25th Anniversary

of Niamath Science Academy





EDITORIAL

Dear Readers,



By the Grace of Almighty and prayers from wellwishers like you, Niamath Science Academy has entered 25 years of services for the cause of Unani System of Medicine.

A few Glimpses of Niamath Science Academy

• Organizes National Seminars and Conferences on different branches of Unani System of Medicine.



• Conducts free medical camps in different localities of State of Tamil Nadu.



• Offers membership to Unani Physicians and associate membership to others.



• Organized an International conference on Unani System of Medicine.



• Awarding Gold Medals and Merit Certificates to the students of Unani College for whom the examinations are conducted by the Tamilnadu Dr.M.G.R. Medical University.



• Sponsoring and co-sponsoring Medical Seminars and Conferences in different parts of the country.



• Instituted Prof. Hakim Syed Khaleefathullah Gold Medal to the outgoing Unani student from Govt. Unani Medical College, Chennai.



• Have completed clinical research programme for the treatment of Chronic Sinusitis with Unani research drug UK-500 in collaboration with the Institue of Oto-rhino-laryngology, Government General Hospital, Chennai.



• Felicitating prominent Hakims for their meritorious services to the Unani System of Medicine.



• Brought out a brochure on the recommendations of “WHO” entitled ‘Prevent Dehydration in Children during Diarrhoea” in three languages such as English, Tamil & Urdu and distribtued free of cost.



• Publishing Monthly Magazines, Herbal Unani Med in English and Mooligai Doctor in Tamil.



• Producing T.V. Talk Show, Live T.V. / Radio shows.



• Conducting Inter ISM Colleges Essay Competition.



• Awarding Gold Medal to the best Unani Student from all the Unani Medical Colleges in the Country.



• Started a Unani manufacturing unit _ Niamath laboratories.



• A Unani Hospital - S.K’s Herbal Medical Hospital,



• A Unani Wellness Centre - S.K’s Integrated Meidcal Wellness Centre,



• A Unani Research Trust - Niamath Research Foundation,



• A Therapy Resort - Centre for Ilaj Bid Tadbir - Regimental Therapy,



• Education - S.K. Educational Academy.



• Welfare Activities - S.K’s Welfare Centre,



• Poor Boys and Girls Home - SJK Charitable Trust.





Infertility Care in Unani System

of Medicine



If a young and healthy couple has been trying for a baby for 12 months without success, they must investigate the cause, preferbale with the help of an unani infertility specialist. Some of the reasons in Unani system that hinder conception are as follows :

Incorrect Intercourse

Assess for yourself if you are performing ‘peno-vaginal’ inter-course in the correct fashion. A marriage may remain unconsummated due to :

• Lack of knowledge about how to perform peno-vaginal intercourse



• Lack of sexual attraction



• Difficulties in men such as erectile dysfunction, premature ejaculation, an abnormal tightness of the foreskin, Peyronie’s disease, etc.



• Difficulties in women such as vaginismus, pain during intercourse, tight and unbroken hymen, narrow introitus etc. If peno-vaginal intercourse is not the problem, the man’s semen is to be tested for sperm count and mobility.



Low Frequency

Conception happens only when sperm meets ovum (egg). Each month one ovum is released by one of the two ovaries. This ovum remains available for about 24 to 48 hours. Ovulation occurs around 14 days before the first day of the next menstrual cycle. About five days before and after this day, including the day of ovulation is when there’s a higher possibility of pregnancy. If the frequency is low, a couple might miss the day of ovulation. It needs only one single intercourse for a woman to get pregnant; however it needs to happen on the day of ovulation or immediately around it.

Artificial Lubricant

Artificial lubricants tend to trap sperms and do not allow them to swim towards ovum. Many are also spermicidal in their composition.

You are not ovulating

In some women ovulation either does not occur at all or occur irregularly. This can be found out by a sonography. If ovulation is not occurring, there are several medical reasons and a gynaecologist should be consulted.

Damaged Uterine Lining

Endometrium (inner lining of uterus) needs to be healthy for the implanation of the fertilised ovum (zygote) to occur. If endometrium is damaged, pregnancy does not occur. The common causes of endometrial damage are infections including STDs, tuberculosis etc.

Blocked Fallopian Tubes

Ovum gets transported from ovary to uterus through fallopian tubes. If they are blocked, the possibility of ovum meeting the sperm is hampered. Infections and tuberculosis are common reasons for blocked tubes.

Unable to ‘Hold on’

There are times, when sperm meets ovum and conception takes place, however uterus is unable to hold on to the pregnancy due to loose/lax mouth of the uterus (cervix) and a miscarriage occurs. There are women who suffer from repeated miscarriage and are unable to continue the pregnancy for nine months.

Combined Infertility

In some cases each partner is independently fertile but as a combination the couple cannot conceive together without medical assistance. The cause in such cases is often suspected to be either immunological or genetic in nature.

Unexplained Infertility

There are instances when the above mentioned problems don’t exist, yet the couple is unable to have a baby. Upto 26 percent of infertile couples have unexplained infertility. In these cases, abnormalities are likely to be present but cannot be defected by available methods. Even the most experienced infertility specialist is unable to ascertain the reason and the adoption is suggested. Upto 26 percent of infertile couples have unexplained infertility.







Flossing, Essential for Tooth Care



In the hectic lives that we live, a standard procedure of dental hygiene that many of us tend to ignore is that of flossing. Here are a few reasons as to why flossing is essential for the upkeep of your pearly whites :



• Large-sized chunks of food (read fruit peels and pop corn) that get lodged in between teeth, might not always get flushed out with the toothbrush. Here’s where the floss comes into play.



• Regular flossing helps you prevent tooth decay and gum disease.



• Flossing can be done in a matter of minutes, so you can flash that smile in places where it matters most.









Impotence



Impotence is a man’s inability to produce, or maintain, a penile erection. For this reason, an impotent man cannot have sexual intercourse. The condition may be short-lived or may last for a long time. Brief bouts of impotence may follow depression and illnesses, such as influenza, or after taking drugs or alcohol, but in these cases the man can except a swift return to former potency. Impotence is not the same as infertility or sterility.



Q : What causes impotence?



A : Impotence usually has a psychological origin. There may, however, be a physician cause, such as a small or deformed penis. Impotence may also be caused by certain diseases or disorders; for example. Cushings syndrome, hypopituitarism, polyneuritis, a stroke, diabetes mellitus, or alcoholism. Impotence may also occur as an aftereffect of certain surgical procedures, and the patient should be informed of this before such an operation.

Q : How is impotence treated?



A : Where the impotence has a psychological basis, a physician may arrange for the problem to be discussed with a sex therapist or marriage counselor. The patient’s sexual partner should be involved in such discussion and any consequent treatement, because the partner’s reassurance and encouragement are essential.



Where impotence is the result of a physical disease or disorder, the underlying cause must be treated first. A small or deformed penis, for example, may be corrected by surgery. Unfortunately, impotence caused by some physical disorders may be permanent.



Incontinence is the lack of voluntary control of the bladder or bowels, particularly in an adult. Voluntary control of the bladder during the daytime is not achieved until about the age of two years, and at night may not occur until some years later.

Q : What can cause incontinence of the bladder?



A : Any neurological disorder that interferes with normal sensations from the bladder can prevent control of the sphincter muscle that normally closes it. Such disorders include spina bifida, damage to the spinal cord, multiple sclerosis, and nerve degeneration that occurs with conditions like diabetes mellitus and strokes, or senility. This type of incontinence is also common in attacks of epilepsy.



Incontinence may also result from partial obstruction caused by enlargement of the prostate gland (prostatomegaly) and from disorders of the muscle that controls the outflow of urine; such as muscle disorder may follow an operation or cancer. Some women develop stress incontinence because of prolapse (a displacement) of the womb, which presses on the bladder and changes its anatomy so that urine escapes when the woman coughs or laughs. Incontinence may also result from an injury to the spinal cord that prevents impulses between the brain and bladder.

Q : How is incontinence treated?



A : The treatment of any form of incontinence must be directed toward the cause. Special bags may be used for urinary incontinence, but fecal incontinence is more difficult to control; absorbent pads have to be worn in waterproof undershorts.



A new treatment involves electrical stimulation of the muscles that close the exit the bladder and rectum. Impetigo is an infectious skin disease that is usually caused by staphylococcus or streptococcus bacteria. It is common among children, and may appear as a complication of an existing skin condition such as eczema or ichthyosis. Chronic impetigo in older persons is known as ecthyma.

Q : Why is impetigo common among children?



A : The body’s immunity is less well developed in children. Frequent colds with a runny nose move staphylococci from the nose on to the face. Nose blowing and scratching beneath and around the nose produce minor abrasions on the skin, which allow the bacteria to enter. Other areas, such as the hands and legs, may also become infected.

Q : What are the symptoms of impetigo?



A : Small blisters appear on the skin. These rapidly break down to form pale, crusty, oozing areas that spread. The condition may be complicated by further infection from streptococcus bacteria.

Q : How is impetigo treated?



A : Medical advice should be sought promptly because the infection can spread rapidly to other person. Physicians usually prescribe an antibiotic medication to be taken orally. In some cases, topical applications of antibiotic ointments may be prescribed. These are usually applied after the affected areas are gently washed to remove the crusts and ooze.

Q : Are there any complications of impetigo?



A : Yes, If additional streptococcal infection breaks out on the area affected by impetigo, it can cause the kidney disorder Glomerulonephritis.



A talk about Infertility



Infertility is the inability to produce offspring. It is not the same as sterility, because an infertile person may have no physical disorder of the reproductive system.



Many couples are temporarily infertile. The likelihood of becoming pregnant on any one occasion is only about one percent. However, over a period of two years, ten percent of couples are infertile.



Fifty percent of women under the age of thirty who have regular intercourse can become pregnant within six months. Nearly ninety percent may be pregnant within a year, the remainder within two years. Older women usually take longer.

Q : What should a couple do if they believe they are infertile?



A : Taking into consideration the above statistics, it is advisable for a couple to delay any kind of investigations for at least a year. During this time they can work out the exact ovulation day of the woman. To do this, the woman takes her temperature first thing in the morning before having anything to eat or drink. Fourteen days before the onset of menstruation, the temperature rises by about 1oF (0.5oC). The rise in temperature occurs twenty four hours after ovulation. If a temperature chart is kept for three to four months, a woman can estimate the day of ovulation.



The ovum is ready for fertilization for twenty four hours. It is not known for certain how long a sperm can survive in the womb, but it is thought to beup to three days.

Q : Why are some couple infertile?



A : A sexual problem, such as complete ignorance about the mechanics of intercourse, is a more common factor than is realized. Other sexual difficulties that disrupt fertility include frigidity and impotence.



Sometimes a woman who ovulates only occasionally has a partner with a low sperm count. This means the chance of fertilization is greatly reduced.



In fifty percent of infertile couples, both partners are affected because of some physical reason. In the remaining fifty percent, half the men and half the women are physically incapacitated.

Q : What conditions can make a man infertile?



A : Apart from sexual problems, infertility results if a condition or disorder affects (1) the total number of sperm produced during ejaculation; or (2) the number of viable, or normal, sperm produced. Such disorders include any infection of the sexual organs, for example, epididymitis; veneral disease; prostatitis; mumps; or a blockage of the vas deferens (sperm duct).



The temperature of the testicles affects the production of sperm. Undescended testicles are too warm to produce healthy sperm. In the same way, some men become temporarily infertile in hot environments, or from wearing tight undershorts that hold the testicles too close to the body. More rarely, varicose veins of the spermatic cord, known as varicoceles, increase the blood flow of the testicles, and keep them too warm. Other causes of infertility include certain chromosome abnormalities, Klinefelter’s syndrome, cystic fibrosis. Certain drugs, and irradiation of the testicles.

Q : How is a man’s fertility assessed?



A : A physician examines the man’s testicles and then the prostate gland during a rectal examination. A sample of semen is collected and examined within two hours using a microscope to determine the sperm count. If any abnormality is noticed, the test is repeated two or three times to ensure an accurate diagnosis.

Q : How is infertility in a man treated?



A : General attention to health is essential. If the man is overweight, he must diet to lose weight. He should not smoke and should moderate his drinking, if necessary. Loose undershorts often help to increase the number of sprm produced, and sometimes the physician recommends bathing the testicles in cold water twice a day. If the sperm count is low, abstinence from sexual intercourse three to four days before the expected day of ovulation should increase the number of sperm ejaculated.



Infections of the reproductive organs must be treated; a varicocele can be removed by a minor operation. If no sperm are being produced, or if there is a blockage in the vas deferens, it is seldom possible to cure the condition, although sometimes an operation can unblock the sperm duct. Undescended or retractile testicles have to be treated during childhood.



Sexual problems, such as impotence or premature ejaculation, need sympathetic discussion with sex therapist or physician.

Q : What conditions make a woman infertile?



A : Infertility in women results if a condition or disorder affects (1) ovulation; (2) the movement of the ovum along the fallopian tube; (3) the ability of the fertilized ovum to implant in the wall of the womb; or (4) normal sexual intercourse.



Ovulation may be disrupted by anxiety, or one of various hormone disorders. A hormone imbalance may occur for a few months following a course of contraceptive pills. Illness such as tuberculosis or diabetes mellitus affects ovulation, and it is also thought that obesity, smoking, and alcohol affects it. An ovarian cyst also disrupts ovulation.



The movement of the ovum is restricted by any infection of the fallopian tube, including salpingitis, venereal diseases, or an abscess. The lining of the tube becomes scarred, and even if an egg is successfully fertilized, an Ectopic pregnancy is likely.



Disorders that affect the womb included endometriosis, endometritis, polyps, and fibroids. In some women, a congenital anomaly results in a deformed womb.



The presence of an intact hymen or vaginismus may indicate problems with techniques of sexual intercourse. Dyspareunia (painful intercourse) may indicate a gynecological infection.



Sometimes cervical secretions kill the sperm even when intercourse is successful.

Q : How is infertility in a woman assessed?



A : Some tests can be carried out at home, for example, the temperature test for the day of ovulation described above. A gynecological examination is necessary to see if there is any local infection in the vagina, cervix, or fallopian tubes. It is usual for a physician to check general health with a chest X-ray, blood test, and urine sample. A cervical smear is taken to eliminate the possibility of local infectiondue to cervicitis as well as cancer.



A postcoital test may have to be done. Vaginal secretions are examined two to three hours after intercourse to make sure that the sperm are still moving vigorously, and are not being killed by the secretions.



If the results of these tests are normal, a D and C operation is usually performed to examine the lining of the womb. This may be followed by a salpingogram to show the shape of the womb and the condition of the fallopian tubes.

Q : How is infertility in a woman treated?



A : Anxiety is a cause of infertility among many couples who have not been able to have children for a few years. Medical investigations often act as a form of psychotherapy, which has led some infertile couples to conceive even before treatment begins.



If an infection is discovered during the investigations, it is promptly treated. However, repair operations on already scarred fallopian tubes are rarely successful. Adjustment of a womb abnormality is also difficult, but is sometimes successful.



Hormone disorders are easier to treat, Ovulation can be stimulated with a drug called clomiphene, combined with a small dose of estrogen. Care is taken to prevent multiple pregnancy.



In a technique introduced in Britain during the late 1970’s infertile women have become pregnant after having a fertilized ovum implanted in the womb. The ovum is taken from the woman at ovulation, fertilized in a laboratory by sperm taken from the husband, and then replaced in the woman’s womb. But this method is still in its experimental stages.

Q : How successful are treatments for infertility?



A : Of those couples who seek treatment, twenty percent of the women conceive before treatment is started. A further twenty percent become pregnant within two years of treatment. It is important, however, that each partner follows the physician’s advice. Conception may occur after years of infertility. This may happen after the adoption of a child, but there is no scientific explanation for it.





Lactation



Lactation is the secretion of milk from the female breasts, and the period of lactation is is the length of time for which nursing continues. Lactation is controlled by a complex interaction between various hormones in the mother’s bloodstream.

Q : What makes the breasts start producing milk at the end of pregnancy?



A : Throughout pregnancy, the breasts develop and increase in size in response to increased amounts of the hormones estrogens, progesterone, and chorionic gonadotrophin (the chorion is the membrane that encloses the fetus). These hormones are produced by the placenta, the organ of chemical interchange between mother and fetus. The increase in breast size is caused partly by the larger number of ducts that form in the breast and partly by an increase in the amount of fatty tissue.



Milk is not formed until after the baby is born. Milk production is stimulated by the hormone Prolactin produced by the pituitary gland at the base of the brain, which in turn is stimulated by changes that take place at the onset of labor.



But “first milk” or colostrum, a fluid rich in fat and proteins, is secreted near the end of pregnancy. It contains antibodies from the mother that help to protect the baby against disease. As soon as the baby is born, the mother’s hormone levels drop rapidly, prolactin secretion starts, and milk is produced.

Q : Why does milk secretion sometimes occur before the baby starts sucking?



A : The contraction of the breast tissue to expel milk is partly a reflex to the baby sucking and partly a response to the presence of the hormone Oxytocin (also secreted by the pituitary gland). This hormone may be produced in response to the mother’s emotional reaction when she hears the baby crying. Oxytocin also causes contraction of the womb, and this accounts for an increase in vaginal flow when breast-feeding takes place.

Q : How may lactation be stopped?



A : If the woman does not want to breast feed, hormone injection of estrogens may be given after the birth of the baby, and this is usually sufficient to prevent lactation. But, if milk appears later, further estrogens should be given.



The problem is more difficult if lactation needs to be stopped once it has started. A combination of estrogens, restricted fluid intake, and a firm brassiere may stop lactation.

Q : Are there any dangers in using estrogens to stop lactation?



A : Yes, although risks are small and probably affect only women who are over the age of thirty-five, those who smoke, or those who have had an operation, such as a Cesarean section. There is also a slightly increased risk of venous thrombosis because of the effect of the estrogens.

Q : Can anything be done if lactation does not begin?



Lie on the back, with the hands under the head, the legs stretched out, the toes outward, and the feet together. Raise the shoulders, arms and chest at least one foot from the floor. Hold the position for a moment, then lower the head and shoulders gently to the floor. Repeat twenty times.



A : Little can be done because the reasons for failure to start lactation are not fully understood.

Q : Are there any problems that may occur during lactation?

A : Yes. Gradual failure of lactation, once it has started, is usually caused by a combination of the mother’s fatigue and anxiety as well as lack of sufficient fluid. This may occur when the mother returns home from the hospital, and it is relatively easy to treat.



Other problems include engorgement of the breasts, failure to produce sufficient milk, or Mastitis (Inflammation of the breasts). Infection of the breast ducts usually results from a cracked nipple, but it may occasionally be a complication of Puerperal Fever, a condition that can develop after a woman has given birth. Part of a breast becomes tender, swollen, and inflamed, and a sudden fever occurs, often starting with a shivering attack. A physician may prescribe antibiotics and painkilling drugs. If possible, breast-feeding should continue because this empties the affected area.





Jaundice



Jundice, known medically also as icterus, is a condition characterized by a yellowing of the skin and the whites of the eyes. It is a symptom, not a disease in itself. The yellow coloration is caused by an excess in the body of the Bile pigment bilirubin. Normally, bilirubin is formed by the breakdown of hemoglobin during the destruction of worn-out red blood cells. It is then excreted by the liver into the bile via the bile ducts.

Q : What causes an excess of bilirubin in the body?





A : An excess can be caused by (1) over production of bilirubin; (2) the failure of the liver to metabolize bilirubin or to excrete it; or (3) a blockage of the bile ducts.



Overproduction of bilirubin may be caused by the destruction of an excessive number of red blood cells (hemolytic anemia). The liver cannot then excrete bilirubin fast enough. This occurs in malaria, thalassemia, and hemolytic disease of the newborn.



Mild jaundice occurs as a common and normal condition in newborn babies, because at birth there is a deficiency in the enzyme that helps to excrete bilirubin. Rarely, this enzyme deficiency can also cause jaundice in adults. But in babies, the condition disappears within a few days as the enzyme is formed.



Jaundice may also result from various diseases that can affect the liver, such as hepatitis or cirrhosis.





A talk about Menstrual Problems



Menstrual problems may occur at any time between menarche (when periods first begin) and Menopause (when they end).



During puberty, many girls have irregular periods. But as a rhythm becomes established, problems become less common, and the absence of periods (Amenorrhea) is usually a sign of pregnancy or of a psychological probelm.



The most common problem during the early years of menstruation is pain, and in later years there may be feelings of irritation and depression, breast tenderness, and ankle swelling because of Premenstrual Tension. Also, fluid retention may occur for a few days before menstruation.



Bleeding between periods may occur at any time, but is most common during the few years before menopause. If it persists, you should consult a physician. Heavy periods or irregular periods also commonly occur.



A threatened Miscarriage may simulate a menstrual problem when in fact it is caused by pregnancy.

Q : What conditions cause abnormal menstrual bleeding?





A : Heavy periods may be caused by various conditions that affect the womb, such as Endometriosis, Endometritis, Fibroids, or Salpingitis. Occasionally, general, disorders involving reduction in clotting ability, may cause abnormal menstrual bleeding. More frequently, heavy periods are associated with the hormone imbalance related to menopause or, less frequently, to an ovarian Cyst.



At any age, one of the most common casues of abnormal bleeding is psychological disturbance because of Anxiety, Depression, or Sexual problems.

Q : How is abnormal menstruation treated?





A : Treatment depends on the cause. A woman experiencing this problem should consult a physician. A diagnosis will be made after physical and gynecological examinations. If necessary, it will include a Cervical Smear test and a vaginal swab to discover if any infection is present. A pregnancy test reveals if pregnancy is the cause of lack of menstruation.



If no physical cause can be found for the absence of menstruation, a hormonal disturbance may be the cause. The physician may prescribe a regular course of synthetic hormones. This usually produces menstruation, followed by normal periods when the hormone treatment is stopped.

Q : What are other treatments if diagnosis is uncertain or hormone therapy is unsuccessful?





A : A diagnostic D and C (dilation and curettage) is a simple and minor operation that allows a general gynecological examination as well as a microscopic examination of the lining of the womb. Often this simple operation is in itself sufficient to return menstruation to normal. The woman does not need to remain hospitalized for more than a day.



If abnormal bleeding continues, either because of hormonal disturbance, fibroids, or cancer, a Hysterectomy (surgical removal of the womb) may have to be performed. But this operation is becoming less common. Hysterectomy induces menopause. Troublesome symptoms occur only if the ovaries are removed as well as the womb. seven day and occurs every twenty four to thirty four days the length of the menstrual cycle. About half-way through the cycle, an egg is released from an ovary to travel along a fallopian tube to the womb. This process is called ovulation.

Q : How is the length of a menstrual cycle calculated?





A : The menstrual cycle is the time between the first day of one period and the first day of the next, including the days when bleeding occurs.

Q : Are all menstrual cycles the same?





A : No. Most women have a slight variation, within a day or so, in the length of their menstrual cycles, and each woman’s cycle can also vary from month to month. The cycle tends to be the same length, usually about twenty-eight days, but some women have a cycle that is consistently longer or shorter than this.

Q : Is menstruation always the same?





A : Like the menstrual cycle, the period may have slight variations in individual women. Bleeding is usually heavier in the first day or two and then becomes lighter for the next two or three days.

Q : How does the body control menstruation?





A : Regularity of menstruation is a complex balance between the levels of hormones produced by the ovaries (estrogens and progesterone) and those produced by the pituitary gland at the base of the brain, the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). FSH stimulates the ovary to produce estrogen in the first half of the menstrual cycle. Estrogen causes a thickening of the lining of the womb. In mid-cycle, a sudden increase in LH causes ovulation, and progesterone alters the nature of the womb lining in preparation for a fertilized egg.



Fertilization produces an embryo that stimulates another hormone to maintain the womb lining. If fertilization does not take place, the womb lining is shed as the menstrual flow, and the cycle of events begins all over again.

Q : How are the hormones from the pituitary gland involved in menstruation?





A : As the production of estrogen increases from the ovaries, its rising concentration diminishes the level of FSH from the pituitary by a mechanism known as a “feedback”. The pituitary then releases LH, again controlled by feedback of progesterone from the ovaries.

The feedback of the various hormones is detected by the hypothalamus int he brain. The hypothalamus can also be affected by other factors, such as emotions, anxiety, or depression, and the effects of other hormones in the bloodstream.

Q : Why do menarche and menopause occur?





A : The onset of menstruation is associated with the hormonal changes of puberty, and the final and of menstruation is caused by aging of the ovaries. But in neither case is the exact mechanism fully understood.

Q : What care should a woman take during menstruation?





A : There is not need to restrict any activities during menstruation unless the blood flow is extremely heavy. Absorbent pads (sanitary napkins) or internal tampons may be worn. Sanitary napkins are more obstrusive and may cause vulval soreness, but they are more absorbent than tampons. Tampons left in the vagina for a long time may produce offensive discharge because of vaginitis. Menstrual blood has no harmful effects on the woman or anything that it may touch.

Q : At what age may a girl use internal tampons?





A : This depends on her size. It is often advisable to attempt to insert the first tampon when she is not menstruating, because the technique is sometimes difficult to learn.



Premenstrual Tension



Premenstrual tension, or syndrome, consists of various symptoms that, in some women, occur regularly for several days before each menstrual period. Symptoms vary in severity and include irritability, depression, fatigue, headaches, breast tenderness and a feeling of abdominal swelling. There may also be running nose, asthima, migraine, and backache. Premsnstrual tension can also make women anxious, intolerant, and prone to accidents.

Q : What causes premenstrual tension?



A : The cause is thought to be a hormonal disturbance, accompanies by retention of water within the body tissues.

Q : Can premenstrual tension aggrevate any other problems?



A : Yes, Depression, from causes other than premenstrual tension, tends to be increased. Women who suffer from epilepsy may have convulsion only during this time. Any marital problems may be made worse if the wife’s irritability is increased.

Q : What treatments can help premenstrual tension?



A : A physician may prescribe a diuretic (water-removing) drug. This is often quite effective an may also be combined with medication to help depression. Tranquilizers help to combat irritability, but make fatigue worse.



If these simple treatments are not successful, hormone preparations of progesterone generally give relief from all the symptoms. In some cases, a physician may prescribe the contraceptive pill.







A talk about Pregnancy and childbirth



Pregnancy and childbirth



A normal pregnancy lasts about 265 days, although pregnancies naturally vary in duration (for Emergency delivery of child).

Q : Can a woman always be sure that her estimated date of confinement is correct?



A : No. A woman whose periods have always been irregular is unlikely to reach an accurate date for delivery based on calculation. This is because the date of ovulation, and thus fertilization, probably occurred about two weeks before a period was due



It is possible for bleeding to occur during pregnancy, lasting one or two days. However, it may make a woman think she has menstruated and become pregnant a month later than was actually the case.



Q : What are early symptoms of pregnancy?



A : Often, the earliest sign is the absence of a period (amenorrhea). This may be accompanied by a feeling of heaviness in the breasts, slight nausea first thing in the mornings (morning sickness), and frequency of urination.

Q : What tests and examinations are carried out to confirm pregnancy?



A : A pregnancy test can be performed using a sample of urine, after the period has been overdue for eight days. If this is positive, it is relatively certain that the woman is pregnant. If the test is negative, it should be repeated in a week’s time.



Once the period is more than two weeks overdue, a gentle vaginal examination usually reveals an enlargement of the womb. This, combined with other symptoms suggestive of pregnancy test.

Q : How are the common problems of early pregnancy treated?



A : Morning sickness affects about fifty percent of women. For the more severe condition (hyperemesis gravidarum) a physician may prescribe antinauseant drugs to be taken at night. A couple of crackers before getting out of bed in the morning helps to control mild nausea. Breast tenderness is relieved by wearing a firm brassere that gives good support.

Q : What information is required and what examinations and tests are carried out by the obstertrician?



A : It is most important for the woman to give the fully history of any previous pregnancies or abortions she may have had.



She will also be asked about any illnesses or disorders she may have had. Chronic nephritis, diabetes mellitus, high blood pressure, and rheumatic valve disease of the heart all can cause problems during pregnancy. If there is a family history of diabetes mellitus, there is a possibility that the patient could develop mild diabetes while under the stress of pregnancy.



A complete physical examination includes weighing, breast examination, blood pressure test, urine test, cervical smear, and vaginal examination. At each subsequent visit blood pressure, weight, and urine are monitored, and the obsterician checks the ankles for signs of edema. The growth of the wombe is checked each visit after the fourteenth week of pregnancy. The obstetrician can check this by feeling the abdomen.



Finally, some laboratory test are made on a sample of the woman’s blood. The blood group and rhesus (Rh) factor are determined, and tests are made for anemia and syphilis. The blood should alsobe tested for antirubella (German measles) and other antibodies.



The obstetrician usually discusses the findings of the examinations and tests with the patient to reassure her that the pregnancy is normal, and to emphasize the importance of regular prenatal checkups. At first these are generally given on a monthly basis, unless there is some abnormality present. But later in pregnancy the visits become more frequent, usually occuring every two weeks from the twenty eighth week of pregnancy, and weekly from the thrith-sixth until delivery.

Q : Should a woman in early pregnancy keep to a special diet and carry out routine exercise?



A : Unless she suffers from a condition that demands special attention (such as obesity or diabetes mellitus), diet and exercise are dictated by common sense.

Q : May sexual intercourse continue throughout pregnancy??



A : Yes. In general, intercourse may take place as usual. If there is a history of spontaneous abortion, however, the obsterician probably will advise avoiding intercourse during the first three months at around the times when a period would normally have occured.

Q : What tests and examinations may be carried out during the middle three months of pregnancy?



A : Using ultrasonic equipment, the obstertrician usually can detect fetal life by the end of the thrid month of pregnancy. There is no danger for either the mother or fetus in this technique. Ultrasound may continue to be used if there are any problems, such as the possibility of twins.







Nausea



Nausea is the sensation of feeling sick in the stomach. Many conditions can cause nausea, which is a preliminary symptom before vomiting. Nausea may also accompany any sudden shock, either from a physical cause, such as an accident, or emotional shock, such as revulsion on seeing something unpleasant.

Q : What physical conditions cause nausea?



A : Any digestive disorder, particularly acute or chronic gastrits, may be accompanied by nausea. Probably the most common cause is eating too much rich, fatty food, or drinking too much alcohol, particularly on an empty, stomach. Nausea may precede vomiting in Morning sickness and is a frequent symptom of early pregnancy.

Q : How is nausea treated?



A : The treatment of nausea depends on the cause. A severely nauseated person may be more comfortable lying down in a quiet place, possible with head and shoulders raised. Anyone with persistent nausea should consult a physician. the womb, under local anesthetic. This procedure may be carried out if there is any possibility of a congential fetal abnormality, such as Down’s syndrome. It also can detect developmental disorders of the nervous system, as well as other abnormalities.

Q : What is “quickening” and at what stage can be felt?



A : Quickening describes the first movements of the fetus in the womb felt by the mother. A woman undergoing her first pregnancy usually feels it between the eighteenth and twentieth weeks. In subsequent pregnancies, however, when the mother is aware of what to expect, she may feel it about two weeks earlier.

Q : What are the common problems of the latter half of pregnancy?



A : Many minor problems may affect a woman as pregnancy progresses, although few are serious.



Backache : This is extremely common because the ligaments that normally hold the joints in place are affected by hormones which cause them to become more stretched and relaxed.



The woman is advised to wear low-heeled shoes and to place a firm board under her mattress (or under her side of it). Muscle strengthening exercises and instruction on how to hold the body properly help to relieve backache. Occasionally, it is necessary to wear a lumbar support corset.



Headaches : A common symptom, these may be associated with fatigue and the additional stress and anxiety placed upon a woman during pregnancy. They are generally not serious and seldom need more than simple treatment.



Constipation : This is a common complaint throughout pregnancy, caused by the production of the hormone progesterone. This hormone has a relaxing effect on the intestinal tract. The condition often is improved by adding increased bulk to the diet, such as bran and fresh vegetables as well as by drinking additional fluids.



Increased frequency of urination : This occurs not only in the early days of pregnancy, but also towards the end because of increased pressure on the bladder.



Painless increase in urination is seldom anything to worry about. If there is any discomfort, however, it should be reported to the obsetrician because urinary infections, such as Cystitis, can occur during pregnancy.



Hearburn : The production of the hormone progesterone during pregnancy causes relaxation fo the muscle at the lower end of the esophagus (gullet). This allows the normal acid contents of the stomach to pass back into the exophagus.



The symptoms can be improved by taking frequent small meals, and by avoiding a large meal before going to bed. Antacid medicines often can help, as can raising the head and shoulders at night.



Ankle swelling : This is a common symptom caused by the effect of progesterone on the blood vessels, as well as by the pressure and weight of the pregnant womb on the veins that carry blood from the legs. Varicose veins may aggravate the condition.



To treat swollen ankles, the feet should be raised above the level of the pelvis as often as possible during the day, and the foot of the bed should be raised at night.



Varicose veins and hemorhoids : Varicose veins may occur as a result of increased pressure withint he veins of the legs. The enlarged womb presses down on the veins of the pelvis and obstructs the blood flow from the legs to theheart. Hemorrhoids (piles) is a similar condition, usually caused by the pressure set up in the anal area by the straining action of constipation.

Situps



Lie stretched out on the back, with the arms above the head. Swing the arms upward and forward, and rais the body to a sitting position. Complete the movement by leaning forward and touching the toes, trying also to touch the forehead to the knees, then return to the original position. Repeat fifteen times.



During pregnancy, women with varicose veins should wear elastic stockings. Hemorrhoids can be relieved with ointments and by taking preventive measures against constipation.



Insomnia : Sleeplessness commonly occurs in the last few weeks of pregnancy. Insomnia may be caused by the large abdomen, backache, or vigorous fetal movements. If necessary, the obsterrician may prescribe a mild sedative.



Palpitations and sweating : These symptoms are similar to those experienced during Menopause and are caused by the effects of the hormones on the mother’s body during pregnancy. They are seldom severe.

Q : What regimen of diet and exercise should be followed in the latter half of pregnancy?



A : During the second half of pregnancy, the mother should pay particular attention to diet. The fetus requires increased nourishment, but the woman must avoid excessive weight gain.



First-class proteins (such as those in eggs, milk, fish and meat), together with vegetable proteins, are particularly important.



Energy requirements are supplied mainly by carbohydrates in the diet. These should be adjusted to fit in with the protein and the small amont of fat that makes up the remainder of the diet.



Fresh fruit and vegetables are an essential part of the diet because they supply vitamins and the bulk that helps to prevent constipation. The obsterician often prescribes small doses of supplementary vitamins and iron.



Milk contains protein, calcium, and phosphorus, the minerals responsible for bone formation. But milks is not essential as long as the diet includes meat and cheese.



Regular exercise is an essential part of maintaining physical and psychological well-being.







Laparoscopy



Laparoscopy is an examination of the interior of the abdomen with a lighted tube called a laparoscope. Laparoscopy is also known as peritoneoscopy.

Q : How and why is laparoscopy performed?



A : The examination can be carried out under local or general anesthesia. A small incision is made, usually next to the navel; the instrument is then passed through the peritoneum, the membraneous sac that lines the abdominal cavity. Carbon dioxide or nitrous oxide gas is passed into the peritoneal cavity through a needle to swell the abdomen and make it possible to examine the organs, such as the liver, interstine, bladder, or womb.

Disorders such as cancer, Crohn’s Disease, and cysts of the ovary can be diagnosed using this technique.

Q : Can any operations be performed with a laparoscope?



A : Yes. A surgeon can take a small piece of tissue for microscopic examination (biopsy), or perform a sterilization operation in a woman.

Q : Is laparoscopy a safe procedure?



A : Yes, the examination is relatively safe and simple to perform.

Q : When should a pregnant woman start attending prenatal classes?



A : The timing depends on the recommendation of the individual obstetrician, but it is usual to defer prenatal classes until the last three months of pregnancy. Usually a series of eight to twelve weekly classes are attended by the same group of prospective parents. They are told about the normal development of the fetus, the progress of pregnancy, and the stages of labor.



The class also is shown exercises to strengthen the back and pelvic muscles, as well as special methods of breathing which may be of assistance during the various stages of labor. The women are asked to practice these exercises at home.



At least one class is devoted to the care of the newborn baby; how to bathe and dress the baby, as well as how to change a diaper. Often a mother who has just had a baby returns to the class to demonstrate baby care, bringing her own infant with her.



It is usual, at some point during prenatal classes, to discuss the problems that may arise in labor, and the kind of action that the obsterician may take.

Q : What is “lightening” and when can it be expected to occur?



A: Lightening is the sensation of increased physical comfort that is experienced when the fetus has descended into the lower part of the womb, in the pelvic cavity, thus relieving pressure on the upper abdominal area. It usually occurs about the thirty-sixth week, but in women who have had babies before, it may not occur until labor starts.

Q : What special tests or examinations are carried out by the obsterician during the last three months of pregnancy?



A : Provided the pregnancy is developing normally, the only special tests needed are a reassessment of the level of hemoglobin in the blood to check for anemia, a repetition of the antibody test for the Rh (rhesus) factor, and sometimes a test of the urine to ensure that there is no infection. The obstertician usually performs an internal, gyneocological examination about the thirty-seventh week of pregnancy. This is done to assess the size of the pelvis to ensure that there is enough room for the fetus to be born.

Q : Why may pregnancy end prematurely and is this a problem?



A : In many cases the cause of premature birth is not known. Factors that may contribute to prematurity include preclampsia, twins, and prepartum hemorrhage. If premature rupture of the membranes occurs, without the onset of labor it usually is advisable to keep the woman resting in bed until at least the thirty sixt week of pregnancy, when labor can be induced.



The main problem of premature labor is that it produces an immature baby who will require specialized care.

Q : What are the problems associated with prolonged pregnancy?



A : There is a gradual deterioration in the placenta toward the end of pregnancy. Even at forty-two weeks, however, the placenta still is capable of providing a mature fetus with all the nourishment it needs. But there is a greater liklihood of fetal death occurring, so the obstetrician usually induces labor if the woman is considered to be more than a week overdue, and if the circumstances are favourable for induction.

Q : Is infection serious during pregnancy?



A : Rubella (German measles) is a serious infection when contracted by a woman in early pregnancy. It greatly increases the risk of congential anomalies in the fetus. Infection with a type of herpes virus may be fatal to the fetus. Any infections should be reported to the obstetician.



Q : What is the onset of labor?



A : During the final two or three weeks the woman may notice the occasional, irregular but firm contraction of her womb. The abdomen hardens, but no discomfort is felt. If this is confused with the actual onset of labor, it is termed a false labor. Labor commences when regular, powerful contractions occur every twenty to thirty minutes accompanied by a dull ache or pain in the lower abdomen and back.



Sometimes there is a “show” of blood and mucus from the vagina as the plug of mucus which blocks the cervix during pregnancy breaks apart and the cervix starts to open



Rupture of the membranes (bag of waters) followed by a rush of clear fluid from the vagina, occasionally may be the first sign of labor.



As soon as the contractions are occurring every ten to fifteen minutes, or the membranes have ruptured, the patient should go to the hospital. She should take a suitcase that has already been packed with some clothing for the baby and a dressing gown, nightdress, and nursing brassiere, as well as toilet articles for the mother.

Q : What occurs during labor, and how can the mother help?



A : Labor is divided into three stages. The first stage continues, with regular contractions of increasing frequency, until the cervix of the womb is fully open (dilated). The second stage includes the passage of the baby through the pelvis, until it is delivered. The third stage is the expulsion of the placenta and membranes from the womb.



The first stage of labor varies greatly in duration but commonly takes between five and ten hours. It is shorter in women who have previously had a baby.



At first, contractions may occur only every twenty to thirty minutes, each one lasting for ten to fifteen seconds. As the contractions become more frequent and longer in duration, the cervix progressively dilates. It is during these contractions that the breathing methods, learned in the prenatal classes, are useful. Usually during this first stage of labor, the membranes rupture.



Eventually the contractions occur every two to three minutes, and the woman feel the urge to push. This sensation may be accompanied by a dull, deep backache. This is the beginning of the second stage of labor. The second stage is one of hard, physical effort with contractions coming every one to two minutes, and each one lasting at least thirty seconds. The second stage seldom continues longer than two hours, and is frequently over in less than an hour. Before it commences, the obstetrician usually carries out a careful, sterile gynecological examination to ensure that the cervix is fully dilated, and to assess the position of the fetal head.



During the second stage of labor the fetal head is pushed down into the mother’s plvis. When it reaches the pelvic floor, the back of the head rotates round to the front of the pelvis. The fetus’s chin is pressed down onto its chest. As the fetus extends the head from this bent position upward, the mother’s vulva is extended and stretched open. The head is “crowned” at the moment when the vulva is stretched round the greatest circumference of the fetal head.



During this stage, the mother can help by taking a deep breath prior to the contraction, and forcibly trying to expel the baby through the pelvis by “bearing down” during the contraction. It is most comfortable if she can keep her knees bent, and her head and shoulders raised. This exrcise and position is taught in the prenatal and natural childbirth classes.



As the fetal head is crowned, the obstetrician may decide to cut the skin at the back of the vulva (episiotomy) so that the fetal head can be delivered more easily, and the ensure that the vagina does not tear. A neat cut is easier to repair than a ragged laceration. Once the head comes through,t he rest of the body follows quite rapidly.



Just after being born, the baby’s mouth is sucked clear of mucus so that breathing can take place easily, and the eyes are cleaned. The umbilical cord is clamped, tied and cut, and the baby is wrapped in a towel. The baby often is handed to the mother so that she can enjoy her first moments with her child.



The third stage of labor usually is over within thirty minutes. Contraction of the womb is helped by an injection of ergometrine given to the mother as the baby is delivered. There is slight vaginal bleeding as the obstetrician gently maneuvers the placenta out of the womb. All that is required of the mother at this stage is a final, gentle push.



While waiting for the placenta to be expelled, the obstetrician may inject a local anesthetic, stitch up the episiotomy, and repair any minor damage to the vagina that has occured during delivery of the baby.

Q : What can the woman’s partner do to help during labor?



A : During the first stage of labor, which may last some hours, he can accompany his partner while she welks up and down in her room or the corridor of the hospital. During contractions, he can apply gentle but firm pressure with his hands to her back, as well as reminding her to breathe correctly. In the second stage, while int he delivery room, he can provide encouragement to his partner. He also can help to support her neck and legs when she is trying to expel the fetus.

Q : How can pain be reduced during labor?



A : Painkilling drugs, such as Pethidine, can be given during labor if requested. An injection of either a local or a spinal anesthetic causes only slight discomfort, and allows the woman to remain fully conscious throughout labor. A skilled anesthesiologist is required to carry out this procedure. Occasionally, quite severe headaches may occur for two or three days after delivery. From time to time, general anesthesia is needed during labor.

Q : What can the obstetrician do if labor is not normal?



A : Sometimes the obstetrician decides, before labor commences, that a normal delivery would be too risky. This may occur with a placenta previa, abnormalities of the pelvies or, sometimes, if the woman has previously had a Cesarean section. In such cases, the obsterician performs a Cesarean just before the baby is due.



Sometimes, problems occur once labor has already started, such as fetal distress, or prolonged labor. To deal with these problems the obstetrician either performs a Cesarean, if labor still is in the firs stage, or helps the delivery by carefully applying forceps around the baby’s head. In this way, the baby is gently, firmly, and steadily pulled out.



A Malpresentation requires repositioning of the baby’s head by internal manipulation. This can be done either by the hand or, more usually, with a pair of special forceps.

Q : Are there any dangers involved int he use of forceps?



A : There is a slight chance that the fetus will be damaged or bruised as a result of pressure exerted by the forceps. The risks of fetal damage should be weighed against the risks of not using additional methods to help a difficult delivery.

Q : How long is it necessary to stay in the hospital?



A : This depends on the obsterician’s advice as to whether both the mother and the baby are well enough to return home. If the pregnancy has been normal, the mother and child are well, and lactation is established, discharge from the hospital can often take place within forty eight hours of delivery.

Q : What can the mother do to help in her physical recovery after labor?



A : It is usual to allow twenty-four hours of rest after labor. The mother can help to get her figure backto normal with exercises to strengthenthe muscles of the pelvis, abdomen and back. Care should be taken not to do these too strenuously at first. The ligaments of the joints are still soft, and excessive exercise could cause joint strains.

Q : Why is it sometimes necessary to induce labor artificially and how is it done



A : Labor is induced if either the health or life of the mother of fetus is at risk. It may be recommended for a variety of reasons; preeclampsia; a pregnancy that has continued for more than a week or ten days past the expected date of delivery; a placenta previa in which the placenta is obstructing the passage of delivery; a maternal problem such as diabetes mellitus; or rhesus incompatibility of the blood, which could lead tohemolytic disease of the newborn.



Generally, prostaglandin or oxytocin is given to the woman, either intravenously or in tablet from. Labor usually starts within a few hours. Artificial rupture of the membranes that surround the fetus (amniotomy) also may aid induction of labor. The procedure is carefully monitored, and an induced labor should follow the pattern of a normal labor.

Q : Are there any things that a woman should avoid during pregnancy and the puerperium?



A : Yes. All drugs, including aspirin, must be avoided during early pregnancy unless they have been prescribed by a physician. This is primarily to reduce the chances of congenital malformation in the fetus. There also is evidence that drugs, such as marijuana, heroin and cocaine, can cause problems in babies sood after they are born. Drug addiction must be stopped before labor takes place.



Mothers who smoke cigarettes are more likly to go into premature labor than those who do not. Their babies also tend to be born smaller than average, greately increasing the chances of the baby dying.



Some drugs may adversely affect the mother. For example, many commonly used drugs aggravate the symptoms of heartburn during the latter months of pregnancy and should be avoided.







A talk about Learning Disabilities



Learning disabilities are a group of disorders that interfere with a child’s ability to learn. They may, therefore, cause a child to do poorly in school, or not to do as well as the child otherwise might.

There are many types of learning disabilities. A learning-disabled child may, for example, have difficulty concentrating, memorizing, or coordinating certain kinds of physical movements. A learning disability may also interfere with a child’s ability to speak, spell, understand spoken language.

Q : Solve mathematical problems, What are the causes of learning disabilities?

A : Finding the exact cause of a child’s learning disability is not always easy. Researchers believe, however, that most learning disabilities result from damage to major nerves leading to the brain or from minor damage to the brain itself. The nervous system damage interferes with the ability to received and use information transmitted from the disabled child’s senses to his or her brain. Many children suffering from a learning disability nevertheless tend to be of average or above average intelligence, and they do not seem to have an unusual incidence of abnormal hearing or vision.

Q : What might cause nerve or brain damage?



A : Such damage can occur before birth, during the birth process, or after birth. Damage before birth can result from poor nutrition and illness in the mother, which may affect the fetal nervous system. Certain injuries during pregnancy, particularly those involving the abdomen or pelvis, can also result in nervous system damage to the unborn child. In addition, some hereditary defects in the mother or the father, or both, can cause nerve or brain damage before birth.



During the birth process, nerve or brain damage can occur if labor is prolonged or particularly difficult, or if the mother is given too much of certain drugs, such as painkillers.



Nerve or brain damage after birth can result from many causes, including injuries to the skull or spinal cord, malnutrition, inherited chemical imbalances, or disease. Research suggests that certain chemicals, especially lead in paint, may also contribute to learning disabilities after birth.

Q : Can a learning disability be present when there is no damage to nerves or to the brain?



LA : Yes. Although research into this phenomenon continues, scientists are generally of the opinion that a learning disability can come about without nervous-system damage. Scientists have found, for example, that continued absence of various early learning experiences, such as hearing language or handling objects, can result in certain learning disabilities in children.

Q : What are the symptoms of a learning disability?



A : The symptoms of a learning disability depend on the type of disorder involved. The symptom of one type of learning disability, Dyphasia, is a child’s difficulty in speaking or in understanding oral language. Dyslexia, on the other hand, shows itself as a difficulty in reading and writing. Dysgraphia, a third type of learning disability, is likely when a child is unable to control the finger muscles used in writing.



Still other types of learning disability interfere with a child’s power to concentrate or to behave in a socially acceptable manner. Such a child is considered to suffer from hyperactivity, or Hyperkinesis. Hyperactive children who are more often boys than girls tend to speak and to act impulsively and boisterously. These children are also usually impatient. Their conduct, whether at home or at school, is generally looked upon by peers and adults as disruptive and uncontrolled.



Other learning disabilities display themselves as a lack of distinguishing left from right or of distinguishing between letters of the alphabet that have some similarities in form, such as b and d.

Q : How are learning disabilities diagnosed?



A : The parent is usually the first person to suspect that a child had a learning disbility. The parent usually alerts the family physician or pediatrician. Upon examination, the physician or pediatrician may refer the child to other specialists for further testing and evaluation. The specialists may include a neurologist, a psychologist, a child psychiatrist, an eye specialist, an ear specialist, and a speech therapist. In addition, one or more of these may recommend that a social worker become involved in the evaluation of the child to try to determine if some factor in the home enviornment is contributing to or even causing the child’s learning disability. Some schools provide for the diagnosis and treatment of children with learning disabilities.

Q : How are learning disabilities treated?



A : The kind and extent of treatment of a child with a learning disability depends on the individual diagnosis. In sum, there is no one from of treatment that seems to work well with all of the various types of learning disabilities. Scientists therefore continue to study the effectiveness and safety of many of the treatment methods presently used.







Lichen



Lichen planus is a suddenly occurring skin inflammation that usually starts at the wrists and spreads to the trunk. The condition may last many weeks or months.

Q : What are the symptoms of lichen planus?



A : The skin lesions are small, slightly raised purple or red areas that glisten. They occur on the front surfaces of the forearms, trunk, and shins. In severe cases, the lesions may occur anywhere on the body. The lesions itch and are often surrounded by scratch marks. They may even occur in the mouth, or on the vulva or penis. Occasionally, the nails may be involved resulting in ridging and splitting.



Sometimes the symptoms subside with in three months, the patches lose their shiny color and become brown and scaly, before disappearing. In some patients, the condition lasts for many years.

Q : What is the treatment for lichen planus?



A : There is no specific treatment, although usually the lesions can be kept under control with creams or lotions containing corticosteriod drugs.







A talk about Prolapse



Prolapse is an abnormal, downward displacement of a part of the body. Examples include prolapse of the rectum, in which the membrances that line the rectum protrude through the anus; and prolapse of the uterus (womb), in which the supporting ligaments become so weak that the womb is displaced into the vagina. Prolapse of the rectum is relatively uncommon and may be the result of an underlying disorder or a congenital abnormality.



Q : How is prolapse of the rectum treated?



A : This seldom is a problem whenit occurs in infants providing a physician is consulted. By applying gentle pressure to the protruding tissue, it generally can be pushed back inside and the condition usually is self curing in a matter of weeks. In the elderly, prolapse of the rectum is a more serious matter. If it recurs frequently or if it is not possible to push it back an operation may have to be done to remove the surplus membranes. Alternatively, a circle of wire or nylon can be placed around the anus to tighten the opening.

Q : Why does prolapse of the uterus occur?



A : The cause is a gradual slackening of the ligaments that support the walls of the vagina and the uterus. This usually happens because the ligaments are stretched during childbirth; they also become weakened after menopause because of lack of hormone production. Although prolapse of the vagina may occur without prolapse of the uterus, the two usually occur together.

Q : What are the symptoms of prolapse of the uterus?



A : The main symptoms is a sensation of something falling out of the vagina. This is sometimes accompanied by a deep ache in the lower abdomen. If the prolapse is severe, the neck of the uterus (cervix) sticks out of the vagina, between the labia; this is known as a procidentia.



Other symptoms include incontinence of urine on coughing, laughing, or lifting weights (stress incontinence); and, occasionally, difficulty in defecating. The prolapse may be accompanied by a vaginal discharge.

Q : How is a prolapse of the uterus treated?



A : The best treatment is a surgical operation to shorten the ligaments that support the womb and to stitch the top of the vagina back into a firm position. This operation usually is accompanied by removal of the uterus, or part of the cervix, or both.



If an operation cannot be performed, a plastic ring (pessary) can be inserted into the vagina to hold the utersus in place.

Q : Is there any way in which a woman can prevent a prolapse of the uterus from accurring?



A : Yes. Care during childbirth is essential so that the second stage of labor does not last too long. After childbirth, the woman should strenthen the muscles and ligaments surrounding the uterus by doing postnatal exercises, as recommended by a physiotherapist.







A talk about

Mental Illness



Mental illness is an abnormality of normal thinking or behavior without any obvious physical cause. Mental illness is a relative term. It refers to the behavior of those who deviate from what is normally expected of them by others. Because of this and also because the normal range of behavior is so wide, it is often extremely difficult to establish that a person is mentally ill. If the abnormality is so great orif the history of the disorder is obviously one of profound mental disturbance, then a physician may be able to make a diagnosis. Diagnosis and treatment are made easier if a patient consults a physician voluntarily.e.

Q : What types of mental illness may occur?

A : There are several different ways of classifying mental illness, none of which is completely satisfactory. One of the most widely used systems of classification divides mental illness into three main categories (1) psychoses (2) neuroses and (3) personality disorders.



In addition to these main categories are sexual disorders, mental retardation, and the demantias. None of these fit easily into any of the three main categories.

Q : What are psychoses?



A : Psychoses are gross disturbances of mental functioning and behavior accompanied by a distintegration of the personality and loss of contact with reality. Psychoses are characterized by persistent delusions and hallucinations. The patient usually has no insight into the disorder. Psychoses are thought to be caused by an inherited chemical or hormonal disorder that affects the brain. The main psychoses are schizophrenia; manic-depressive illness; and paranoia.



Q : How are psychoses treated?



A : Psychoses may be treated with trans-quilizers, such as chlorpromazine and Mellaril, which may be combined with electroconvulsive therapy (ECT). Because many patients with psychotic disorders do not realize that they are mentally ill, such treatment often has to be given after compulsory hospitalization. Treatment of psychoses is not always effective, although the symptoms can usually be alleviated. Some patients respond well and become normal for long periods. However, the condition may return at any time after treatment ceases.

Q : What are neuroses?



A : Neuroses are an exaggeration of the normal responses to the stresses of life. In a patient with a neurosis, the reaction interferes with normal activities. Unlike a psychotic patient, however, a pseron with a neurosis is aware of the disorder and usually seeks medical help. Anxiety, depression, hypochondria, hysteria, obsession, and phobias are all neuroses.



Q : How are neuroses treated?



A : The treatment of neuroses is often difficult. Sumptoms, such as hysteria, may be controlled with tranquilizing drugs. If such treatments is given early in the disorder, the symptoms may disappear spontaneously. However, it is usually necessary to combine drug treatment with psychotherapy or behavior therapy.

Q : What are personality disorders?



A : There are several different types of personality disorders (1) personality pattern disturbances, including schizoid (shy and seclusive), cyclothymic (alternations of depression and elation), and paranoid behavior (delusions of persecution); (2) personality trait distrubances, which have a single dominant characteristic, such as compulsiveness; and (3) psychopathic personality disturbances, which are marked by antisocial behavior without feelings of guilt. Alcoholism and drug Additction are also considered to be personality disorders.

Q : How are personality disorders treated?

A : Most personality disorders need expert psychiatric treatment, which may involved behavior therapy using desenstization methods that expose the patient to the conditions including the disorder.

Q : Can mental illness occur in children?

A : Yes. Apart from mental retardation and certain types of mental defect, children may also become depressed. Autism is a rare condition that some psychiatrists believe to be a form of juvenile schizophrenia.

Q : How can the community and the family help a patient who is mentally ill?

A : It is important that the family, frien\ds, and the family physician are aware that some forms of mental illness, such as schizophrenia and manic-depressive psychosis, are more common in certain families. An awareness of this possibility means that treatment can be started early, even if it requires compulsory hospitalization.



Provisions should be made for those who are so mentally ill that they are a danger to themselves or to others. Most patients with depression are aware of their condition and realize the need for treatment. However, those with a psychotic illness smay not be aware of their disorder, and compulsory hospitalization may be necessary. A physician will be able to give advice about the necessary procedures.



Most people with hysterical or mildly paranoid personalities are able to adapt to normal life, although their behavior may seem strange.



Cooperation between hospitals, the family, and the community means that fewer patients are compulsorily detained for psychiatric treatment than previously. Many patients are encouraged to lead as normal a life a possible while under overall supervision of a psychiatrist or as social worker, which may include some form of psychotherapy.



Mental retardation is subnormal intelligence. It may be caused by lack of brain development, or brain damage from injury or illness.

Q : What causes mental retardation?

A : In most cases the cause is unknown but the normal variation in intelligence that occurs in the population can produce persons with below average as well as above average intelligence. Several rare inherited disorder, such as phenylketonuria, Tay-Sachs syndrome, and von Recklinghausen’ disease may cause mental retardation.



Chromosomal abnormalities (of which Down’s syndroms, or mongolism, is the most common) and prenatal infection (such as rubella and toxoplasmosis) may also result in brain damage. Smoking during pregnancy and various disorders, such as preeclampsia and placenta previa, may reduce the blood flow to the developing fetus. This may produce a mild form of fetal mainutrition that may affect development of the brain.



Brain damage may occur at birth. It may, for example, be caused by asphyxia or hemolytic disease of the newborn. Premature babies, especially if their birth weight is less than 3lb (1.5 kg), are more likely to be mentally retarded during infancy and childhood. Such damage may be caused by a serious head injury; a serious infection, such as meningitis; or poisoning, especially with heavy metals such as lead. Chronic malnutrition, such as kwashiorkor, can also prevent normal brain development, thereby reducing intelligence.



In many cases of mild mental retardation, social and economic factors are more significant than medical causes. These factors include poverty, social isolation, and cultural deprivation during early childhood. It has also been shown that if an infant is seprated from its mother for a continuous period during its first year of life, mental retardation may result. If the separation lasts for longer than six months the mental retardation may be irreparable.

Q : How is mental retardation assessed?

A : In some cases, mental retardation may be detected at birth or soon afterward. For example, Down’s syndrome is usually apparent at birth. However, mental retardation, particularly if it is mild, is often detected first by the parents, who may notice that their child has problems with feeding; or is slow in learning to crawl or walk. In such cases, the parents should consult a pediatrician who will examine the baby to try to find a cause. The examination usually includes a full neurological investigation, sometimes with an electroencephalogram (EEG), skull X rays, hearing tests, and vision tests. From these, a pediatrician may be able to give the parents an indication of the degree of the child’s retardation and the problems that they may encounter. Many parents find it difficult to accept that their child may be mentally retarded, and, even if they suspect that this may be the case, refrain from seeking expert confirmation. Professional advice, however, is essential if the child’s learning potential is to be developed as fully as possible, and will help the parents to cope with the strain and responsibility of bringing up a mentally retarded child.

An accurate assessment of an infant’s intelligence is impossible. When the child is about three years old, an intelligence less may be given. This can give a reasonable indication of the severity of mental retardation, which may help the parents to plan for the child’s future.



Mental retardation is generally classified as mild, moderate, or severe. Individuals are assessed according to their degree of subnormality and their potential for learning social, occupational, and academic skills.



Children with mild retardation (with an Intelligence quotient in the range of 50-70) can usually be taught to do simple mathematics, to read and write, and to perform uncomplicated tasks. Those with severe retardation may have difficulties with speech, coordination; bladder control, and bowel control. The most severely retarded seldom learn to walk and usually remain incontinent, needing lifelong supervision.

Q : Can mental retardation be prevented?

A : In some cases it is possible to prevent mental retardation. At present, however, it is not possible to prevent most cases of mental retardation. If any inherited disorder has occurred in the family of either of the potential parents, a genetic counselor may be able to give advice about the likelihood of retardation in their children. Some chromosomal abnormalities can be detected by testing fluid from the womb during pregnancy (amniocentesis). If this indicates that the baby will be retarded, an abortion can be performed if the parents wish it.



The possibility of brain damage caused by malnutrition of the fetus can be reduced by stopping smoking before pregnancy, and by skilled prenatal care during pregnancy.



Tests for phenylketonuria are performed routinely within a day or two of birth. If these positive, a special diet will prevent brain damage. Early heart investigation. Treatment is directed at the cause, once it has been discovered. The patient must have complete rest oxygen if necessary and corticosteriod drugs.







Parkinson’s Disease



Parkinson’s disease is a chronic disorder of the nervous system characterized by tremors, slow movements, and generalized body stiffness. It occurs most commonly in the middle aged and elderly. Parkinson’s disease does not affect mental faculties, although these may appear to be impaired if the patient’s speech is affected. Parkinsonism is the term that denotes the symptoms of Parkinson’s disease.



The cause of Parkinson’s disease itself often is not known, although parkinsonism may be caused by several factors. In some patients, parkinsonism is thought to be caused by arteriosclerosis, in which there is degeneration of the brain cells that control body movements. Parkinsonism also may be caused by encephalitis; a brain tumor; brain damage; or poisoning, either from drugs such as reserpine, or from chemicals such as manganese and carbon monoxide.

Q : What are the symptoms of Parkinson’s disease?



A : The onset of symptoms usually is gradual and their progress is slow. The initial symptoms include an occasional trembling of one hand and increasing clumsiness of the same arm. As the disorder progresses, both sides of the body become affected, movements become slow and stiff, the face assumes a blank expression because of rigid face muscles, and the patient may drool.



In the later stages there may be continual hand tremors with “pill rolling” movement of the fingers, the arms may be held in a bent position, and the body may be bend forward in a permanent stoop. The patient also may walk slowly with shuffling steps, and then start to run to prevent falling forward. This characteristic gait is called festination. The patient’s handwriting may become small and illegible, and speech may become so slurred as to be unintelligible.

Q : How is Parkinson’s disease treated?



A : There is as yet no cure, but the symptoms can be controlled in many cases. Drug treatment with levodopa (L-dopa), particularly when combined with carbidopa, can control the symptoms in some patients and enable them to resume a normal life for several years. Some patients respond to treatment with the drug amantadine, either by itself or combined with L-dopa.



If treatment with L-dopa or amantadine is ineffective, atropine-like drugs may be used. However, these tend to cause adverse side effects, such as constipation, a dry mouth, and retention of urine.



Occasionally, the surgical destruction of a small area of the brain may alleviate the symptoms. Such surgery usually is, effective against the tremors.







Prostate Gland



Prostate gland is a walnut-sized organ that is part of the male urinogenital system. It lies beneath the bladder and surrounds the urethra, the tube that carries urine from the bladder. The prostate gland produces secretions that maintain the vitality of sperm



Prostate problems generally cause difficulties with utination, because the prostate gland surrounds the urehra (the tube that carries urine from the bladder). A gradual enlargement of the prostate gland (benign prostatomegaly) normally occurs with increasing age. But enlargement also may be caused by cancer of the prostate (prostatitis), caused by an infection, tends to occur in younger men.

Q : What symptoms occur with prostate problems?

A : The symptoms caused by benign prostatomegaly, prostatis, and cancer are all similar. There is increased frequency of pasing urine, combined with a feeling that the bladder is not empty, even immediately after urination. Sometimes there is extreme urgency as well as slight discomfort on passing urine (dysuria) or, alternatively, the patient is unable to pass urine even when he has the opportunity. Usually he has to urinate several times at night (nocturia) and occasionally there is blood in the urine (hematuria).



Sometimes the patient cannot pass urine at all. This may occur gradually over a matter of a few weeks (chronic retention), with backflow of excess urine leading to kidney failure (uremia). Or it may occur suddenly, as a painful acute retention of urine. Any form of retention needs urgent medical treatment

Q : How are prostate problems treated?



A : Treatment depends on the cause.



Prostatic hypertrophy is enlargement of the prostate gland.



Prostatitis is inflammation of the prostate gland. It may occur as the result of a venereal disease, nonspecific urethritis, or infection spreading from the intestine, or it may develop after an examination of the inside of the bladder (cystoscopy).



Prostatitis causes symptoms similar to those of other prostate problems. Painful and frequent passing of uring (dysuria) is a common symptom if the infection is actue.



Prolonged treatement with antibiotics may be necessary and the patient usually is advised to avoid sexual intercourse until the infection is cured.



Prostatomegaly is an increase in the size of the prostate gland. It normally occurs in men over the age of fifty years and slowly, but steadly, worsens so as to cause the minor symptoms of prostate problems. This conditions is known as benign prostatomegaly and often needs no treatment. But if the symptoms become severe or are cause by cancer, medical treatment is necessary.

Q : Can complication arise from benign prostatomegaly?



A : Yes. Complications arise from back presure of the bladder. These may result in (1) retention of urine, and bleeding from a dilated vein, which causes blood in the urine (hematuria); (2) the formation of bladder stones (calculi); and (3) damage to the kidney, causing hydronephrosis and uremia.

Q : How is benign prostatomegaly treated?

A : Surgical removal of the prostate gland (prostatectomy) is the only way of curing the symptoms. Occasionally it may be neessary to reduce the pressure caused by retention of urine by catheterizing the patient for a few days before the operation. He may require treatment for kidney failure, and his general health may need to be improved as well.

Q : What is the treatment for prostatomegaly caused by cancer?

A : In the early stages of the disorder, an operation to remove the prostate gland often cures the condition. In later stages, particularly if the man is elderly and the cancer has spread, treatment with female hormones (estrogens) often is effective. It can prevent further spread and development for many years, as well as reduce the size of the gland and lessen the symptoms.







How to do

A Daily Detox



Detoxification is a process by which the accumulated toxins in the body are flushed out, thereby cleansing the internal system. Low levels of energy, tiredness, fatigued mind etc. are symptoms of the body in need of a detox. Accumulation of toxins in the body can give rise to heart problems and sometimes even cancer. Here are some easy tips to daily detoxify your body :

• Every morning drink a glass of warm water with a little freshly-squeezed lime juice. This will help cleanse the kidneys.



• Clean your tongue with the help of a tongue cleaner or with the back of your toothbrush. This will help getting rid of the unattractive coating on the tongue and toxins that have accumulated overnight.



• Exercise regularly by hitting the gym or going for a brisk walk for at least 30 minutes. This will help in increasing your heart rate and maintaining a healthy heart.



• Herbal teas contain natural herbs that contain anti-oxidants, nutrients and natural liver cleansing properties, such as stimulating bile production. They are available in flavours like ginger, lemon, camomile etc.



• Drink plenty of water through, out the day. This not only avoids dehydration but also aids digestion and is necessary for good skin.



• High fibre foods is beneficial for maintaining gut health and digestive system. Fresh, raw fruits and vegetables, and whole grain foods constitute fibre. Opt for whole grain or multi-grain bread, beans, pulses and legumes.



• Eat yogurt daily. Yogurt contains useful bacteria that help cleanse and maintain a healthy digestive tract.



• Consume organic foods because they are not exposed and hence, do not contain residues of harmful pesticides, chemicals and other pollutants.



• Quit smoking. Cigarettes contain more than 4000 chemicals that only result in polluting the body.







A talk about Indigestion



Indigestion is incomplete or imperfect digestion. But the condition is poorly defined, and it can vary according to situation and person. Acute indigestion is unpleasant and the chronic form is debilitating. Chronic indigestion is sometimes a symptom of a more serious disorder, such as hiatus hernia, a gall bladder disorder, or a peptic ulcer. It common during the later stages of pregnancy.

Q : What are the symptoms of indigestion?



A : Usually the person experiences vague abdominal discomfort, and feels generally bloated. Burping may bring temporary relief. The symptoms may be severe enough to produce ill-defined pain that may or may not vary in intensity. Sometimes the feeling of discomfort increases, the patient feels nauseous, and vomits. The symptoms usually last for only about two hours, although about of indigestion can last many weeks.



In addition to these symtpms, there may be Heartburn. This produces a burning sensation beneath the breastbone that is sometimes accompanied by a bitter taste of fluid rising up into the mouth.

Q : What causes indigestion?



A : If the symptoms are sever enough to interfere with normal life, or to disturb sleep, a physician should be consulted within twenty-four hours.

Q : How is indigestion treated?



A : Treatment depends on the cause of the indigestion. Many patients find that the symptoms improve after a light, easily disgestible meal, or a glass of milk. Others find that an antacid medicine or tablets bring relief, particularly from heartburn.



In cases of excessive acid production, the physician may prescribe an anthistamine that prevents acid being produced. If anxiety, depression and tension seem to be the main reasons for the indigestion, the physician may prescribe tranquilizers or antidepressant drugs. Definite physical causes are treated in the appropriate way.



Infarction is an area of dead tissue in an organ that has had its blood supply cut off due to blockage in a blood vessel, usually an artery, supplying it. The seriousness of the condition depends on where the infarction occurs.

Q : What causes a blockage in a blood vessel?



A : Thrombosis (blood clotting) in an artery creates a blockage and may be caused by Arteriosclerosis or damage to the vessel. A blood clot from another part of the body may become trapped in an artery; this is known as an Embolism.

Q : What are the symptoms of an infarction?



A : These depend on which part of the body is affected. If the infarction is in the heart muscle (myocardial infarction), the patient’s symptoms may vary from severe pain radiating from the left side of the chest to the left arm, the neck, shoulders, back, and jaw to a feeling of mild indigestion. If the infarction is in the brain the patient suffers a stroke. In both instances, there are no alternative blood supplies, and the tissues die. If the infarction is in the leg, the patient experiences acute cramplike pain and the leg becomes white and cold. If the patient does not receive immediate surgery. Gangrene rapidly sets in. An infarctionin the kidney produces blood in the urine (hematuria).

Q : Can an infarction be treated?

A : No. Once the tissue has died. it cannot be replaced. It can gradually heal and form scar tissue. Treatment is aimed at preventing an embolism or thrombosis from developing and causing an infarction. Emergency surgery can replace part of the femoral artery with a graft or plastic tubing, but if the tissues have already died (gangrene), amputation is the only treatement).



Infection is the invasion of the body by disease-producing organisms. There are six main types of infective organisms (1) viruses (2) Bacteria; (3) fungi (4) Protozoa (5) worms; and (6) Rickettsia. Infection may enter the body in the air that is breathed; in food or water that is eaten or drunk; directly through the skin; or from another part of the body in which the organism produces no ill effects.



Itching



Itching, known medically as pruritus, is a symptom that is produced by a disturbance to the nerve endings just under the skin. The reasons for itching are not fully understood. Some people feel itching sensations much more easily than others, and an itching skin condition such as measles can cause much more distress in one patient than another.

Q : What conditions may cause itching?



A : Itching may be a symptom of dry skin following sunburn or ichthyosis. There are many other skin disorders than may be accompanied by itching, including Eczema, Urticaria, Scabies, and lichen planus. Generalized itching, which is often worse when the person is tired or warm in bed, may occur for no obvious reason. Various investigations may be carried out of discover if the cause is uremia, or a liver disorder such as Jaundice or Cirrhosis. Sometimes continued itching or itching that stops and starts again is a symptom of underlying anxiety or depression. Occasionally, a malignant disease, such as Hodgkin’s Disease, produces itching for some years before the disease itself appears. Rarely itching occurs during pregnancy, when it may be accompanied by urticaria.

Q : What causes indigestion?



A : If the symptoms are sever enough to interfere with normal life, or to disturb sleep, a physician should be consulted within twenty-four hours.

Q : Why do areas of itching occur?



A : Itching in one spot may be caused by sensitivity to chemicals or materials. Examples include perfume behind the ears, nickel on jewellery, or clothing made of wool or an artificial fiber.



Local itching around the anus (pruritus ani) may be associated with the slight moist discharge from a Hemorrhoid (piles), following diarrhea or, quite commonly, as a form of allergy to anesthetic ointments used in the treatment of hemorrhoids. In children, anal itching, particularly at night, may be caused by Threadworm.



Itching of the vulva (pruritus vulvae) may occur with any form of local infection, such as vulvitis or vaginitis; or it may be associated with skin infections, such as Moniliasis (thrush). Genital itching is a common symptom of Diabetes Mellitus and may occur with Leukoplakia, a condition that develops before cancerous change in the vulva.

Q : How is itching treated?

A : Areas of irritation that occur after sunburn or dry skin from any cause may be helped with soothing creams and lotions, such as calamine. If the itching persists a physician may carry out investigations to discover the cause and prescribe the appropriate treatment.



Antihistamine and antipruritic drugs and creams may aid in controlling the symptoms and sometimes the physician may prescribe corticosteriod creams or ointments to be used for a short time.