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Thoracic cage injuries - simple and complicated

Acanthosis nigricans - cause and significance

Acanthosis nigricans is a hyperpigmented velvety lesion usually found in the neck and the axillary region. It can also be seen elsewhere e.g. the belt line, creases over the dorsal surface of fingers. The palms and soles are typically not involved. Pathologically, it is characterized by an increased number of melanocytes associated with hyperkeratotic epidermal papillomatosis. It is strongly associated with insulin resistance but it is a non-specific condition and can also be found in obesity, polycystic ovarian syndrome, endocrine diseases like acromegaly and Cushing's syndrome, as well as some malignant tumours. The severity of the acanthosis nigricans correlates with the degree of insulin resistance and the level of serum insulin. The exact mechanism of its formation is still unclear but it is speculated that there are related IGF-1 receptors in the skin which are activated by ambient hyperinsulinemia. If the insulting factor is removed, there may be a regression of the

Classification of Diabetes Mellitus

Diabetes is divided into 4 different classes: 1) Type 1 diabetes (results from beta-cell destruction, usually leading to absolute insulin deficiency) 2) Type 2 diabetes (results from a progressive insulin secretory defect on the background of insulin resistance) 3) Other specific types of diabetes due to other causes, e.g. genetic defects in beta-cell function, genetic defects in insulin action, diseases of the exocrine pancreas (such as cystic fibrosis, pancreatitis) and drug- or chemical-induced (such as in the treatment of HIV/AIDS or after organ transplantation) 4) Gestational diabetes mellitus (GDM) (diabetes diagnosed for the first time during pregnancy that is not clearly overt diabetes).

Respiratory failure - Definition, classification and difference between acute and chronic type

Respiratory failure may be classified as hypercapnic or hypoxemic. Hypercapnic respiratory failure is defined as an arterial PCO2 (PaCO2 ) greater than 45mmHg. Hypoxemic respiratory failure is defined as an arterial PO2 (PaO2 ) less than 55 mmHg when the fraction of oxygen in inspired air (FiO2) is 0.60 or greater. In many cases, hypercapnic and hypoxemic respiratory failure coexist. Distinctions between acute and chronic respiratory failure are summarized in the table below. In general, acute hypercapnic respiratory failure is defined as a PaCO2 greater than 45 mmHg with accompanying acidemia (pH less than 7.30). The physiological effect of a sudden increase in PaCO2 depends on the prevailing level of serum bicarbonate anion. In patients with chronic hypercapnic respiratory failure e.g. COPD, a long-standing increase in PaCO2 results in renal compensation and an increased serum bicarbonate concentration. A superimposed acute increase in PaCO2 has a less dramatic effect th

May-Thurner syndrome

As seen in the diagram above, the left common iliac vein is predisposed to be compressed by the right common iliac artery. This can lead to stasis and eventually causing thrombosis. Another effect is that the pulsatile nature of the artery over the vein leads to turbulence in the blood flow, thereby favouring thrombosis.  Because of this anatomical predisposition, most Deep Vein Thrombosis (DVT) seen during pregnancy occur in the left iliac vein system. All the classic investigations done for cases of DVT should be performed here also.

Intensity training

Whether you are using the threadmill, the elliptical, the rowing machine or the stationary bike for your indoor workout, it is always better to start with around 5 minutes of warm up. Traditionally people go on the threadmill at a constant speed for around 30-45 minutes. In the first few days it will help you lose some weight but eventually no. The best way of losing weight is to do intensity training. This means doing intense activity for a short time and then continue at a lower pace and repeat this over. The best machine should have a built-in heart monitor and a digital watch. Calculate your maximum heart rate by subtracting your age from 220. Max Heart rate= 220-age (in years) For women it is better to use this formula: Max heart rate=206-0.88 age (in years) 1) After warming up, start at 80-90% of your max heart rate for 1 minute. 2) Then, recover for 2 minutes at 50-60% of your max heart rate. 3) These 3 minutes make 1 interval. Do 8 intervals in all. For beginners:

Sardines healthier than swordfish

It is healthier to eat small, oily fish like sardines, herring and anchovies than larger predators like swordfish or king mackerel. Recent studies found that the level of mercury in the sardines was much lower and as we move up the food chain, there is more mercury concentrated in the fishes. So, it is better to get the omega 3 from the smaller fishes.