Skip to main content


Showing posts from October, 2012

Body Mass Index - BMI

Body Mass Index is also known as the Quetelet Index, after the Belgian astronomer, statistician, sociologist and mathematician Lambert Adolphe Jacques Quetelet. It is a very easy and frequently used method to assess obesity, though it is not a direct measure of adiposity. It is c alcula ted by dividing the patient body mass (kg) by the square of his/her height (m). BMI = kg/ m 2 Classification of weight status: BMI (kg/m 2 ) Obesity Class Risk of Disease Underweight < 18.5 Healthy weight 18.5–24.9 Overweight 25.0–29.9 Increased Obesity 30.0–34.9 I High Obesity 35.0–39.9 II Very high Extreme Obesity > 40 III Extremely high Obesity is defined as a BMI varying from 30-39.9 kg/ m 2 . It is further classified into grades I, II and III. Extreme obesity with a BMI of greater than 40 is also called as morbid obesity. As seen on the right side of the table above, being overweight and the various classes of obesity is closely related t

Ataxic gait

This type of gait can be seen in cases of cerebellar or sensory ataxia. Cerebellar ataxia and gait: The problem here lies with the coordinating mechanisms in the cerebellum and its connecting systems. The gait is a clumsy, staggering, unsteady, irregular, lurching, titubating and wide-based. The patient may sway to either side, back or forward. Leg movements are erratic, and step length varies unpredictably. The patient is unable to follow a straight line on the floor (to walk tandem). With a lesion of the cerebellar vermis, the patient will exhibit a lurching, staggering gait but without laterality, the ataxia will be as marked toward one side as the other. Cerebellar ataxia is present with eyes both open and closed; it may increase slightly with eyes closed but not so markedly as in sensory ataxia. A gait resembling cerebellar ataxia is seen in acute alcohol intoxication. With a hemispheric lesion the patient will stagger and deviate toward the involved side. In disease l

Edema - Definition, pathophysiology, causes, clinical features

 DEFINITION  Edema is an abnormal presence of excessive fluid in the interstitial space.  PATHOPHYSIOLOGY  The movement of water and low molecular weight solutes such as salts between the intravascular and interstitial spaces is controlled primarily by the opposing effect of vascular hydrostatic pressure and plasma colloid osmotic pressure. Normally the outflow of fluid from the arteriolar end of the microcirculation into the interstitium is nearly balanced by inflow at the venular end. A small residual amount of fluid may be left in the interstitium and is drained by the lymphatic vessels, ultimately returning to the bloodstream via the thoracic duct. Either increased capillary pressure, diminished colloid osmotic pressure or inadequate lymphatic drainage can result in an abnormally increased interstitial fluid i.e. edema. An abnormal increase in interstitial fluid within tissues is called edema, while fluid collections in the different body cavities are variously

Mitral facies

Mitral facies is one of the cutaneous manifestations of systemic diseases. The pathology in question here is mitral stenosis. Mitral facies refers to rosy cheeks (bright circumscribed flush over the malar bones) with a bluish tinge. The rose colour is because of the dilatation of malar capillaries while the bluish tinge is because of the cyanosis. This facies is usually seen in long standing cases of severe mitral stenosis associated with pulmonary hypertension and low cardiac output.  The picture above is that of a patient with chronic severe mitral stenosis. Yet, the rosy cheeks are not that prominent. The reason for this is that the patient underwent mitral valve replacement surgery and thus the cutaneous signs are regressing.  Red cheeks may also be seen in weather-beaten people i.e. those who work a lot outside in the open air. Purple cheeks may be seen in congestive heart failure. Finally, in systemic lupus erythematosus (SLE) the cheeks will have a red raised erupti

Type 2 Diabetes Mellitus - Exercise benefits and regime

The positive benefits of exercise in a diabetic patient include: 1) cardiovascular risk reduction, 2) reduced blood pressure, 3) maintenance of muscle mass, 4) reduction in body fat and weight loss, 5) lowering plasma glucose (during and following exercise) and 6) increasing insulin sensitivity. Also since the diabetics lack the normal glucoregulatory mechanisms, they are more prone to be affected by either hypo or hyperglycemia if exercising. That is why it is better to have the blood glucose monitored before, during and after the exercises. It is not advised to do exercises if the blood glucose level is below 5.6 mmol/L or more than 14 mmol/L with ketones present. The exercise regime recommended is as follows: 1) At least 150 minutes of moderate to vigorous exercise per week distributed over at least 3 days. One example of such a moderately intense exercise is brisk walking. 2) Ideally resistance training should also be done for 3 non consecutive days per week. e.g. sm