IMedicals

Wrist(Walker-Murdoch) and Thumb(Steinberg) sign

Hydrocephalus can be defined broadly as a disturbance of formation, flow, or absorption of cerebrospinal fluid (CSF) that leads to an increase in volume occupied by this fluid in the CNS. This condition also could be termed a hydrodynamic disorder of CSF. Acute hydrocephalus occurs over days, subacute hydrocephalus occurs over weeks, and chronic hydrocephalus occurs over months or years. Conditions such as cerebral atrophy and focal destructive lesions also lead to an abnormal increase of CSF in CNS. In these situations, loss of cerebral tissue leaves a vacant space that is filled passively with CSF. Such conditions are not the result of a hydrodynamic disorder and therefore are not classified as hydrocephalus. An older misnomer used to describe these conditions was hydrocephalus ex vacuo.

Clinical features of hydrocephalus are influenced by the following:
* Patient's age
* Cause
* Location of obstruction
* Duration
* Rapidity of onset

Deep venous thrombosis (DVT) is a manifestation of venous thromboembolism (VTE). Although most DVT is occult and resolves spontaneously without complication, death from DVT-associated massive pulmonary embolism (PE)

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are manifestations of a single disease entity, namely, venous thromboembolism (VTE).

Signs and Symptoms
•Edema - Most specific symptom
•Leg pain - Occurs in 50% of patients but is nonspecific
•Tenderness - Occurs in 75% of patients
•Warmth or erythema of the skin over the area of thrombosis
•Clinical symptoms of PE as the primary manifestation

Complications
•As many as 40% of patients have silent PE when symptomatic DVT is diagnosed
•Paradoxic emboli (rare)
•Recurrent DVT
•Postthrombotic syndrome (PTS)

Mucopolysaccharidoses type 1(Hunter syndrome)
The mucopolysaccharidoses (MPSs) are a family of metabolic disorders caused by deficiency of lysosomal enzymes needed to degrade glycosaminoglycans (GAGs), or mucopolysaccharides.

Mucopolysaccharidosis type I (MPS I) is the most common type of MPS. MPS I is heterogeneous, and symptom severity varies widely.

MPS I is now divided into two subtypes: severe MPS I and attenuated MPS I. Patients with severe MPS I typically have an earlier onset of symptoms, a decline in intellectual function, and a shorter lifespan.

Clinical presentation
•Facial dysmorphism or coarsened facial features
•Corneal clouding
•Visceral involvement
•Skeletal involvement
•Joint stiffness
•cardiopulmonary

Prognosis
MPS I-HS(Hurler Scheie syndrome) and MPS IS(Scheie syndrome) are considered attenuated forms. Symptoms tend to develop later in life, starting in the teenaged years and into the early third decade of life. Symptoms are milder than those observed in MPS IH (Hurler syndrome).

Ramsay Hunt syndrome (herpes zoster oticus) occurs when a shingles outbreak affects the facial nerve near one of your ears. In addition to the painful shingles rash, Ramsay Hunt syndrome can cause facial paralysis and hearing loss in the affected ear.

Ramsay Hunt syndrome is caused by the same virus that causes chickenpox. After chickenpox clears up, the virus still lives in your nerves. Years later, it may reactivate. When it does, it can affect your facial nerves.

Prompt treatment of Ramsay Hunt syndrome can reduce the risk of complications, which can include permanent facial muscle weakness and deafness.

Pink eye (conjunctivitis) is an inflammation or infection of the transparent membrane (conjunctiva) that lines your eyelid and covers the white part of your eyeball. When small blood vessels in the conjunctiva become inflamed, they're more visible. This is what causes the whites of your eyes to appear reddish or pink.

Pink eye is commonly caused by a bacterial or viral infection, an allergic reaction, or — in babies — an incompletely opened tear duct.

Though pink eye can be irritating, it rarely affects your vision. Treatments can help ease the discomfort of pink eye. Because pink eye can be contagious, early diagnosis and treatment can help limit its spread.

Cutis marmorata telangiectatica congenita (CMTC)

This is a rare congenital (present at birth)disorder characterized by discolored patches of skin caused by widened (dilated) surface blood vessels. As a result, the skin has a purple or blue “marbled” or “fishnet” appearance (cutis marmorata).

In some affected individuals, ulcerations or congenital skin defects (aplasia cutis) can be present. The latter association can be part of Adams-Oliver syndrome. Additional associated abnormalities have been reported including pink or dark red, irregularly shaped patches of skin (nevus flammeus); loss of muscle tissue (wasting) on one side of the body (hemiatrophy); elevated fluid pressure within the eye (glaucoma); and/or undergrowth (hypotrophy) of one leg.

However, many if not all of those cases represent forms of Klippel-Trenaunay syndrome or related disorders, in particular Cowden’s disease. The most common association of true CMTC is with soft tissue (subcutaneous fat and muscle) hypoplasia.

The disorder formerly known as macrocephaly-cutis marmoratatelangiectatica congenital (M-CMTC) is a distinct genetic disease and is now called macrocephaly-capillary malformation (M-CM/MCAP) Virtually all cases of CMTC occur randomly for no apparent reason (sporadically). It is thought that CMTC represents a form of genetic mosaicism.

OVARIAN CANCER
Ovarian cancer is the most common cause of cancer death from gynecologic tumors in the United States. The precise cause of ovarian cancer is unknown, but several risk and contributing factors have been identified.

RISK FACTOR
Factors that can increase your risk of ovarian cancer include:
•Older age -The risk of ovarian cancer increases as you age. It's most often diagnosed in older adults.

•Inherited gene changes - A small percentage of ovarian cancers are caused by genes changes you inherit from your parents. The genes that increase the risk of ovarian cancer include BRCA1 and BRCA2, BRIP1, RAD51C, RAD51D and Lynch syndrome.

•Family history of ovarian cancer - If you have blood relatives who have been diagnosed with ovarian cancer, you may have an increased risk of the disease.

•Being overweight or obese - Being overweight or obese increases the risk of ovarian cancer.

•Postmenopausal hormone replacement therapy - Taking hormone replacement therapy to control menopause signs and symptoms may increase the risk of ovarian cancer.

•Endometriosis - Endometriosis is an often painful disorder in which tissue similar to the tissue that lines the inside of your uterus grows outside your uterus.

•Age when menstruation started and ended - Beginning menstruation at an early age or starting menopause at a later age, or both, may increase the risk of ovarian cancer.

•Never having been pregnant - If you've never been pregnant, you may have an increased risk of ovarian cancer.

PREVENTION
There is no known way to prevent ovarian cancer, but these things are associated with a lower chance of getting ovarian cancer—
•Having used birth control pills for five or more years.
•Having had a tubal ligation (getting your tubes tied), both ovaries removed, or a hysterectomy (an operation in which the uterus, and sometimes the cervix, is removed).
•Having given birth.
•Breastfeeding. Some studies suggest that women who breastfeed for a year or more may have a modestly reduced risk of ovarian cancer.

ASHERMAN'S SYNDROME also known as uterine synechiae, is a condition characterised by the formation of intrauterine adhesions, which are usually sequela from injury to the endometrium, and is often associated with infertility.

Synechiae are usually a consequence of uterine trauma caused by:
•Infections
•Prolonged use of intrauterine devices (IUDs)
•Post-miscarriage or postpartum curettage
•Caesarean sections in which there were infection issues
•Myoma or polyp removal procedures

However, there are cases where uterine synechiae have no apparent cause.

Patients may present with infertility, pregnancy loss, menstrual abnormalities (e.g. 2ry amenorrhoea, hypomenorrhoea, dysmenorrhoea) or abdominal pain

Intrauterine adhesions result secondary to trauma to the basal layer of the endometrium with subsequent scarring 1. This may be from a previous pregnancy, dilation and curettage, surgery, or infection (e.g. TB endometritis).

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In ASTHMA the air passages in the lungs become narrow due to inflammation and tightening of the muscles around the small airways.
This causes asthma symptoms:
•Cough
•Wheeze
•Shortness of breath
•Chest tightness.
These symptoms are intermittent and are often worse at night or during exercise. Other common “triggers” can make asthma symptoms worse. Triggers vary from person to person, but can include viral infections (colds), dust, smoke, fumes, changes in the weather, grass and tree pollen, animal fur and feathers, strong soaps, and perfume.

Causes
Many different factors have been linked to an increased risk of developing asthma, although it is often difficult to find a single, direct cause.

•Asthma is more likely if other family members also have asthma – particularly a close relative, such as a parent or sibling.
•Asthma is more likely in people who have other allergic conditions, such as eczema and rhinitis (hay fever).
•Urbanisation is associated with increased asthma prevalence, probably due to multiple lifestyle factors.
•Events in early life affect the developing lungs and can increase the risk of asthma. These include low-birth weight, prematurity, exposure to to***co smoke and other sources of air pollution, as well as viral respiratory infections.
•Exposure to a range of environmental allergens and irritants are also thought to increase the risk of asthma, including indoor and outdoor air pollution, house dust mites, moulds, and occupational exposure to chemicals, fumes, or dust.
•Children and adults who are overweight or obese are at a greater risk of asthma.

Managements
Asthma cannot be cured, but good management with inhaled medications can control the disease and enable people with asthma to enjoy a normal, active life. Medications include; bronchodilators(such as salbutamol) and steroids(such as beclometasone)

CUSHING SYNDROME occurs when your body has too much of the hormone cortisol over time. This can result from taking oral corticosteroid medication. Or your body might produce too much cortisol.

Too much cortisol can cause some of the hallmark signs of Cushing syndrome — a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. Cushing syndrome can also result in high blood pressure, bone loss and, on occasion, type 2 diabetes.

Treatments for Cushing syndrome can return your body's cortisol levels to normal and improve your symptoms. The earlier treatment begins, the better your chances for recovery.

Most Common Symptoms
•Weight gain and fatty tissue deposits, particularly around the midsection and upper back, in the face (moon face), and between the shoulders (buffalo hump)
•Pink or purple stretch marks (striae) on the skin of the abdomen, thighs, breasts and arms
•Thinning, fragile skin that bruises easily
•Slow healing of cuts, insect bites and infections
•Acne

Complications
•Bone loss (osteoporosis), which can result in unusual bone fractures, such as rib fractures and fractures of the bones in the feet
•High blood pressure (hypertension)
•Type 2 diabetes
•Frequent or unusual infections
•Loss of muscle mass and strength

BREASTFEEDING
Exclusive breastfeeding for 6 months has many benefits for the infant and mother. Chief among these is protection against gastrointestinal infections which is observed not only in developing but also industrialized countries. Early initiation of breastfeeding, within 1 hour of birth, protects the newborn from acquiring infections and reduces newborn mortality. The risk of mortality due to diarrhoea and other infections can increase in infants who are either partially breastfed or not breastfed at all.

Breast-milk is also an important source of energy and nutrients in children aged 6–23 months. It can provide half or more of a child’s energy needs between the ages of 6 and 12 months, and one third of energy needs between 12 and 24 months. Breast milk is also a critical source of energy and nutrients during illness, and reduces mortality among children who are malnourished.

Children and adolescents who were breastfed as babies are less likely to be overweight or obese. Additionally, they perform better on intelligence tests and have higher school attendance. Breastfeeding is associated with higher income in adult life. Improving child development and reducing health costs results in economic gains for individual families as well as at the national level.

Longer durations of breastfeeding also contribute to the health and well-being of mothers: it reduces the risk of ovarian and breast cancer and helps space pregnancies–exclusive breastfeeding of babies under 6 months has a hormonal effect which often induces a lack of menstruation. This is a natural (though not fail-safe) method of birth control known as the Lactation Amenorrhoea Method.

Recommendation
WHO and UNICEF recommend that children initiate breastfeeding within the first hour of birth and be exclusively breastfed for the first 6 months of life – meaning no other foods or liquids are provided, including water.

GIANOTTI-CROSTI SYNDROME(GCS) is a distinct infectious exanthem with associated lymphadenopathy and acute anicteric hepatitis.

Gianotti and Crosti initially described GCS as associated with a hepatitis B virus exanthem, which they termed papular acrodermatitis of childhood.

A similar constellation of characteristics was later found to be associated with several infectious agents and immunizations that were called papulovesicular acrolocated syndromes.

Etiology
•Viral infections
•Bacterial nfections
•Immunizations

Prognosis
Prognosis is excellent. Lesions clear within 4-12 weeks. No long-term complications are associated with Gianotti-Crosti syndrome (GCS). The mere presence of a rash does elicit some degree of social morbidity, depending on the age of the affected child. Although typically nonpruritic, some reports document pruritus in the later stages of the rash. The only significant morbidity involves the underlying infectious process, particularly the hepatitis B virus.

BREECH PRESENTATION is defined as a fetus in a longitudinal lie with the buttocks or feet closest to the cervix.

Predisposing factors for breech presentation include prematurity, uterine malformations or fibroids, polyhydramnios, placenta previa, fetal abnormalities (eg, CNS malformations, neck masses, aneuploidy), and multiple gestations.

Types of breeches
•Frank breech (50-70%) - Hips flexed, knees extended (pike position)
•Complete breech (5-10%) - Hips flexed, knees flexed (cannonball position)
•Footling or incomplete (10-30%) - One or both hips extended, foot presenting

Complications
A major complication of breech presentation is CORD PROLAPSE(where the umbilical cord drops down below the presenting part of the baby, and becomes compressed). The incidence of cord prolapse is 1% in breech presentations, compared to 0.5% in cephalic presentations.

Other complications include:

•Fetal head entrapment
•Premature rupture of membranes
•Birth asphyxia – usually secondary to a delay in delivery.
•Intracranial haemorrhage – as a result of rapid compression of the head during delivery.

Management
At term, the options for management of breech presentation are;
•External cephalic version
•Caesarean section
•Vaginal breech birth

PENETRATING INTRACRANIAL TASER INJURY

A 22-year-old man presented to the emergency department after a taser injury. The patient was in an altercation with law enforcement when he received a taser shot to his forehead from approximately 6 feet away.

The patient reported a loss of consciousness during the event and complained of a headache, but was otherwise neurologically intact with Glasgow Coma Scale score of 15.

Computed tomography imaging demonstrated a taser barb invading the inner cortex of the right frontal bone. The patient was admitted to the neurosciences intensive care unit, where neurosurgery attempted bedside removal.

Bedside removal failed, as part of the taser end piece remained, crossing the inner table of the right frontal calvarium extending slightly into the right frontal extra-axial space, and the patient was taken to the operating room for complete removal. Postoperatively, the patient made an unremarkable and complete recovery.

Man with Organic Solvent Chemical Burns to Hands

A 33-year-old man presented to the Emergency Department (ED) with chemical burns on his hands from handling paint thinner without using gloves.

He had approximately 7 h of direct contact of Klean-Strip® on his bilateral hands. Klean-Strip is comprised primarily of Stoddard solvent, a petroleum-derived mixture of organic hydrocarbons.

The patient reported severe burning pain throughout his palms and fingers. The palmar aspects of his hands were discolored and waxy, with a leather-like texture, particularly at his distal fingertips.

Burns with organic solvents such as hydrocarbons cause a corrosive dissolution of lipids, unlike thermal burns, which cause local tissue denaturation and release of local inflammatory mediators due to an exothermic reaction.

Infectious mononucleosis (mono) is often called the KISSING DISEASE. The virus that causes mono (Epstein-Barr virus) is spread through saliva. You can get it through kissing, but you can also be exposed by sharing a glass or food utensils with someone who has mono. However, mononucleosis isn't as contagious as some infections, such as the common cold.

You're most likely to get mononucleosis with all the signs and symptoms if you're a teen or young adult. Young children usually have few symptoms, and the infection often goes undiagnosed.

If you have mononucleosis, it's important to be careful of certain complications such as an enlarged spleen. Rest and enough fluids are keys to recovery.

Prevention
Mononucleosis is spread through saliva. If you're infected, you can help prevent spreading the virus to others by not kissing them and by not sharing food, dishes, glasses and utensils until several days after your fever has improved — and even longer, if possible. And remember to wash your hands regularly to prevent spread of the virus.

The Epstein-Barr virus may persist in your saliva for months after the infection. No vaccine exists to prevent mononucleosis.

IMPACTED WISDOM TEETH are third molars at the back of the mouth that don't have enough room to emerge or develop normally.

Wisdom teeth are the last adult teeth to come into the mouth (erupt). Most people have four wisdom teeth at the back of the mouth — two on the top, two on the bottom

Impacted wisdom teeth can result in pain, damage to other teeth and other dental problems. In some cases, impacted wisdom teeth may cause no apparent or immediate problems. But because they're hard to clean, they may be more vulnerable to tooth decay and gum disease than other teeth are.

Impacted wisdom teeth that cause pain or other dental complications are usually removed. Some dentists and oral surgeons also recommend removing impacted wisdom teeth that don't cause symptoms to prevent future problems.

Prevention
You can't keep an impaction from occurring, but keeping regular six-month dental appointments for cleaning and checkups enables your dentist to monitor the growth and emergence of your wisdom teeth. Regularly updated dental X-rays may indicate impacted wisdom teeth before any symptoms develop.

FETAL MACROSOMIA is used to describe a newborn who's much larger than average.

A baby who is diagnosed as having fetal macrosomia weighs more than 8 pounds, 13 ounces (4,000 grams), regardless of his or her gestational age. About 9% of babies worldwide weigh more than 8 pounds, 13 ounces.

Fetal macrosomia may complicate vaginal delivery and can put the baby at risk of injury during birth. Fetal macrosomia also puts the baby at increased risk of health problems after birth.

Causes
Genetic factors and maternal conditions such as obesity or diabetes can cause fetal macrosomia. Rarely, a baby might have a medical condition that makes him or her grow faster and larger.
Sometimes it's unknown what causes a baby to be larger than average.

Risk factors
•Maternal diabetes
•A history of fetal macrosomia
•Maternal obesity
•Excessive weight gain during pregnancy
•Previous pregnancies
•Having a boy
•Overdue pregnancy
•Maternal age

BENEFITS OF EXERCISE
•It controls weight
•Itcombats health conditions and diseases
•It improves mood
•It boosts energy
•Its promote better sleep
•It enhance your s*x life
•It can be fun

For most healthy adults, the U.S. Department of Health and Human Services recommends these exercise guidelines:

•Aerobic activity. Get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity. The guidelines suggest that you spread out this exercise during the course of a week. To provide even greater health benefit and to assist with weight loss or maintaining weight loss, at least 300 minutes a week is recommended. But even small amounts of physical activity are helpful. Being active for short periods of time throughout the day can add up to provide health benefit.

•Strength training. Do strength training exercises for all major muscle groups at least two times a week. Aim to do a single set of each exercise using a weight or resistance level heavy enough to tire your muscles after about 12 to 15 repetitions.

Moderate aerobic exercise includes activities such as brisk walking, biking, swimming and mowing the lawn. Vigorous aerobic exercise includes activities such as running, heavy yardwork and aerobic dancing. Strength training can include use of weight machines, your own body weight, heavy bags, resistance tubing or resistance paddles in the water, or activities such as rock climbing.

AIRPLANE EAR(ear barotrauma) is the stress on your eardrum that occurs when the air pressure in your middle ear and the air pressure in the environment are out of balance. You might get airplane ear when on an airplane that's climbing after takeoff or descending for landing.
Airplane ear is also called ear barotrauma, barotitis media or aerotitis media.

Self-care steps — such as yawning, swallowing or chewing gum — usually can counter the differences in air pressure and improve airplane ear symptoms. However, for a severe case of airplane ear, you might need to see a doctor.

Symptoms
Airplane ear can occur in one or both ears. Common signs and symptoms include:
•Moderate discomfort or pain in your ear
•Feeling of fullness or stuffiness in your ear
•Muffled hearing or slight to moderate hearing loss

If airplane ear is severe, you might have:
•Severe pain
•Increased ear pressure
•Moderate to severe hearing loss
•Ringing in your ear (tinnitus)
•Spinning sensation (vertigo)
•Bleeding from your ear