The symptom called ‘Jaundice’ refer to yellow appearance of the skin, sclera and the mucous membranes resulting from the increased bilirubin concentration in body fluids. It is detectable while the plasma bilirubin exceeds 50µm o1/1(3mg/dl). The internal tissues and the body fluids are colored yellow but not the brain since bilirubin does not cross blood-brain barrier other than in immediate neonatal period.
Cholestasis is the failure of bile flow, and the cause may lie anywhere between hepatocyte and duodenum. The jaundice becomes gradually severe in the unrelieved cholestasis because the conjugated bilirubin is unable to enter bile canaliculi and passes back into blood. It happens also because there is the failure of the clearance of un-conjugated bilirubin arriving in liver cells.
Aetiology: - Cholestasis may be because of failure of the hepatocytes to generate the bile flow, to the obstruction to bile flow in bile ducts in portal tracks, or to the obstruction to bile flow in extra-hepatic bile ducts between porta hepatic and papilla of Vater. The cause of cholestasis may operate at more than one of these levels. Those confined to extra-hepatic bile ducts can be amenable to the surgical correction.
Clinical Feature: - The clinical features in the cholestasic jaundice include those to the cholestasis itself and to the development of the cholangitis consequent on biliary obstruction. Jaundice is very variable. It may be static or may fluctuate. If it is prolonged and severer; it may give the skin a greenish look. Stools are pale or clay colored for the deficiency of pigment derived from bilirubin. The urine is dark from renal excretion of conjugated bilirubin. Many patients may have pruritus generated and the accessible parts of the body may also show scratch marks. The lipid deposits may develop in skin during prolonged cholestatic jaundice. Most of them are xanthelasmas on eyelids but sometimes xanthomas also occur. Prolonged cholestasis may also cause marked mal absorption leading to weight loss, severe steatorrhoea, and hemorrhagic tendency because of Vitamin K deficiency associated with the calcium and vitamin D deficiency. Clinical and biochemical evidence of the biliary cirrhosis and hepatocellular failure occur eventually. Cholangitis, due to the infection with or without rigors and the coincident pain and the hepatic tenderness may indicate the development of the hepatic abscess. None of the features are pathognomonic of any particular cause, but are more likely to be in some diseases than the others. Read more…
According to a recent study by a group of scientists led by Kerry Ressler of Emory University in Atlanta, it has been found that Post-Traumatic Stress Disorder or more popularly known as PTSD is a result of both genetic as well as environmental influence on the patient suffering from despair.
The findings published in the Journal of The American Medical Association have re-affirmed that environmental factors coupled with genetic variants affect tremendously on mental health. The findings also states that, no single factor of genetic or environmental can result in serious stress related disorder. All people who have had unpleasant experiences like war, accidents, terrorist attacks or natural disaster might not develop PTSD. Only those with genetic background are at risk of developing the dreaded condition that might stop someone from leading a normal life. The traumatic experiences of the past leads to nightmares, flashbacks, depressions or mood swings. But everybody who experiences bad or horrific experiences suffers from PTSD. It has been found that identical twins sharing all their genes and serving the Vietnam War were likely both to suffer more than their fraternal peers. But genes alone are not the cause for such traumatic and depressive life.
The research team had studied 900 adults who grew up in deprived urban communities and faced difficulties during their growing up periods. They were asked to answer a questionnaire that detailed their life including child or sexual abuse at one stage or the other.
Dr. Ressler also examined the gene variants known as FKBP5 normally related to how a body responds to stress. The team found that the gene made little or no effect in isolation to many. But when gene and environmental factors were put together, they made big difference in either raising or reducing the risk of PTSD on people. Dr. Ressler says
“These results are early and will need to be replicated, but they support the hypothesis that combinations of genes and environmental factors affect the risk for stress-related disorders like PTSD”
For centuries, people thought it to be a demonic act. But today it has come out of the closet and has become a worrying fact for many societies around the world. Hollywood star Cameron Diaz opens doors with her elbows for fear of contamination: Michael Jackson goes through surgeries to look better – Is it madness? Till fifteen years ago, many thought so. But recent studies ad new frontiers in gene research, scanning technologies and treatments have shown that it is a disease known as Obsessive Compulsive Disorder (OCD). “OCD stands as a condition where the brain tries to do something it’s wired to do – warning you of danger – but goes overboard in the process.” According to World Health Organization (WHO) – OCD has become one of the top 10 debilitating diseases in the world.
Actually, it is kind of a “mental hiccup”. OCD throws up persistent, distressing thoughts, images and ritual behaviors that a person is driven to perform. “Everyone has intrusive thoughts, but people can ignore those and move on with their lives. For those with OCD, the thoughts become their lives.’ Says Dr. Ramesh Sagar, associate professor of psychiatry at the All India Institute Of Medical Sciences (AIIMS), Delhi. It is an obsession because the sufferers recognize these as a mental projection and try to ignore those without much success. It’s a compulsion, because the repetitive, seemingly purposeful acts follow rigid rules.
An OCD patient’s life is torn with fear, guilt, doubt, distasteful images, depressions and a sense of defeat and the suffering and anguish is far worse than one normal human being can imagine. Obsessions and compulsions parade as infinitely personalized variations on a number of morbid themes – from aggression, harm avoidance, contamination, unpleasant or excessive sexual ideation, religious concerns, compulsion to collect, need for symmetry or order, to fear of illness. Contamination and fears of harming oneself or others are the most common obsessions, while cleaning and checking are the most common compulsions.
Research shows that, moderate amount of anxiety helps people to complete their assignments more efficiently. So all anxieties are not cases of OCD. Indeed it’s a bit of difficult to diagnose OCD. However, the key to diagnosing authentic cases of OD is how great imact odd behaviors have on people’s lives. The question is – why do some people get over-active internal alarms than most others? The answer lies in a small structure in the brain called the amygdale, where danger is processed. “If this risk centre is overactive, it would keep on alerting you to peril even after you have attended to the problem” points out Sagar. Functional magnetic resonance imaging (fMRI) show that apart from amygdale, there are other anatomical hot spots involved in the disorder: the orbitofrontal cortex, striatum, anterior cingulum and thalamus. Together, this wiring regulates your response to the stimuli around you, including how anxious you are I the face of threatening or frustration.
No other mental disorder hides as stealthly, delays diagnosis, or causes as much embarrassment. But better treatments are breaking its hold. Treatment for OCD is a long process divided into several stages from selective serotonin reuptake inhibitions (SSRI) to cognitive behavioral therapy. Researchers are working on the possibility of using surgery and a technique called deep brain stimulation.(apply low doses of current) to calm the OCD tossed brain.
Some Facts About OCD:
Common Compulsions:
- Washing and cleaning 41%
- Checking 38%
- Repeating 16%
- Ordering 16%
- Counting 5%
- Hoarding 3%
Common Obsessions:
- Contamination 45%
- Pathologic doubt 35%
- Aggression 32%
- Sex 20%
- Religious 17%
- Symmetry/exactness 14%
- Hoarding 3%
Primary Causes for OCD:
- GENES: can run in the family
- STRESS: in about one in 3 cases
- LIFE CHANGES: sudden role change, puberty, child birth, new job etc.
- BRAIN CHANGES: imbalance of a chemical called serotonin
- PERSONALITY: Obsessive, perfectionist, high on morality and responsibility.
Cure Conundrum:
- Routinely mislabeled as other disorders –depression to schizophrenia
- Underdiagnosed and undertreated due to stigma and lack of awareness
- OCD striking a young person mean an entire childhood lost.
- The disease often leads to breakdown of family life and causes job-related problems
Rethinking Remedies:
- New research has revealed genetic links, one in four children with OCD has a first-degree relative with a similar condition
- Modern scans can show up the landscape of OCD
- New treatments with anti-depressants (selective serotonin reuptake inhibitors) are in force
- Cognitive behavioral therapy is proving effective.
FactFile:
- Just 20 years ago OCD was considered a rare disorder, affecting only 0.5% people.
- Now it is believed to affect 2-3% of the total population and 1% children
- Who says- OCD is one of the top 10 causes of disability
- Over 12 million Indians suffer from it in one form or another
- 58% patients seeking treatment come from urban background
- Average timelag between onset and a proper diagnosis is 17 years.
- 40% patients recover completely
- 30% show good improvement
This writing is inspired by a report on India Today magazine, issued on March3, 2008.
