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Psoriatic arthritis

Other Names: Arthritis psoriatica,Arthropathic psoriasis or Psoriatic arthropathy

Definition:
Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis — a condition that features red patches of skin topped with silvery scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin lesions appear.

Joint pain, stiffness and swelling are the main symptoms of psoriatic arthritis. They can affect any part of your body, including your fingertips and spine, and can range from relatively mild to severe. In both psoriasis and psoriatic arthritis, disease flares may alternate with periods of remission.

It is a type of inflammatory arthritis that will develop in up to 30 percent of people who have the chronic skin condition psoriasis. Psoriatic arthritis is classified as a seronegative spondyloarthropathy and therefore occurs more commonly in patients with tissue type HLA-B27.

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No cure for psoriatic arthritis exists, so the focus is on controlling symptoms and preventing damage to the joints. Without treatment, psoriatic arthritis may be disabling.

Classification:
There are five main types of psoriatic arthritis:

*Asymmetric: This type affects around 70% of patients and is generally mild. This type does not occur in the same joints on both sides of the body and usually only involves fewer than 3 joints.

*Symmetric: This type accounts for around 25% of cases, and affects joints on both sides of the body simultaneously. This type is most similar to rheumatoid arthritis and is disabling in around 50% of all cases.

*Arthritis mutilans (M07.1): Affects less than 5% of patients and is a severe, deforming and destructive arthritis. This condition can progress over months or years causing severe joint damage. Arthritis mutilans has also been called chronic absorptive arthritis, and may be seen in rheumatoid arthritis as well.

*Spondylitis (M07.2): This type is characterised by stiffness of the spine or neck, but can also affect the hands and feet, in a similar fashion to symmetric arthritis.

*Distal interphalangeal predominant (M07.0): This type of psoriatic arthritis is found in about 5% of patients, and is characterised by inflammation and stiffness in the joints nearest to the ends of the fingers and toes. Nail changes are often marked.

Symptoms:
*Pain, swelling, or stiffness in one or more joints is commonly present.

*Asymmetrical oligoarthritis (70%) (Involvement of the distal interphalangeal joints (DIP) is a characteristic feature).

*Sacroiliitis/spondylitis (40%)

*Symmetrical seronegative arthritis (15%)

*Distal interphalangeal joint arthritis (15%)

*Hand joints involved in psoriasis are proximal interphalangeal (PIP) + distal interphalangeal (DIP) + metacarpophalangeal (MCP) + wrist
Joints that are red or warm to the touch.

*Sausage-like swelling in the fingers or toes, known as dactylitis.

*Pain in and around the feet and ankles, especially tendinitis in the Achilles tendon or plantar fasciitis in the sole of the foot.

*Changes to the nails, such as pitting or separation from the nail bed.

*Pain in the area of the sacrum (the lower back, above the tailbone).

*Along with the above noted pain and inflammation, there is extreme exhaustion that does not go away with adequate rest. The exhaustion may last for days or weeks without abatement. Psoriatic arthritis may remain mild, or may progress to more destructive joint disease. Periods of active disease, or flares, will typically alternate with periods of remission. In severe forms, psoriatic arthritis may progress to arthritis mutilans which on X-ray gives pencil in cup appearance.

*Because prolonged inflammation can lead to joint damage, early diagnosis and treatment to slow or prevent joint damage is recommended.

*Scaly skin lesions are seen over extensor surfaces (scalp, natal cleft and umbilicus).

*The nail changes are pitting, onycholysis, sub–ungual hyperkeratosis and horizontal ridging.

Causes:
Psoriatic arthritis occurs when the body’s immune system begins to attack healthy cells and tissue. The abnormal immune response causes inflammation in your joints as well as overproduction of skin cells.

It’s not entirely clear why the immune system turns on healthy tissue, but it seems likely that both genetic and environmental factors play a role. Many people with psoriatic arthritis have a family history of either psoriasis or psoriatic arthritis. Researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis.

Physical trauma or something in the environment — such as a viral or bacterial infection — may trigger psoriatic arthritis in people with an inherited tendency.

Diagnosis:
There is no definitive test to diagnose psoriatic arthritis. Symptoms of psoriatic arthritis may closely resemble other diseases, including rheumatoid arthritis. A rheumatologist (a doctor specializing in diseases affecting the joints) may use physical examinations, health history, blood tests and x-rays to accurately diagnose psoriatic arthritis.

Factors that contribute to a diagnosis of psoriatic arthritis include:

*Psoriasis in the patient, or a family history of psoriasis or psoriatic arthritis.

*A negative test result for Rheumatoid factor, a blood factor associated with rheumatoid arthritis.

*Arthritis symptoms in the distal Interphalangeal articulations of hand (the joints closest to the tips of the fingers). This is not typical of rheumatoid arthritis.

*Ridging or pitting of fingernails or toenails (onycholysis), which is associated with psoriasis and psoriatic arthritis.

*Radiologic images indicating joint change.

*Other symptoms that are more typical of psoriatic arthritis than other forms of arthritis include inflammation in the Achilles tendon (at the back of the heel) or the Plantar fascia (bottom of the feet), and dactylitis (sausage-like swelling of the fingers or toes)

During the exam,the doctor may ask for the following tests:

Imaging tests:

*X-rays. Plain X-rays can help pinpoint changes in the joints that occur in psoriatic arthritis but not in other arthritic conditions.
Magnetic resonance imaging (MRI). MRI utilizes radio waves and a strong magnetic field to produce very detailed images of both hard and soft tissues in your body. This type of imaging test may be used to check for problems with the tendons and ligaments in your feet and lower back.
Laboratory tests:

*Rheumatoid factor (RF). RF is an antibody that’s often present in the blood of people with rheumatoid arthritis, but it’s not usually in the blood of people with psoriatic arthritis. For that reason, this test can help your doctor distinguish between the two conditions.

*Joint fluid test. Using a long needle, your doctor can remove a small sample of fluid from one of your affected joints — often the knee. Uric acid crystals in your joint fluid may indicate that you have gout rather than psoriatic arthritis.

Treatments:
The underlying process in psoriatic arthritis is inflammation; therefore, treatments are directed at reducing and controlling inflammation. Milder cases of psoriatic arthitis may be treated with NSAIDS alone; however, there is a trend toward earlier use of disease-modifying antirheumatic drugs or biological response modifiers to prevent irreversible joint destruction.

Nonsteroidal anti-inflammatory drugs:
Typically the medications first prescribed for psoriatic arthritis are NSAIDs such as ibuprofen and naproxen followed by more potent NSAIDs like diclofenac, indomethacin, and etodolac. NSAIDs can irritate the stomach and intestine, and long-term use can lead to gastrointestinal bleeding. Other potential adverse effects include damage to the kidneys and cardiovascular system.

Disease-modifying antirheumatic drugs:
These are used in persistent symptomatic cases without exacerbation. Rather than just reducing pain and inflammation, this class of drugs helps limit the amount of joint damage that occurs in psoriatic arthritis. Most DMARDs act slowly and may take weeks or even months to take full effect. Drugs such as methotrexate or leflunomide are commonly prescribed; other DMARDS used to treat psoriatic arthritis include cyclosporin, azathioprine, and sulfasalazine. These immunosuppressant drugs can also reduce psoriasis skin symptoms but can lead to liver and kidney problems and an increased risk of serious infection.

Biological response modifiers:
Recently, a new class of therapeutics called biological response modifiers or biologics has been developed using recombinant DNA technology. Biologic medications are derived from living cells cultured in a laboratory. Unlike traditional DMARDS that affect the entire immune system, biologics target specific parts of the immune system. They are given by injection or intravenous (IV) infusion.

Biologics prescribed for psoriatic arthritis are TNF-(alfa) inhibitors, including infliximab, etanercept, golimumab, certolizumab pegol and adalimumab, as well as the IL-12/IL-23 inhibitor ustekinumab.

Biologics may increase the risk of minor and serious infections. More rarely, they may be associated with nervous system disorders, blood disorders or certain types of cancer.

Other treatments:
Retinoid etretinate 30mg/day is effective for both arthritis and skin lesions. Photochemotherapy with methoxy psoralen and long wave ultraviolet light (PUVA) are used for severe skin lesions. Doctors may use joint injections with corticosteroids in cases where one joint is severely affected. In psoriatic arthritis patients with severe joint damage orthopedic surgery may be implemented to correct joint destruction, usually with use of a joint replacement. Surgery is effective for pain alleviation, correcting joint disfigurement, and reinforcing joint usefulness and strength.

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Lifestyle and home remedies

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Prognosis:
Seventy percent of people who develop psoriatic arthritis first show signs of psoriasis on the skin, 15 percent develop skin psoriasis and arthritis at the same time, and 15 percent develop skin psoriasis following the onset of psoriatic arthritis.

Psoriatic arthritis can develop in people who have any level severity of psoriatic skin disease from mild to very severe.

Psoriatic arthritis tends to appear about 10 years after the first signs of psoriasis. For the majority of people this is between the ages of 30 and 55, but the disease can also affect children. The onset of psoriatic arthritis symptoms before symptoms of skin psoriasis is more common in children than adults.

More than 80% of patients with psoriatic arthritis will have psoriatic nail lesions characterized by nail pitting, separation of the nail from the underlying nail bed, ridging and cracking, or more extremely, loss of the nail itself (onycholysis).

Men and women are equally affected by this condition. Like psoriasis, psoriatic arthritis is more common among Caucasians than Africans or Asians

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Psoriatic_arthritis
http://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/basics/tests-diagnosis/con-20015006
http://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/basics/causes/con-20015006
http://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/basics/definition/CON-20015006

Bauhinia herrerae

 

Botanical Name : Bauhinia herrerae
Family:Leguminosae/Fabaceae
Subfamily: Caesalpinioideae
Tribe: Cercideae
Genus: Bauhinia
Kingdom: Plantae
Order: Fabales

Synonyms : Bauhinia klugii Standl.,Schnella herrerae Britton & Rose

Common Name :Cowfoot Vine

Habitat : Native to South America

Description:

Bauhinia trees typically reach a height of 6–12 m and their branches spread 3–6 m outwards. The lobed leaves usually are 10–15 cm across.

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The five-petaled flowers are 7.5–12.5 cm diameter, generally in shades of red, pink, purple, orange, or yellow, and are often fragrant. The tree begins flowering in late winter and often continues to flower into early summer. Depending on the species, Bauhinia flowers are usually in magenta, mauve, pink or white hues with crimson highlights

Medicinal Uses:
The stem is used as an astringent to staunch diarrhea and bleeding, to reduce hemorrhage, and to wash wounds.  Boil a handful of chopped vine in 3 cups of water for 10 minutes; allow to cool and drink ½ cup 6 times daily for headaches, internal wounds, and bleeding, or 2 cups in ½ hour for hemorrhage.  Use this same decoction to wash bleeding or infected wounds.  For headaches, mash a handful of leaves in 1 quart of water, place in sun for 1 hour and wash head with this water.  The leaves are a component of some of the traditional bath mixtures used to treat many ailments.

This is an old remedy for birth control among Maya women, now apparently mostly forgotten.  Prepared from a handful of vine that has been boiled in 3 cups of water for 10 minutes, a cup is consumed before each meal all during the menstrual cycle.  It is said that this dose is effective for up to 6 months.  Drinking this decoction during 9 menstrual cycles is said to produce irreversible infertility in women.

Disclaimer:
The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider.

Resources:
http://www.nybg.org/bsci/belize/Bauhinia_herrerae.html.
http://www.theplantlist.org/tpl/record/ild-10345
http://www.herbnet.com/Herb%20Uses_C.htm

https://en.m.wikipedia.org/wiki/Bauhinia

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Marburg virus

Definition:
Marburg virus or simply Marburg is the common name for the genus of viruses Marburgvirus, which contains one species, Lake Victoria marburgvirus. The virus causes the disease Marburg Hemorrhagic Fever (MHF), also referred to as Marburg Virus Disease, and previously also known as green monkey disease due to its primate origin. Marburg originated in Central and East Africa, and infects both human and nonhuman primates. The Marburg Virus is in the same taxonomic family as Ebola, and both are identical structurally although they elicit different antibodies.

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Ebola virus and Marburg virus live in animal hosts, and humans can contract the viruses from infected animals. After the initial transmission, the viruses can spread from person to person through contact with body fluids or contaminated needles.

Marburg virus is a severe and highly contagious form of haemorrhagic fever caused by a virus from the same family – the filoviruses – as Ebola haemorrhagic fever (EHF), although it’s not as deadly as its cousin.

No drug has been approved to treat Ebola virus or Marburg virus. People diagnosed with Ebola or Marburg virus receive supportive care and treatment for complications. Scientists are coming closer to developing vaccines for these deadly diseases.

The virus was first discovered in 1967, during simultaneous outbreaks at laboratories in the former Yugoslavia and Frankfurt and Marburg, Germany. Since 1967 sporadic small outbreaks have been reported but in 2004-5 a major outbreak in Angola led to more than 140 deaths from the Marburg virus.

Symptoms:
During the incubation period, which lasts between five and ten days, no symptoms are apparent.

You may click to see:Marburg Virus Pictures from CDC

Signs and symptoms typically begin abruptly within five to 10 days of infection. Early signs and symptoms include:

*Fever
*Severe headache
*Joint and muscle aches
*Chills
*Sore throat
*Weakness

Over time, symptoms become increasingly severe and may include:

*Nausea and vomiting
*Diarrhea (may be bloody)
*Red eyes
*Raised rash
*Chest pain and cough
*Stomach pain
*Severe weight loss
*Bleeding from the nose, mouth, rectum, eyes and ears

The disease can then become increasingly damaging, causing:

•Jaundice
•Delirium
•Liver failure
•Extensive haemorrhage from multiple sites, which can give rise to bloody diarrhoea and vomiting of blood (known as heamatemesis)

Many people infected with the virus die, usually from haemorrhagic shock or liver failure. In areas where medical support is poor, the death rate can be much higher. The infection can be difficult to diagnose, because many of the initial signs are similar to those of other infectious diseases, such as malaria or typhoid fever.

 

Causes:
The virus appears to be rare and only found in Africa where cases have occurred in Uganda, Kenya, Zimbabwe and Angola. In the natural habitat the reservoir of the virus is the Egyptian fruit bat, which is found in Africa, but how the virus jumps from animals to humans is not known. Some people have developed the disease after visiting caves where the bats are found.

Transmission from animals to humans:
The virus can be transmitted to humans by exposure to an infected animal’s bodily fluids. Examples include:

*Blood. Butchering or eating infected animals can spread the viruses. Scientists who have operated on infected animals as part of their research have also contracted the virus.

*Waste products. Tourists in certain African caves and some underground mine workers have been infected with the Marburg virus, possibly through contact with the feces or urine of infected bats.

Transmission from person to person :
Infected people typically don’t become contagious until they develop symptoms. Family members are often infected as they care for sick relatives or prepare the dead for burial.

Once a human is infected they can pass the virus on to others through their body fluids, most commonly blood but also faeces, saliva and vomit. The virus may also possibly be spread via aerosols of tiny infected droplets produced when patients cough and splutter. However, the research suggests that sick humans don’t usually generate sufficient volumes of infectious aerosols to pose a significant hazard to those around them.

Medical personnel can be infected if they don’t use protective gear such as surgical masks and latex gloves. Medical centers in Africa are often so poor that they must reuse needles and syringes. Some of the worst Ebola epidemics have occurred because contaminated injection equipment wasn’t sterilized between uses.

There’s no evidence that Ebola virus or Marburg virus can be spread via insect bites.

 

Risk Factors:
For most people — including international travelers — the risk of getting Ebola or Marburg hemorrhagic fever is low. The risk increases if you:

*Travel to Africa. You’re at increased risk if you visit or work in areas where Ebola virus or Marburg virus outbreaks have occurred in the past.

*Conduct animal research. People are more likely to contract the Ebola or Marburg virus if they conduct animal research with monkeys imported from Africa or the Philippines.

*Provide medical or personal care. Family members are often infected as they care for sick relatives. Medical personnel also can be infected if they don’t use protective gear such as surgical masks and latex gloves.Prepare people for burial. The bodies of people who have died of Ebola or Marburg hemorrhagic fever are still contagious. Helping prepare these bodies for burial can increase your risk of developing the disease yourself.

 

Complications:
Both Ebola and Marburg hemorrhagic fevers lead to death for a high percentage of people who are affected. As the illness progresses, it can cause:

*Multiple organ failure
*Severe bleeding
*Jaundice
*Delirium
*Seizures
*Coma
*Shock

One reason the viruses are so deadly is that they interfere with the immune system’s ability to mount a defense. But scientists don’t understand why some people recover from Ebola and Marburg and others don’t.

For people who survive, recovery is slow. It may take months to regain weight and strength, and the viruses remain in the body for many weeks. People may experience:

*Hair loss
*Sensory changes
*Liver inflammation (hepatitis)
*Weakness
*Fatigue
*Headaches
*Eye inflammation
*Testicular inflammation

Diagnosis:
Ebola and Marburg hemorrhagic fevers are difficult to diagnose because many of the early signs and symptoms resemble those of other infectious diseases, such as typhoid and malaria. But if doctors suspect that you have been exposed to Ebola virus or Marburg virus, they use laboratory tests that can identify the viruses within a few days.

Most people with Ebola or Marburg hemorrhagic fever have high concentrations of the virus in their blood. Blood tests known as enzyme-linked immunosorbent assay (ELISA) and reverse transcriptase polymerase chain reaction (PCR) can detect specific genes or the virus or antibodies to them.

It is similar to Ebola using the Enzyme-Linked ImmunoSorbent Assay (ELISA) test. Polymerase Chain Reaction (PCR) technique has been successfully used for detection of Marburg virus. PCR detection for Marburg virus by Hänninen 2001

Treatment :
There is no cure for Marburg disease as there is no specific antiviral therapy indicated for treating Marburg, and hospital care is usually supportive in nature. Hypotension and shock may require early administration of vasopressors and haemodynamic monitoring with attention to fluid and electrolyte balance, circulatory volume, and blood pressure. Viral haemorrhagic fever (VHF) patients tend to respond poorly to fluid infusions and may develop pulmonary edema.

Prognosis:
If a patient survives, recovery is usually prompt and complete, though it may be prolonged in some cases, with inflammation or secondary infection of various organs, including: orchitis (testicles), hepatitis (liver), transverse myelitis (spinal cord), uveitis (eyes), and parotitis (salivary glands) Recovered patients often have little or no memory of being sick, though only 40-60% survive.

Prevention:
Strict hygiene measures help to prevent spread when an outbreak occurs, and an experimental vaccine is currently being tested.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/marburg_virus.shtml
http://www.mayoclinic.com/health/ebola-virus/DS00996
http://en.wikipedia.org/wiki/Marburg_virus
http://hardinmd.lib.uiowa.edu/cdc/275.html

http://hardinmd.lib.uiowa.edu/cdc/6562.html

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Cuts and Bleeding

Definition:
•Cuts, lacerations, gashes and tears (Wounds that go through the skin (dermis) to the fat or muscle tissue)
•Scrapes, abrasions, scratches and floor burns (Superficial wounds that don’t go all the way through the skin)
•Bruises (bleeding into the skin) without an overlying cut or scrape

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When Sutures (stitches) are Needed
•Any cut that is split open or gaping needs sutures.
•Cuts longer than ½ inch (12 mm) usually need sutures.
•On the face, cuts longer than ¼ inch (6 mm) usually need closure with sutures or skin glue.
•Any open wound that may need sutures should be checked and closed as soon as possible (ideally, within 6 hours). There is no cutoff, however, for treating open wounds to prevent wound infections.

Cuts Versus Scratches: Helping You Decide
•The skin (dermis) is 2 mm (about 1/8 inch) thick.
•A cut (laceration) goes through it.
•A scratch or scrape (wide scratch) doesn’t go through it.
•Cuts that gape open at rest or with movement need closure to prevent scarring.
•Scrapes and scratches never need closure, no matter how long they are.
•So this distinction is important.

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Symptoms:
Bleeding usually follows some sort of traumatic incident.

Dark red blood may ooze from small skin scrapes, or flow quickly from larger cuts. If an artery is damaged, the blood will appear brighter red and may spurt in pulses from the wound.

If there has been an accident involving glass, it may be possible to see the glass in the wound. This can be particularly painful, especially if the child tries to move the affected area.

In major accidents, broken bones occasionally stick out through a cut.

Causes:
Most children have scrapes, falls, cuts and bruises as they learn to walk, climb and understand how to manoeuvre to avoid dangers.

Even tiny amounts of blood can seem like a lot to a child, so bleeding may frighten them because they don’t understand the blood loss will stop when clotting occurs.

You hear a loud thud and then screaming from the next room. You run in to find your three-year-old sitting on the floor, holding her forehead, while blood streams down her face. You look at the cut and blood seems to be pouring out. By the time you get her to the ER, her whole shirt and the back of your car looks like it’s covered in blood, but your daughter actually appears well. You are confused, and perhaps embarrassed, when the ER nurse takes a look at the wound and says, “oh, she’ll be alright. It’s just a little cut.”

This scenario happens to many parents. It is often difficult to assess cuts, especially when they are actively bleeding. Here is the Dr. Sears guide to what to do if your child is injured with a cut or scrape, how to decide if stitches are needed, and guidelines for proper wound care for scrapes and stitches.

Treatment:
In most cases, blood loss is minor and soon stops of its own accord. Gentle pressure on the wound can help to slow blood loss. A clean, dry pad or plaster can also be applied to keep the wound clean.

For actively bleeding cuts:
*Step one is DON’T PANIC. If you stay calm, then your child may stay calm also.
*Step two is to cover the cut with whatever you can get your hands on the fastest. If you can cover the cut quickly, then your child will panic less.
*Step three is to look at the cut. Get an initial impression if it is minor or major.
*Step four is to stop the bleeding. Find a more appropriate item such as a clean towel or cloth and gently but firmly press it to the cut. Don’t keep peeking underneath every 10 seconds. Hold it in place for at least two minutes (longer if necessary).
*For cuts that involve a large bump or bruise, such as on the head, you may also want to apply some ice wrapped in the towel.
*Once the bleeding has stopped or dramatically decreased, take a closer look at the wound to assess how severe it is. Proceed to the next step below.

THERE IS BLOOD EVERYWHERE!YOU ARE  WORRIED YOUR CHILD HAS LOST TOO MUCH BLOOD!
Try to remain calm. It is virtually unheard of for any one to lose so much blood from a cut that it puts them in any danger. Cuts on the head and face bleed more than anywhere else on the body. This is because there are many more blood vessels in the skin here. Many parents worry that these cuts have caused a lot of blood loss. You can rest assured; the blood looks like a lot more than it really is.

HOW DO YOU DECIDE IF YOU SHOULD GO TO THE DOCTOR?
Simple cuts that do not require stitches do not need to be seen by your doctor.If it is obvious that your child does need stitches, do not rush in to your doctor’s office. Instead, call the office to find out what time would be best to come in. Since stitches usually take at least a half hour to do in the office, most offices would prefer to try to make some time later during the day, rather than squeezing you in immediately. Some offices may prefer to direct you to an ER or a plastic surgeon for the stitches, so calling ahead may save you a trip.

If you are not sure whether or not stitches are needed, here are some guidelines:

*Check to see if the cut is gaping open. If it is not, then gently tug on it to see if it gapes open. If it does, than it probably will need to be closed.
*Any cut that is gaping open with visible dark red muscle or yellowish fat should probably be closed, even if it is small.
*Any cut that is gaping and is larger than ½ cm (or 3/16 of an inch) should probably be closed. Get a ruler and measure it if you are not sure. Cuts smaller than this may not require closure, but if they are gaping, than it is best to have a doctor check out the cut.
Small cuts that are not gaping may not require actual stitches, but may still benefit from steri-strips (see below)
*Any cut, even a small one, that is gaping open on the face should be seen by a doctor because of the risk of a scar.

There are two main reasons to get stitches:1. To stop active bleeding. If a cut is large and continues to bleed, then closing it is obviously beneficial. Most cuts, however, will stop bleeding after a while if pressure is applied with a towel or cloth.2. For cosmetic reasons. Cuts on the face obviously will have a better cosmetic outcome if they are closed. However, for a small cut on a body part where you are not concerned about a scar, then closing it is not as important. Decide if the trauma of doing stitches will be worth it.

HOW SOON YOU NEED TO SEE A DOCTOR FOR STITCHES?
Most cuts can generally be closed as long as 24 hours after the accident. Some cuts should be closed sooner, but it is very safe to wait at least 8 hours to have a cut closed. Therefore, if the cut occurs at night, it is generally ok to wait until the next morning, as long as you can get the bleeding to stop. Very important – if you do decide to wait, wash the cut under the faucet to get out any dirt. Do not let the cut dry out. The best thing to do is to buy a bottle of sterile saline and some gauze. Wet the gauze and tape it over the cut. Change this every two hours to keep it moist. If you cannot do this, then put some antibiotic ointment on the cut and cover it with gauze or a band-aid. Repeat this every few hours to keep it moist. Stitches generally don’t require urgent care.

FOUR OPTIONS FOR CLOSING A CUT
There are four ways to close a cut. Your doctor will discuss these options with you:

1. Steri-strips. Also known as “butterfly” strips, these narrow strips are placed over the cut, with a bit of tension to keep it closed. A sticky liquid is placed on the skin to hold the strips on. These generally stay on for 2 to 5 days if kept dry and not accidentally pulled off. These are used for cuts that are small, not gaping open, not very deep and not over a joint or area of skin tension. If they stay in place for at least three days, the outcome can be just as good as stitches or even better because steri-strips avoid the “railroad track” appearance of some stitch lines. A big advantage is that they are quick and painless. A disadvantage is that they are not as strong and will not stay in place as long as stitches.

2. Stitches. These have the advantage of providing more strength and little to no risk of being pulled off too soon. An obvious disadvantage is the time and pain involved in putting them in.

3. Skin super glue. This is a skin glue that is applied by rubbing it over the cut while the cut is being held closed. It has the advantage of being quick and painless. It is a good choice for clean, straight cuts that are not gaping too much nor under tension. If you are hesitant to put your child through the trauma of stitches, but steri-strips are not enough, then this may be an option. If done well, the cosmetic outcome is the same as stitches.

4. Staples. These are often used in the scalp (within the hair). They are very fast, and close the cut almost as well as stitches.

WHO SHOULD DO THE STITCHES? A PLASTIC SURGEON, THE PEDIATRICIAN, OR AN ER DOCTOR?
No matter who does the stitches, there will be at least a slight scar. Even the best plastic surgeon in the world will leave a scar. It is, however, important to minimize the scar. Parents are naturally worried about this. Here are some suggestions on deciding where to have the stitches done.

*Plastic surgeon. The most common reason to use a plastic surgeon is for cuts on the face. An ER doctor or pediatrician could easily handle very small cuts on the face, but a plastic surgeon will be most able to minimize the scar. You can have the stitches done in the surgeon’s office or in an ER by the surgeon.
*ER doctors have the advantage over pediatricians of doing stitches more often. They often put in stitches several times a day. This allows an ER physician to become quite skilled in stitches.
*Your pediatrician. For simple cuts anywhere besides the face, your pediatrician is probably the best place to go for the stitches, unless the office is very busy that day. Remember, there will be a scar no matter who does the stitches. Your pediatrician will do an excellent job in minimizing the scar.

HOW DO YOU TAKE CARE OF THE WOUND AFTER IT IS CLOSED?
Ask your doctor for some specific guidelines on proper wound care. Here are some general guidelines to follow:

*For 24 to 48 hours, do not allow it to get wet in the bath or shower.
*After 48 hours, it is ok to get the wound wet.
*Steri-strips are an exception. Keep them dry for at least 5 days. After that, they have been on long enough and you may get them wet to encourage them to come off. Do not pull them off unless they come off easily.
*Avoid the build-up of a scab. A thick scab within the wound can increase the scar and prevent the skin from growing together well. You can prevent scab build-up by dabbing diluted peroxide (½ water mixed with ½ peroxide) to the wound and then gently removing any loose scab. Do not pick away any scab that is still firmly stuck. Wait for it to loosen up from the peroxide. Do this twice a day.
*Apply antibiotic ointment twice a day.
*Keep the wound covered for at least 48 hours. You can continue to cover it if it is convenient to do so for several more days.
WHAT CAN YOU DO FOR THE LONG-TERM TO MINIMIZE THE SCAR?
*Sun protection. Damaged skin is very susceptible to becoming permanently discolored by the sun for up to 6 months following an injury. It is very important to minimize sun exposure to the healing cut. Keep it covered with a hat or clothing as much as possible. When necessary (especially for long days at the park, beach, or swimming pool), apply a strong sunscreen or even a sun block (the white stuff that doesn’t soak in). Do not apply sunscreen until two weeks after the cut.
*Flax seed oil. This is an oil you can buy in a nutrition store. It contains all the essential fats that are necessary for skin to grow and heal itself. It is not proven that this actually helps for sure, but theoretically it will. It is very healthy to take anyway, even without a wound. Give 1 tsp each day for infants, and 2 tsp for children mixed in a smoothie. Do not apply the oil to the skin; it needs to work internally.
*Vitamin E oil. You can rub this oil onto the cut after the stitches are removed. There is not a definite proven benefit, but it may help the healing.

WHEN DO YOU GET THE  STITCHES   REMOVED?
*Face. These should be removed in 3 to 5 days. Why so soon? Because by five days the stitch thread starts to react with the skin and this can leave a mark for each stitch. If the stitches are not turning red where they enter the skin, then it is best to wait the full 5 days. If a stitch reaction is occurring sooner, then see your doctor before 5 days to consider having them removed. Your doctor may put steri-strips over the cut to provide a few more days of strength. Do not wait more than 5 days.
*Body and scalp. (within the hair) 7 to 10 days.
*Extremities. 10 to 14 days. If the stitches are done over a joint area that bends and stretches, then you should wait 14 days. If not, then 10 days is enough.
Ask the doctor who puts in the stitches when they should be removed.

HOW CAN YOU TELL WHEN IT’S GETTING INFECTED?
Over the first few days it is normal for the skin around cuts and scrapes to turn slightly red. If the redness continues to spread, your child develops a fever, or you see a foul- smelling greenish discharge from the wound, see or call your doctor. Your child may need an antibiotic by mouth. It is generally not necessary to page the doctor overnight for this. It can wait until morning.

SCRAPES (ABRASIONS)
Although scrapes are generally minor and do not warrant a trip to the doctor’s office, large scrapes can leave a permanent discoloration to the skin if not properly cared for. Here are some guidelines to follow to help you properly care for scrapes.

*Wash off the scrape as soon as possible with soap and warm water. Rinse or gently wipe away any dirt.
*See your doctor if there is any dirt or gravel stuck in the scrape that you can’t remove.
*Do not let the scrape dry out and form a scab. A thick scab may lead to permanent discoloration.
*Follow these steps twice a day until the scrape is healed:

#Wash with warm water under a faucet to rinse away debris and germs. Dab it dry
#Apply a diluted peroxide solution (½ water mixed with ½ peroxide) and let it sit for two minutes.
#Dab or wipe away any scab what has accumulated.
#Rinse away the peroxide.
#Apply an antibiotic ointment. See antibiotic ointment
#For large scrapes, instead of an antibiotic ointment, call your doctor for a prescription cream called Silvadene. It is used for burns, but also works well on large scrapes. Do not page your doctor after hours for this cream. You can use antibiotic ointment for a day until you can get the cream. This cream contains silver, so it may form a “tarnished” black color on the bandages.
#Apply a non-stick gauze pad over the cream or ointment. One brand name is called Telfa, but you can use any non-stick gauze.
#Tape or wrap gauze over this pad.
#For small scrapes, you do not need to meticulously follow all these steps. Simply use the peroxide and an antibiotic ointment, and try to prevent a scab from forming.
#Sun protection is very important. See the section above under long-term steps to minimize the scar.
#You can stop putting on the cream and dressing once the scrape has healed to a light pink color, with no more red, sore areas.
#Watch for infection according to the guidelines above.

You may click to see :
*How to Stop a Bleeding Cut…
*Home Remedy for Bleeding ….
*First Aid: Cuts, Scrapes and Stitches….

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/cuts2.shtml
http://kidshealth.org/parent/firstaid_safe/emergencies/bleeding.html
http://www.lpch.org/healthLibrary/ParentCareTopics/skininjurycutsscrapesbruises.html
http://www.askdrsears.com/html/8/t085600.asp

http://odlarmed.com/?cat=62&paged=2
http://www.formulamedical.com/Topics/Symptoms/Bleeding%20external.htm

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Statins May Raise Stroke Risk in Some

People who have had a type of stroke caused by bleeding in the brain should avoid taking cholesterol-lowering drugs known as statins, U.S. researchers said
. The drugs increase the risk of a second stroke in these patients.

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It was especially true of people who had strokes in one of their brain’s four lobes, which have a greater chance of recurrence than strokes that occur deep in the brain.

People who have a stroke in one of their lobes have a 22 percent risk of a second stroke when they take statins, compared with a 14 percent risk among those not taking a statin.

According to Reuters:
“The researchers said it is not clear how statins increase the bleeding risk in these patients. It may be having low cholesterol increases the risk of bleeding in the brain, or it may be that statins affect clotting factors in the blood that increase the risk of a brain hemorrhage in these patients.”


Resources:

Reuters January 10, 2011
Archives of Neurology January 10, 2011

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