptoms of altitude sickness if you do get it.
• You may consider taking acetazolamide (Diamox) or possibly dexamethasone before going to a high altitude.2 Talk to your doctor about this.
• Eat a lot of carbohydrates. This includes breads, cereals, grains, and pasta.

What if you have a lung problem or other disease?

Experts do not know much about how altitude affects other diseases. Many people with allergic asthma do better at high altitudes. Still, if you have asthma and are going to high altitudes, continue to use your daily controller medicine and take your quick-relief medicine with you. Talk with your doctor about altitude sickness if you have long-term diseases, especially heart problems, sickle cell anemia, chronic obstructive pulmonary disease (COPD), or sleep apnea.

AAP: Read to kids from birth - Happy JULY 4th

In its first policy statement on literacy promotion, the American Academy of Pediatrics (AAP) advises pediatricians to encourage parents to read to their children beginning in infancy and continuing until at least entry into kindergarten.

The recommendations call for pediatricians to promote literacy at health supervision visits throughout infancy and early childhood until at least children start school by explaining to parents the benefits of reading aloud with their children and advising them about enjoyable, developmentally appropriate reading activities.

All high-risk, low-income children should receive developmentally, culturally, and linguistically appropriate books at health supervision visits. Pediatric providers will need to find ways to distribute such books without placing financial strain on their practices, such as supporting state or federal funding, the statement acknowledges.

To support literacy education, the AAP recommends strategies such as wall posters; distributing materials that are understandable to parents with limited literacy skills; providing information about local library locations and services; promoting the “5 Rs” of early education (reading, rhyming, routines, rewards, relationships); and partnering with child advocates to promote national literacy policies. Pediatric resident training should include literacy promotion, and more research should be done on best practices.

The policy statement originated in growing realization of the significance of brain development in the first 3 years of life and the benefits of reading with young children, which include stimulating brain development and strengthening parent-child relationships at a pivotal time.

Early reading experiences foster long-lasting language, literacy, and social-emotional skills, which many children sorely lack. More than a third of American children enter kindergarten without the language skills they need to learn to read. 

Cover Your Cough - Prevent flu

Cover Your Cough

Stop the spread of germs that can make you and others sick!
Influenza (flu) and other serious respiratory illnesses like respiratory syncytial virus (RSV), whooping cough, and severe acute respiratory syndrome (SARS) are spread by cough, sneezing, or unclean hands.
To help stop the spread of germs,
Cover your mouth and nose with a tissue when you cough or sneeze.
Put your used tissue in the waste basket.
If you don't have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands.
You may be asked to put on a facemask to protect others.
Wash your hands often with soap and warm water for 20 seconds.
If soap and water are not available, use an alcohol-based hand rub.

The Flu Series - Part 1

Reference Source: CDC
Image source: http://www.nationaljewish.org


What is influenza (also called flu)?
The flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and lungs. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccine each year.
Signs and symptoms of flu
People who have the flu often feel some or all of these signs and symptoms:
Fever* or feeling feverish/chills
Cough
Sore throat
Runny or stuffy nose
Muscle or body aches
Headaches
Fatigue (very tired)
Some people may have vomiting and diarrhea, though this is more common in children than adults.
*It’s important to note that not everyone with flu will have a fever.

How flu spreads?
Most experts believe that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes or possibly their nose.

Respiratory Syncytial Virus - How to prevent my severity?

How can I help prevent the spread of RSV?

RSV is spread by coming in close contact with an infected person and the droplets produced when the person coughs or sneezes.  Careful hand washing with soap and warm water is the best way to prevent the spread of RSV. 

Palivizumab (brand name Synagis) is a monoclonal antibody produced by recombinant DNA technology. It is used in the prevention of respiratory syncytial virus (RSV) infections. It is recommended for infants that are high-risk because of prematurity or other medical problems such as congenital heart disease.

Palivizumab is a humanized monoclonal antibody (IgG) directed against an epitope in the A antigenic site of the F protein of RSV. Palivizumab reduced the risk of hospitalization due to RSV infection by 55%. Palivizumab is dosed once a month via intramuscular (IM) injection, to be administered throughout the duration of the RSV season.

Palivizumab targets the fusion protein of RSV, inhibiting its entry into the cell and thereby preventing infection.

The American Academy of Pediatrics (AAP) has published recommendations for the use of palivizumab. Updated AAP recommendations were published in 2009. Palivizumab  is used only for prevention, not for treatment, and once initiated for a given RSV season (usually November–March), it should be continued for the full duration of that season.

Reasons to consider palivizumab prophylaxis include:

Prematurity

• ≤ 28 weeks gestation and < 12 months of age at the start of RSV season
• 29-32 weeks gestation and < 6 months of age at the start of RSV season
• 32-35 weeks gestation and < 3 months of age at the start of RSV season, if there is a risk factor (child care attendance or sibling younger than 5 years old)

Chronic lung disease of prematurity

• Chronic lung disease still requiring oxygen/medication, for the first and second RSV seasons
• Chronic lung disease that required oxygen/medication within the 6 months preceding RSV season, for the first RSV season

Congenital heart disease

• Cyanotic heart disease, for the first 24 months of life
• Moderate to severe pulmonary hypertension, for the first 24 months of life
• Congestive heart failure requiring medication, for the first 24 months of life
• Children who have undergone open heart surgery during RSV season, for one additional dose after cardiopulmonary bypass (only if they still meet one of the other criteria)

Other conditions where prophylaxis might be considered but inadequate data is available:

• Immunocompromise
• Cystic fibrosis

Of note, a course of palivizumab is quite expensive, and the above recommendations were written based on estimates of its overall cost-effectiveness for preventing severe RSV disease.

Who am I and why should you be scared of me now?

I am a very common virus that leads to mild, cold-like symptoms in adults and older healthy children. But I am bad with young babies. Most infants have been infected by me before their second birthday.
I love the season from October to Spring (my season!)

More severe  disease with me may occur in the following infants:

• Premature infants
• Infants with chronic lung disease
• Immunodeficient infants
• Infants with heart disease

The following increase the risk for being affected by me:

• Day care
• Tobacco smoke
• Having school-aged brothers or sisters
• Crowded conditions
  
  
  You get to know about me 4 - 6 days after coming in contact with me.
  Antibiotics cannot make me go away
  If am nice (mild) I go away without treatment.
  Infants and children with a severe infection with me will be in the intensive care unit. Treatment will include:
  • Oxygen ( may need a ventilator)
  • humidified air
  • IV fluids
  
  I AM Respiratory Syncytial Virus
  Belonging to the Paramyxoviridae, I am virus in an enveloped, spherical, negative-strand RNA virus measuring 120-300 nm
  
  
  Diagnosis: You can find me by a direct immunofluorescence test for RSV antigen , and is reported to be 90% sensitive as compared to culture. RSV antigen may appear in the cytoplasm of cells within 8 hours of infection. Viral culture is performed in conjunction with the antigen test. The only acceptable specimen to detect me is a nasopharyngeal aspirate collected in viral transport media.
  Tomorrow I will tell you how to avoid me!!
  Source of picture and some text: http://pathology5.pathology.jhmi.edu/micro/v20n47.htm
  
  

What is in an egg?

Courtesy: http://dailyfitnessmagz.com

Facts:
1. Chicken egg has less cholesterol than the other eggs!
2. If you remove the egg yolk, you completely remove all the cholesterol. Egg white has NO cholesterol
3. Only animal food has cholesterol
4. One egg has only 75 calories but 7 grams of high-quality protein, 5 grams of fat, and 1.6 grams of saturated fat, along with iron, vitamins, minerals, and carotenoids.
5. The egg has disease-fighting nutrients like lutein and zeaxanthin. These carotenoids may reduce the risk of age-related macular degeneration, the leading cause of blindness in older adults. And brain development and memory may be enhanced by the choline content of eggs.
6. "Designer" eggs may come from chickens that are allowed to roam freely (free range) or whose feed is supplemented with omega-3 fatty acids. Hens given feed that is free of animal products produce vegetarian eggs, while those given all-organic feed produce organic eggs.
7.  Some chicken feed is enriched with canola oil, bran, kelp, flaxseed, marine algae, fish oil, or vitamin E to increase the eggs' healthy omega-3 fatty acid content. Certain types of feed are designed to reduce the saturated and total fat content of the egg yolk. Marigold extract has been used to increase the lutein content of eggs

Turner Syndrome: Aortic Coarctation - see the 3D view

Turner's Syndrome: Chromosomal disorder - Turner syndrome affects approximately 1 out of every 2,500 female live births worldwide. It embraces a broad spectrum of features, from major heart defects to minor cosmetic issues. The commenest heart condition is BICUSPID AORTIC VALVE! not Coarctation of Aorta
See this study below:
Pediatr Cardiol. 1999 Mar-Apr;20(2):108-12.: Study shows:
Partial anomalous pulmonary venous drainage (PAPVD; 2.9%), 
Aortic valve disease (stenosis and/or incompetence) (AoVD; 5. 1%), 
Aortic coarctation (AoCo; 4.4%), 
Bicuspid aortic valve (BicAo; 14.7%) are much more frequent in Turner's syndrome than in the normal population, with the difference being statistically highly significant.


High Blood pressure is common because of heart or kidney issues
See and learn below: Magnetic resonance angiography  showing the aortic coarctation.

MR Angiography (MRA) - courtesy -http://turners.nichd.nih.gov/angiography.html

Sleeping positions - today - Tomorrow I will write about the personality traits associated with this

In Professor Chris Idzikowski's survey of 1000 people, he identified six positions and claimed to detect personality traits based on them:

picture source: http://news.bbc.co.uk/2/hi/health/3112170.stm#sleep

• Fetus (41%) – curling up in a fetal position. This was the most common position, and is especially popular with women.
• Log (15%) – lying on one's side with the arms down the side.
• Yearner (13%) – sleeping on one's side with the arms in front.
• Soldier (8%) – on one's back with the arms pinned to the sides.
• Freefall (7%) – on one's front with the arms around the pillow and the head tilted to one side.
• Starfish (5%) – on one's back with the arms around the pillow
• Rest of them did not know how they slept

This is a study of 1000 people ( source Wikipedia)

Sleeping positions and your personality!

The Fetus: Those who curl up in the foetus position are described as tough on the outside but sensitive at heart. They may be shy when they first meet somebody, but soon relax.

Log (15%): Lying on your side with both arms down by your side. These sleepers are easy going, social people who like being part of the in-crowd, and who are trusting of strangers. However, they may be gullible.

The yearner (13%): People who sleep on their side with both arms out in front are said to have an open nature, but can be suspicious, cynical. They are slow to make up their minds, but once they have taken a decision, they are unlikely ever to change it.

Soldier (8%): Lying on your back with both arms pinned to your sides. People who sleep in this position are generally quiet and reserved. They don't like a fuss, but set themselves and others high standards.

Freefall (7%): Lying on your front with your hands around the pillow, and your head turned to one side. Often gregarious and brash people, but can be nervy and thin-skinned underneath, and don't like criticism, or extreme situations.

Starfish (5%): Lying on your back with both arms up around the pillow. These sleepers make good friends because they are always ready to listen to others, and offer help when needed. They generally don't like to be the centre of attention

From Professor  Idzikowski's research published in BBC news

Picture courtesy: Self Discipline blog and photobucket picture

Pterygium colli deformity (well what I meant was - Webbed Neck!)

Congenital skin fold that runs along the sides of the neck down to the shoulders. 

This is seen in Turner syndrome and Noonan syndrome, and  Klippel-Feil syndrome

In the newborn period, webbed neck is the loose folds of skin on the neck. 
As the child grows, the skin may stretch out to look like there is either a very short neck or no neck at all.

A 12-year-old female with Noonan syndrome exhibiting a typical webbed neck.
Picture courtesy: Wiki commons

GO away bad cholesterol - Why do we not want LDL?

Lipoproteins: Lipid (fat) + Protein, whose function is to transport lipids (fats) (such as triacylglycerol) around the body in the blood.
There are 5 major groups 

Lipoprotein structure (chylomicron)
ApoA, ApoB, ApoC, ApoE (apolipoproteins); T(triacylglycerol); C (cholesterol); green (phospholipids)
Picture - Wikipedia


Their size varies - small to Big  (chylomicrons, VLDL, IDL, LDL, & HDL)


Low-density lipoprotein (LDL)  enable transport of multiple different fat molecules, including cholesterol, within the water around cells and within the water-based bloodstream. 


Higher levels of BAD cholesterol AKA type-B LDL particles (as opposed to type-A LDL particles) increase health problems and cardiovascular disease


Blood tests typically report LDL-C - This is a calculated measurement
Direct LDL-C measurement using Nuclear magnetic resonance spectroscopy is superior and more accurate


LDL subtype patterns

LDL particles vary in size and density. Pattern that has more small dense LDL particles, called Pattern B, equates to a higher risk factor for coronary heart disease (CHD) than does a pattern with more of the larger and less dense LDL particles (Pattern A). This is because the smaller particles are more easily able to penetrate the endothelium. 
Pattern I, for intermediate, indicates that most LDL particles are very close in size to the normal gaps in tthe endothelium.
There is also relation ship between higher triglyceride levels and higher levels of smaller, denser LDL particles and alternately lower triglyceride levels and higher levels of the larger, less dense LDL

Paul-Bunnell test - The other name for MONOSPOT test

The mononucleosis spot test looks for two antibodies in the blood that indicate infection with the Epstein-Barr virus (EBV).
. It is used to diagnosis infectious mononucleosis, a disease caused by the Epstein-Barr virus (EBV). About 1 week after the onset of the disease, many patients develop heterophile antibodies. Antibodies reach peak levels in 2 - 5 weeks and may persist for up to 1 year. However, a small number of persons with mononucleosis may never develop such antibodies.
Monospot tests are usually positive in approximately 85% of patients with infectious mononucleosis. Positive test results will not occur until 1 - 2 weeks into the illness.

False-positive results may be occur in persons with:

• Hepatitis
• Leukemia or lymphoma
• Rubella
• Systemic lupus erythematosus (SLE)

COURTESY: http://www.nlm.nih.gov

Algorithm for the management of suspected infectious mononucleosis. (IM = infectious mononucleosis; GABHS = group A β-hemolytic streptococcus; VCA = viral capsid antigen; EBV = Epstein-Barr virus)

Courtesy: http://www.aafp.org/afp/2004/1001/p1279.html

Silly Broncodilators - can they cause hypoxia?

Fall in Arterial Oxygen Pressure

A fall in arterial oxygen pressure (PaO2) has been noted with isoproterenol administration during asthmatic bronchospasm, as ventilation improves and the exacerbation is relieved. 

The same effect has subsequently been noted with newer beta agonists such as albuterol and salmeterol. The mechanism for this seems to be an increase in perfusion of poorly ventilated portions of the lung. 

It is known that regional alveolar hypoxia produces regional pulmonary vasoconstriction in an effort to shunt perfusion to lung areas of higher oxygen tension. 

Administration of inhaled beta agonists may reverse hypoxic pulmonary vasoconstriction by beta 2 stimulation, increasing perfusion to underventilated lung regions. 

Preferential delivery of the inhaled aerosol to better ventilated lung regions increases the ventilation-perfusion mismatch. Oxygen tension falls most in subjects with the highest initial PaO2. Decreases in PaO2 rarely exceed 10 mmHg, and the PaO2 values tend to be on the flat portion of the oxyhemoglobin curve, so that drops in arterial oxygen saturation (SaO2) are minimized. Oxygen tensions usually return to baseline within 30 minutes.

Source: http://www.allbusiness.com/pharmaceuticals-biotechnology/pharmaceutical/14173501-1.html#ixzz1njbKDcNh

 Courtesy Source: http://www.ed4nurses.com/breathsnds.aspx?print=Y : 

Acanthosis nigricans

Darker, thick, velvety skin in body folds and creases. Rarely can cause itching


Commonest cause: Insulin Resistance (Insulin causes hyperplasia of the skin)
Internal Malignancies can cause this as well

Courtesy:

Avril Nimblett, MS, PA-C

 Acanthosis nigricans in children can be a precursor of type 2 diabetes

Image from Wikipedia

Hereditary angioedema (HAE)

Also known as Quincke's disease - An Autosomal Dominant disease

Caused by a deficiency or dysfunction of the C1 esterase inhibitor, a protein of the complement system

People with hereditary angioedema can develop rapid swelling of the hands, feet, limbs, face, intestinal tract, larynx or trachea

Attacks of swelling can become more severe in late childhood and adolescence.

There is usually a family history of the condition. However, relatives may be unaware of previous cases, which may have been reported as an unexpected, sudden, and premature death

Investigations:

• C1 inhibitor function
• C1 inhibitor level
• Complement components C4 and C2
  Treatment:
  Antihistamines and other treatments used for angioedema are of limited benefit in hereditary angioedema. Epinephrine should be used in life-threatening reactions.

  The most effective treatment is a C1 inhibitor concentrate (not available in the US), but this may not be available. Fresh frozen plasma contains C1 inhibitor and will help an episode, but rarely, the swelling will become worse.

  Berinert P (CSL Behring), which is pasteurized C1 inhibitor, was approved by the F.D.A. in 2009 for acute attacks. Cinryze (ViroPharma), which is nanofiltered, was approved by the F.D.A. in 2008 for prophylaxis. Rhucin (Pharming) is a recombinant C1 inhibitor under development that does not carry the risk of infectious disease transmission due to human blood-borne pathogens.

  Newer treatments attack the contact cascade. Ecallantide (Kalbitor, Dyax) inhibits plasma kallikrein, and was approved by the F.D.A. (but not in Europe) for acute attacks in 2009. Icatibant (Firazyr, Jerini) inhibits the bradykinin B2 receptor, and was approved in Europe and approved by the FDA on August 25, 2011.

  
  

  Prophylaxis:

  Attenuated androgens, such as danazol, can reduce the frequency and severity of attacks by increasing the production of C1 inhibitor.

  Helicobacter pylori, a type of bacteria found in the stomach, can trigger abdominal attacks. Getting rid of the bacteria with antibiotic therapy decreases these abdominal attacks.
  Hereditary angioedema can be life threatening and treatment options are limited.

  Courtesy: www.ncbi.nlm.nih.gov, youtube - HAE.org website and Wikipedia