By R. Narkam. Clayton College of Natural Health. 2018.

The medulla consists of a cortex like framework of spongy keratin supporting thin shells of amorphous material bonding air spaces of variable size generic npxl 30 caps with amex. Hair Color Hair color is determined by the melanocytes found only in the matrix area of the follicle at the base of the cortex directly above the follicular papilla purchase npxl 30caps without prescription. Melanocytes transfer packages of melanin (melanosomes) to the cortical cells during anagen order npxl 30caps amex. Pheomelanin, a mutation of eumelanis, is the predominant pig- ment found in blonde or red hair (4). Graying of hair is a normal manifestation of aging and illustrates progressive reduction in melanocyte function. The proportions of eumelanin and phe- omelanin and the total amount of melanin determine the final natural color of the hair (5). Human Hair 3 Black and dark brown hair are the prevalent natural hair colors of peoples of all regions, accounting for more than 90% of all human hair. Blonde hair is characterized by low levels of the dark pigment eumelanin and higher levels of the pale pigment pheomelanin. In certain European populations, the occurrence of blonde hair is more frequent, and often remains throughout adulthood, leading to misinter- pretation that blondeness is a uniquely European trait. Based on recent genetic information, it is probable that humans with blonde hair became more numerous in Europe about 10,000 to 11,000 years ago during the last ice age, as a result of Fisherian runaway mechanisms. Prior to this, early Europeans had dark brown hair and dark eyes, as is predominant in the rest of the world. In humans of many ethnicities, lighter hair colors occur naturally as rare mutations, but at such low rates that it is hardly noticeable in most adult populations. Light hair color is commonly seen in children, and is curiously common in children of the Australian Aboriginal population. Bleached blonde hair can be distinguished from natural blonde hair by exposing it to ultraviolet light, as heavily bleached hair will glow, while natural blonde hair will not. There are no comparable data for red hair, but in the areas of obvious frequency (the fringes of Western and Eastern Europe) it is at a maximum of 10%. Controversial estimations of the original occurrence of the red-haired gene at 40,000 years ago are probable. Red hair is associated with the melanocortin-1 receptor, which is found on chromosome 16. When only one copy of the red-hair allele is present, red hair may blend with the other hair color, resulting in different types of red hair including strawberry blonde (red-blonde) and auburn (red-brown). The Record of the Hair The hair shaft records repeated cosmetic practices—the so-called record of the hair (7). Newly emerging hair has properties that are different from those of the hair tips. The more distal part of the hair shaft, particularly the tip, has typically undergone several hundred washes, the application of hot styling implements, and other cosmetic procedures such as bleaching, perma- nent coloring, and perming in addition to normal exposure to the environment. Genetic evidence suggests that Homo sapiens originated only 200,000–250,000 years ago somewhere in the East African savannah. Despite their apparent phenotypic variation, today’s world population is potentially derived from as few as 1,000 to 10,000 individuals. Using average rates of genetic mutation, this population lived at a time that coincided with the massive Toba volcanic disas- ter, which affected global climate, effectively wiped out all other hominids, and devastated Homo sapiens. Descendants of these “modern” humans migrated out of Africa when the climate improved and populated the earth. This is due in the most part to the gross reduction in breeding pairs in the late Pleistocene era. This core of humanity, survived near-extinction and went on to populate the entire world in less than 5000 genera- tions. In less than 100 generations and 2000 years, world population has risen from 3 million to 6 billion. Of the remainder, 14% live in the Americas, 13% in Africa, and 12% in Europe with only 0. Hair form arose from these clans and, as much as skin color, denotes local origins. Despite serial migrations, the original groups have been preserved largely on a regional basis. Bands, which are the simplest form of human society, and still exist (Inuit, indigenous Australians) expanded into clans and sub- sequently tribes. Until the advent of global agriculture some 7,000 ago, genetic lineages were probably tightly maintained. Where and when the emergence of the archetypal hair forms that are described in the literature occurred is not known. Similarly, knowledge of the hair phenotype of early humans and whether the tightly curled hair of today’s equatorial Africa or a more wavy appearance predominated is speculative (Figs.

Food that may have been contaminated by an ill person should be disposed of properly order 30caps npxl. Scientists have identified six hepatitis viruses cheap npxl 30caps otc, but three - known as A npxl 30 caps fast delivery, B and C - cause about 90 percent of acute hepatitis cases in the United States. People infected with hepatitis can experience effects ranging from mild illness to serious liver damage. Many recover completely from an infection, while others become carriers of the disease and can spread it to others unknowingly. It is especially important for women who are pregnant or are trying to become pregnant to get tested for hepatitis. Typical symptoms of acute hepatitis are:  fever  appetite loss  nausea  abdominal pain  jaundice (yellowish color on the skin and eyeballs) Hepatitis A virus found in human feces; shellfish grown in polluted waters. Yellowed skin, enlarged liver, fever, vomiting, weight loss, and abdominal pain — low mortality, lasts up to four months. In the United States, hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics. Approximately 30 - 50,000 cases occur yearly in the United States and the direct and indirect costs of these cases exceed $300 million. The unfortunate aspect of these statistics is that with 21st century medicine, Hepatitis A is totally preventable, and isolated cases, especially outbreaks relegated to food consumption, need not occur. Viral Hepatitis is a major public health concern in the United States, and a source of significant morbidity and mortality. Hepatitis A is a communicable (or contagious) disease that spreads from person to person. It is almost always true that the virus infects a susceptible individual when he or she ingests it, but it gets to the mouth by an indirect route. When water sources such as private wells are contaminated with feces from infected humans, the water will spread the hepatitis A virus. The virus can enter the water through various ways, including sewage overflows or broken sewage systems. Heating water at a full boil for 1 minute (3 minutes if you live in a high altitude) will kill or inactivate the hepatitis A virus. Because of the small size of the virus, using a point-of-use filter will not remove it from water. Most Common Method of Transmission Food contaminated with the virus is the most common vehicle transmitting Hepatitis A. Outbreaks associated with food have been increasingly implicated as a significant source of Hepatitis A infection. Children often have asymptomatic or unrecognized infections and can pass the virus through ordinary play, unknown to their parents, who may later become infected from contact with their children. Hepatitis A: is much more common in countries with under-developed sanitation systems. This includes most of the world: an increased transmission rate is seen in all countries other than the United States, Canada, Japan, Australia, New Zealand, and the countries of Western Europe. Within the United States, Native American reservations also experience a greatly increased rate of disease. It is not necessary for the patient to withhold food or fluids before any of these tests, unless requested to do so by the physician. Risks Risks for these tests are minimal for the patient, but may include slight bleeding from the blood-drawing site, fainting or feeling lightheaded after venipuncture, or hematoma (blood accumulating under the puncture site). Determining recent infection rests on identifying the antibody as IgM (associated with recent infection). In humans it causes a wide range of symptoms, and some infected persons may have no symptoms at all. Symptoms of leptospirosis include high fever, severe headache, chills, muscle aches, and vomiting, and may include jaundice (yellow skin and eyes), red eyes, abdominal pain, diarrhea, or a rash. If the disease is not treated, the patient could develop kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, and respiratory distress. Leptospira interrogans causes leptospirosis, a usually mild febrile illness that may result in liver or kidney failure. Structure, Classification, and Antigenic Types Leptospira is a flexible, spiral-shaped, Gram-negative spirochete with internal flagella. Outbreaks of leptospirosis are usually caused by exposure to water contaminated with the urine of infected animals. Many different kinds of animals carry the bacterium; they may become sick but sometimes have no symptoms. Leptospira organisms have been found in cattle, pigs, horses, dogs, rodents, and wild animals. Humans become infected through contact with water, food, or soil containing urine from these infected animals. This may happen by swallowing contaminated food or water or through skin contact, especially with mucosal surfaces, such as the eyes or nose, or with broken skin.

Admit If • Risk of suicide is judged high • There is significant weight loss • There is imminent stupor cheap npxl 30 caps with mastercard. Patient Education • Inform the patient that there will be a delay of 2 weeks before beneficial effects of treatment are experienced • Explain about the side effects e cheap 30caps npxl fast delivery. Clinical Features Hyperactivity usually goal oriented discount 30 caps npxl, over generosity, extravagance, disinhibition (promiscuity, drug abuse), irritability, accelerated speech, infectious elated congruent mood, grandiose delusions enhanced self esteem, insomnia, weight loss (no time for food). In severe forms patient appears disorganised, may be violent and has legal involvement. Management − General • Rule out intoxication • Involve family members in management. Use psychiatric community nurses and social workers in involving family to understand the illness and helping the family in rehabilitation of the patient into community activities. Caution: Aim to use lowest dose that is therapeutic in cases of long term use to minimize risk of side effects. Refer If • Poor compliance • Inadequate dosage/therapeutic treatment up to 6 weeks 158 • Misdiagnosis. Patient Education • Compliance to therapy is important to prevent relapses • Relatives should bring the patient to the hospital at early signs of relapse • Drugs may have to be taken for a long time depending on response. Insomnia can be a symptom of most other psychiatric and physical disorders which should be excluded. Management • Forced naps at regular times of the day • Methyl phenidate 30 mg morning and 20 mg midday until symptoms disappear, maximum dose 60 mg daily. May occur in the following conditions: Depression, schizophrenia, under influence of alcohol/drugs, under severe social problems or stress, personality disorder. An emphatic approach is very important if you are to win the confidence of the patient so that he/she will be able to tell you the true story • Assessment of seriousness of the attempt: Every suicide attempt should be regarded as serious. Refer If • Any of the above symptoms present • Has a mental illness • Has difficult social problems. Clinical Features General malaise, joint pains, joint mobility not affected, joint not red, not warm, not tender or only slightly tender. Usually it is a feature of another illness and careful systemic examination is warranted. Pain becomes more severe as attack progresses, but subsides spontaneously in 4 days. Initially intercritical periods are long but later acute attacks occur more frequently. If arthritic attacks frequent, renal damage present or serum uric acid significantly elevated, serum uric acid should be lowered. Joints commonly involved are cervical and lumbar spines, the knees and hip as well as the hands and feet. Clinical Features Symmetrical peripheral polyarthritis mostly of small joints (warm, painful, stiff, swollen). Extra−Articular: fever, weight loss, lassitude, anaemia, subcutaneous nodules, splenomegaly, lyinphadenopathy, keratoconjuctivitis, pericarditis, pleuritis. Admit For • Acute exacerbation • Bed rest (may need to splint the affected joint) • Intensive physiotherapy • Systemic complications Complications All the systems are involved in this disease; this would need specialists attention as would the use of steroids or chloroquine. Tends to affect large and small joints and may interfere with growth and development. Drug treatment is similar to that in adult type except that aspirin is used with caution because of concerns of Reyes syndrome. Clinical Features score 0 1 2 Heart rate (per minute) Absent Less than 100 Over 100 Respiration effort Absent Irregular, slow Regular Muscle tone Limp(floppy) Some flexion of arms, legs Well flexed, active motion Reflex irritability (nasal catheter) No response Some motion, grimace Cries Colour Blue, pale Pink body, blue extremities Completely pink Causes of neonatal asphyxia and anoxia include placental accident (abruptio placentae), cord prolapse and cord compression, maternal administration of drugs which depress respiration (e. Clinical Features Irregular foetal heart: Foetal bradycardia or tachycardia (normal foetal heart; 120−140/min). The lungs may be ruptured during resuscitation causing pneumothorax and surgical emphysema. Liver, spleen and adrenal damage may cause severe bleeding and associated hypovolaemic shock. K haemorrhage 40−50% of babies below distress, Convulsions, Fever Conservative 1500 gms. Does not slowly subside but skull bones due to trauma cross midline Bilateral or may become during delivery unilateral infected calcified or lead to jaundice or anaemia. Sternomastoid tumour Tear of sternomastoid Lump on the side of neck Gentle passive muscle during delivery appearing within first two physiotherapy to (especially breech). Long bones Healing takes place so readily that only minimal splinting is necessary, even where there is misalignment. Clinical Features Uniform enlargement of the head before birth causing obstructed labour or developing insidiously after birth. Management − Operative • A shunt from the ventricle to the atrium or peritoneal cavity inserted in a specialised centre. Contraindications to referral (surgery) • Multiple congenital abnormality • Large hydrocephalus associated with spina bifida with paralysis • Severely infected chest, anaemic, blind and vomiting patients. In other cases There may be tell−tale signs on the the patient may present with: back such as: • Nocturnal ehuresis • Lipoma • Foot−drop • Dimple • Persistent urinary tract infections • Tuft of hair (hypertrichosis) • Naevus • Telangiectasia Investigations • X−ray of full spine will show absent lamina on one side or bilaterally • Myelogram may be useful to rule out associated conditions such as diastematomyelia.

Patient Education • Return to hospital if features of progression to incomplete abortion intensify e npxl 30 caps for sale. Patient Education • If further pregnancy is desired buy npxl 30caps with mastercard, investigate further as under habitual abortion • If further pregnancy is not desired order 30caps npxl with amex, discuss and offer appropriate contraception. Management • Resuscitate with fluids (normal saline and dextrose) if the patient is in shock, consider blood transfusion if necessary • Give Ergometrine 0. Curettage may require sedation with pethidine 100 mg and diazepam 10−20 mg or para−cervical nerve block. If pregnant, substitute cotrimoxazole for tetracycline • Offer cervical cerclage in cases of cervical incompetence • Cases with poor luteal function need a progestin early in pregnancy e. All women should have access to comprehensive quality services for the management of post−abortion complications. Post−abortion counselling, education and family planning services should be offered promptly to help reduce repeat abortions. In the threatened stage, before the cervix opens, the diagnosis of hydatidiform mole is suspected if bleeding does not settle within a week of bed rest. Features of hyperemesis gravidarum, nausea, vomiting, ptyalism, etc are still present and severe after 3 months. When the cervix opens, passage of the typical grape−like vesicles confirms the diagnosis. Investigations • Positive pregnancy test in dilutions after 12 weeks gestation • Confirmation is by ultrasound. Depo provera) may be used • Follow up monthly for pelvic examination and repeat pregnancy test. Admit • If diagnosis of molar abortion is suspected • Choriocarcinoma is suspected. Ectopic pregnancy is usually due to partial tubal blockage and therefore the patient is often subfertile. Investigations 204 • Paracentesis of non−clotting blood is diagnostic in acute and some chronic cases • Culdocentesis in experienced hands is positive with dark blood, especially in chronic cases • Group and cross−match blood. Make note of condition of the other tube and ovary in the record and discharge summary • Where experienced gynaecologist is available, conservative management of affected tube should be attempted • Discharge on haematinics • Review in outpatient gynaecology clinic to offer contraceptives or evaluate further sub− fertility status. The couple has never conceived despite of having unprotected intercourse for at least 12 months • Secondary: The couple has previously conceived but is subsequently unable to conceive for 12 months despite unprotected intercourse. Most patients will require detailed work−up thus refer patients to gynaecologist after a good history and examination rule out immediately treatable causes. Diagnosis • History from couple and individually • Physical examination of both partners. It is commonly associated with acute urinary tract infection in young girls and may be associated with other pelvic tumours in older women. Vaginal examination reveals a mass that is firm, nodular, non−tender and moves with the cervix. Management • Treat associated pelvic inflammatory disease • Correct any anaemia associated with menorrhagia by haematinics or blood transfusion • Where fertility is desired plan myomectomy and where obstetric career is complete, plan hysterectomy with conservation of one ovary in women under 45 years of age. Investigations • Hb, Urinalysis • Plain abdominal X−ray may be useful in calcified tumours and some dermoid cysts • Ultrasound where facilities exist. Management • Cysts greater than 8 cm need laparotomy • Cystectomy or salpingo−oophorectomy and histology. Secondary amenorrhoea refers to cessation of the periods after menstruation has been established. Commonest variety seen is imperforate hymen occurring at menarche (12−14 years) with cyclic abdominal pains. Management • Admit to hospital for cruciate incision, which is a cure for imperforate hymen. A good menstrual history and physical examination is sufficient: a pregnancy test or ultrasound are sufficient to diagnose early pregnancies • In the pathological type investigations focus on uterine lesions, ovarian lesions, pituitary disorders, other endocrine disorders, psychiatric illness or emotional stress and severe general illness. Primary amenorrhoea is investigated after age 18 and secondary amenorrhoea at any age when 6 or more cycles are missed. Metrorrhagia refers to irregular uterine bleeding independent of or in between regular periods. Dysfunctional Uterine Bleeding refers to those cases in which the bleeding is neither due to some obvious local disorder, such as pelvic infection or new growth, nor to some complication of pregnancy. Metropathia haemorrhagica describes periods of amenorrhoea of 6−12 weeks followed by prolonged spotting 2−4 weeks and on curettage and histology there is cystic glandular hyperplasia. Clinical Features • Irregular periods associated with anovulation are commonest at puberty and perimenopause and at some stage during reproductive years, (14−44 years). Management • At puberty re−assurance may suffice 209 • Irregular periods with associated anovulation need hormonal therapy at any age. Accompanied by nervous irritability, depression, headache, listlessness and discomfort in breasts. Investigations • Speculum examination shows easily bleeding lesion on the cervix • Hb • Biopsy.