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Palmar hyperhidrosis

Description:
Palmer hyperhidrosis is profuse perspiration (excessive sweating) of the palms.It is one form of focal hyperhidrosis, meaning profuse perspiration affecting one area of the body. Sweaty palms may be accompanied by profuse perspiration of the feet, forehead, ckeeks, armpits (axillae) or be part of general hyperhidrosis (profuse perspiration throughout the body). Hyperhidrosis refers to profuse perspiration beyond the body’s thermoregulatory (temperature control) needs.

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Palmer  hyperhidrosis is a common condition in which the eccrine (sweat) glands of the palms and soles secrete inappropriately large quantities of sweat. The condition may become socially and professionally debilitating. The condition usually is idiopathic  and  it begins in childhood and frequently runs in families.

Symptoms:
The intensity of symptoms may vary among sufferers and trigger factors should be carefully noted. Common symptoms  are :

*Perspiration of the hands can vary from mild clamminess to severe perspiration resulting in dripping sweat.
*Temperature differences of palmar surface compared to surface temperature of other parts of the body may be noted.
*Sloughing (peeling) of skin may be noted in profuse perspiration.
*Episodes of profuse perspiration may be followed by periods of extreme dryness on the palmar surface.
*Hyperhidrosis often starts in puberty, and family history is often reported.

The secondary effects of palmar hyperhidrosis can result in both psychosocial effects as well as difficulty in undertaking certain tasks or handling equipment. Sufferers of palmar hyperhidrosis are often reluctant to partake in socially expected actions like shaking hands or touching loved ones. The embarrassment of dealing with this condition can affect the level of interactivity in both social and work situations. Difficulties with holding objects, gripping equipment or soiling electronic devices like keyboards may affect functioning at work. Daily activities such as writing with a pen or counting cash notes is often difficult.

Causes:
Hyperhidrosis is either primary focal or secondary generalized.

1. Primary Palmar  Hyperhidrosis

Focal palmar hyperhidrosis is usually localized and is referred to as primary (essential, idiopathic), meaning no obvious cause, except strong family predisposition can be found (4,5), and affected persons are otherwise healthy . Sweating on other locations as feet, armpits and face may appear. Primary palmar hyperhidrosis is caused by overactivity of the sympathetic nervous system, primarily triggered by emotional causes including anxiety, nervousness, anger and fear .

There may be a significant reduction in perspiration during sleep or sedation.

2. Secondary Palmar Hyperhidrosis

In secondary palmar hyperhidrosis hands sweat due to an obvious underlying disorder like:

*Infections including local infections, tuberculosis and tinea ugunium.
*Neurological disorders like peripheral autonomic neuropathy
*Frostbite
*Arteriovenous Fistulas
*Acromegaly
*Acrodynia
*Complex Regional Pain Syndromes
*Pachyonychia Congenita
*Primary Hypertrophic osteoarthropathy
*Dyskeratosis Congenita
*Blue rubber-bleb nevus
*Glomus tumor

*Secondary palmar hyperhidrosis as part of generalized hyperhidrosis due to  several  hormonal causes (diabetes, hyperthyroidism, thyrotoxicosis, menstruation, menopause), metabolic disorders, malignant disease (lymphoma, pheochromocitoma), autoimmune disorders (rheumatoid arthritis, systemic lupus erythrematosus), drugs like hypertensive drugs and certain classes of antidepressants (list of medications causing hyperhidrosis), chronic use of alcohol, Parkinson’s disease, neurological disorders (toxic neuropathy), homocystinuria, plasma cell disorders. Detailed list of conditions causing generalyzed hyperhidrosis.

How Sweat Glands Work:
In eccrine glands, the major substance enabling impulse conduction is acetylcholine, and in apocrine glands, they are catecholamines.

Body temperature is controlled by the thermoregulatory center in the hypothalamus and this is influenced not only by  by core body temperature but also by hormones, pyrogens, exercise and emotions.

Diagnosis:
The first step in diagnosing  the  Palmar  hyperhidrosis is to differentiate between generalized and focal hyperhidrosis.

A thorough case taking and medical history is usually sufficient to diagnose palmar hyperhidrosis and any trigger factors (scheduled drugs, narcotics, chronic alcoholism).

Diagnostic criteria for primary focal (including palmar) hyperhidrosis  are:

*Bilateral and relatively symmetric sweating
*Frequency of at least 1 episode per week
*Impairment of daily activities
*Age at onset before 25 years
*Family history
*Cessation of sweating during sleep

Tests may include:
*Hematological studies may be necessary to identify thyroid disorders (thyroid function test for T3 and T4 as well as thyroid antibodies) and diabetes (fasting blood glucose or a glucose tolerance test).

*X-rays and MRI scans will assist for diagnosing tuberculosis, pneumonia and tumors.

*Superficial electroconductivity can be monitored as any hyperhidrosis reduces skin electrical resistance.

*Thermoregulatory sweat test uses moisture-sensitive indicator powder to monitor moisture. Changes in the color of the powder at room temperature will highlight areas of increased perspiration.

Treatment:
Conservative management should be coupled with prescribed treatment by the Doctor to reduce the symptoms.

*Counseling may be effective in managing primary palmar hyperhidrosis in cases of mental-emotional etiology.

*Trigger foods and aggravating factors should be noted if possible and relevant dietary changes should be implemented.

*Effective prevention of secondary palmar hyperhidrosis is difficult with conservative management and drug therapy or surgery may be required.

*Excessive physical activity and extremes of heat may be two trigger factors that should be avoided as far as possible.

*In cases of diabetes, a glucose controlled diet with low glycemic index may improve glucose tolerance which could assist with palmar hyperhidrosis.

*Abstinence from alcohol and narcotics is advisable if it is the causative factor for sweaty palms.

*Stimulants such as caffeine and nicotine may aggravate palmar hypehidrosis and should relevant dietary and lifestyle changes should be implemented.

*Anti-perspirant compounds like aluminum chloride can be applied on the palms to reduce moisture or palmar surfaces. Recent research on an aluminum sesquichlorohydrate foam has shown that it is effective in reducing sweat in palmar hyperhidrosis

Treatment remains a challenge: options include topical and systemic agents, iontophoresis, and botulinum toxin type A injections, with surgical sympathectomy as a last resort. None of the treatments is without limitations or associated complications. Topical aluminum chloride hexahydrate therapy and iontophoresis are simple, safe, and inexpensive therapies; however, continuous application is required because results are often short-lived, and they may be insufficient. Systemic agents such as anticholinergic drugs are tolerated poorly at the dosages required for efficacy and usually are not an option because of their associated toxicity. While botulinum toxin can be used in treatment-resistant cases, numerous painful injections are required, and effects are limited to a few months.

Standard therapeutic protocol may differ among cases of palmar hyperhidrosis depending on medical history and underlying pathology.

*Anticholinergic drugs have a direct effect on the sympathetic nervous system although there are numerous side effects.

*Treatment should be directed at contributing factors.

*Ionophoresis involves the use of electrotherapeutic measures to reduce the activity of sweat glands.

*Botulinum injections at the affected area may be useful for its anticholinergic effects.

*Surgery should be considered if drug therapy proves ineffective. Endoscopic transthoracic sympathectomy involves resection of the sympathetic nerve supply to the affected area. This prevents nerve stimulation of the sweat gland of the palms. However surgery has a host of complications including exacerbating the problem or increasing generalized hyperhidrosis.

Surgical sympathectomy should be reserved for the most severe cases and should be performed only after all other treatments have failed. Although the safety and reliability of treatments for palmoplantar hyperhidrosis have improved dramatically, side effects and compensatory sweating are still common, potentially severe problems.

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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.aafp.org/afp/2004/0301/p1117.html

Causes and Treatment of Palmar Hyperhidrosis – Sweaty Palms/Hands

Fluctuating BP ‘Warning Sign for Stroke’


People with occasionally high blood pressure are more at risk of stroke than those with consistently high readings, research suggests.

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Current guidelines focus on measuring average blood pressure levels to spot and prevent the chance of a stroke.

But research suggests doctors should no longer ignore variation in test results and give drugs that produce the most steady blood pressure levels.

The Stroke Association called for national guidelines to be overhauled.

In the first of the series of studies published in The Lancet, UK and Swedish researchers looked at the variability in blood pressure readings at doctors’ checks.

They found those with fluctuating readings at different GP visits had the greatest risk of future stroke regardless of what their average blood pressure reading was.

A review of previous trials also found that the differences in effectiveness of several blood pressure drugs could be explained by how well they kept blood pressure on an even keel.

Some drugs, in particular beta blockers, were shown in a separate study in The Lancet Neurology, to increase variation in a patient’s blood pressure.

‘Major implications’

Professor Peter Rothwell of the Department of Clinical Neurology at the University of Oxford, who led the research, said the findings have major implications for how GPs spot and treat people at high risk of stroke.

“At the moment, the guidelines for GPs say not to believe a one-off unusual reading, to bring the patient back and measure again, and as long as it’s not consistently high, there is no need to treat.

“What we’re saying is don’t discount that one-off high blood pressure reading.”

He added that GPs would also need to make sure they prescribe the most effective drug combinations – ideally one that lowers blood pressure but also stabilises it.

It is not know exactly why occasional spikes would increase a person’s risk of stroke but it is thought it puts undue stress on the system.

If you get rapid fluctuations that can cause turbulent flow of blood which can cause damage and stiffening in the arteries,” said Professor Rothwell.

He said anyone with high blood pressure who tests themselves at home might want to mention to their GP if they spot variations in their results.

The National Institute for Health and Clinical Excellence‘s guidelines on high blood pressure is in the process of being rewritten and these latest studies will be taken into account.

Joe Korner, director of communications at The Stroke Association said people who have occasional high blood pressure readings – known as episodic hypertension – are often not treated.

“With this new research it is now important that the clinical guidelines about treating high blood pressure are reviewed.

“In the meantime we urge GPs to read this research to help them prescribe the best treatment for people at risk of stroke.”

Experts stressed that those already prescribed medication for high blood pressure should not worry or stop taking their pills.

Professor Peter Weissberg, medical director at the British Heart Foundation said: “Current practice is not wrong, but this might add a new measure to help doctors make decisions on who to treat for hypertension and which drug to use.”

Source : BBC News:12th.March.2010

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Being Gay is Natural

Homosexuality is widespread in several species, ranging from worms to insects, birds to dolphins, sheep to reptiles. What is more, it serves a purpose:-

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Biologist Nathan Bailey’s recent scientific conclusions may be a shocker for the religious leaders or self-professed moral guardians who are indignant at the recent Delhi High Court ruling decriminalising sexual intimacy between same sex individuals in India.

While some argue that homosexual behaviour is “deviant” or “unnatural”, Bailey, a professor of evolutionary biology at the University of California, Riverside, has amassed scientific evidence that it might be as ubiquitous as life itself.

Bailey and colleague Marlene Zuk, who co-authored the study, collected several past research studies that reveal same sex behaviour — males having sex with males, females with females — in diverse species, from worms to insects, birds to dolphins, sheep to reptiles. While some of them are mere flings, others lead to lifelong relationships. Their study shows that it serves a purpose.

The study, which recently appeared in the journal Trends in Ecology and Evolution, has listed as many as 14 animal species that exhibit homosexual tendencies. “It is by no means an exhaustive list, but it provides a starting point for those interested in obtaining further information and examples,” they say.

The variety and ubiquity of same sex sexual behaviour in animals is impressive. They found thousands of instances of same sex courtship, pair bonding and copulation in a wide range of species.

Domestic sheep exhibit it. Birds like the laysan albatross and zebra finch indulge in it. So do bonobo monkeys, chinstrap penguins, bottlenose dolphins and garter snakes. Behavioural biologists have recorded male-male pairing among insects like the flour beetle and African bat bug too.

In the past, researchers, investigating whether gay sex is genetically encoded, found that tweaking certain genes can turn fruit flies and roundworms into homosexuals.

The attempts to find a genetic link to homosexuality have a strong Indian connection. The first-ever such gene manipulation study was conducted by an Indian scientist Kulbir Singh Gill who was a visiting researcher at Yale University in the 1960s. Gill, while studying the genetic causes of female sterility, almost serendipitously found in 1963 that male flies lacking a gene — later named fruitless gene — court other males. Gill’s pioneering work opened the floodgates and many other scientists subsequently discovered several other genes whose manipulation yields varying types and degrees of male-male courtship in fruit flies.

“Same sex sexual behaviour has long been viewed as a fascinating puzzle from the evolutionary perspective. The most obvious mystery is why animals would engage in sexual behaviour that does not directly result in reproduction,” says Bailey who, along with Zuk, seeks to understand the significance of such acts in the evolution of species.

Interestingly, a closer examination by them led to several significant conclusions. Some species use same sex pairings as a social glue for bonding (bottlenose dolphins), while for others (the bonobos, dung flies) it is a tool to resolve intra-sexual conflicts. In certain other species like fruit flies, immature individuals use them as an opportunity for practice, but for flour beetles it is a ploy for indirect insemination. More often than not, male members among the beetles use same sex copulation to deposit sperm in other males, which then transfer it to females during subsequent opposite sex mating.

“The secret of the peaceful bonobo society appears to rest with their sexual behaviour; in their society sex is used to solve conflicts,” writes Morten Kringelbach, psychiatrist at the University of Oxford, in his recent book The Pleasure Center.

The authors of the new study think that there may be many more animal species indulging in homosexual behaviour. It is difficult to know their sexual orientation, as there are no means of knowing what their ‘desire’ is. “We can only observe what they do,” they say.

Qazi Rahman of Queen Mary, University of London, who has been studying homosexuality in humans, says genes responsible for such behaviour have a significant role in evolution. One reason nature keeps these genes intact — although they have no role in reproduction — is that they confer certain other traits. A certain dosage of gay genes is found to be beneficial even in heterosexual people because they might express traits that are more attractive to the opposite sex — like kindness, parental skills and co-operative traits. But a higher dosage of these genes leads to homosexuality, he adds.

“Evolution keeps genes for homosexuality intact because they benefit heterosexual carriers of those same genes,” Rahman, a scientist of Pakistani descent, told KnowHow. For instance, a study by Rahman and others, which appeared in the Journal of Sexual Archives last year, showed that gay men may tend to come from larger families with more fertile females. In other words, the females in gay men’s families “outreproduce” those in heterosexual men’s families.

Kringelbach says homosexual behaviour is a natural phenomenon in all human societies. Quoting American sex researcher Alfred C Kinsey, who studied in the 1940s and 1950s sexual habits, he says 37 per cent of all men have homosexual experiences, 10 per cent have homosexual relationships lasting longer than three years, and 4 per cent are exclusively homosexual throughout life. “The exact numbers have been disputed but it remains a fact that all serious sex studies have found that homosexuality is naturally occurring among both men and women,” Kringelbach told KnowHow.

Bailey hopes that scientific contributions from animal studies will shed more light than heat on the topic of same sex sexual behaviour.

Source: The Telegraph (Kolkata, India)

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Going gray? Hair ‘Bleaches Itself as People Age’

Why people turn gray is no longer a gray area, for scientists have finally solved the mystery by discovering that hair bleaches itself as  people age.

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A team in Europe has found that going gray is caused by a massive build up of hydrogen peroxide due to wear and tear of our hair follicles. The peroxide winds up blocking the normal synthesis of melanin, our hair’s natural pigment.

According to Gerald Weissmann, the Editor-in-Chief of the ‘FASEB Journal‘, which published the study, “All of our hair cells make a tiny bit of hydrogen peroxide, but as we get older, this little bit becomes a lot.

“We bleach our hair pigment from within, and our hair turns gray and then white. This research, however, is an important first step to get at the root of the problem, so to speak.”

In fact, the scientists made this discovery by examining cell cultures of human hair follicles. They found the build up of hydrogen peroxide was caused by a reduction of an enzyme that breaks up hydrogen peroxide into water and oxygen (catalase).

They also discovered that hair follicles could not repair the damage caused by the hydrogen peroxide because of low levels of enzymes that normally serve this function (MSR A and B).

Sources: The Times Of India

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Psychotherapy for Eating Disorders

Researchers have developed a new form of psychotherapy that is effective in most cases of eating disorders in adults.

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“Eating disorders are serious mental health problems and can be very distressing for both patients and their families,” said Christopher Fairburn, professor and principal research fellow at the University of Oxford.

“Now for the first time, we have a single treatment which can be effective in treating the majority of cases without the need for patients to be admitted to hospital,” added Fairburn, who led the study.

These disorders are a major cause of physical and psycho-social impairment in young women, affecting at least one in 20 between the ages of 18 and 30. Eating disorders are less common in young men.

Three eating disorders are recognised: anorexia nervosa, (hunger signals are ignored to control the desire to eat), accounting for 10% cases in adults; bulimia nervosa, (repeated binge eating) which accounts for a third of all cases; and the remainder are classed as atypical eating disorders, which account for over half of all cases.

In these atypical cases, the features of anorexia nervosa and bulimia nervosa are combined in a different way, according to an Oxford release.

These disorders vary in their severity, but typically involve extreme and relentless dieting, self-induced vomiting or laxative misuse, binge eating, driven exercising and in some cases marked weight loss.

Common associated features are depression, social withdrawal, perfectionism and low self-esteem. The disorders tend to run a chronic course and are notoriously difficult to treat. Relapse is common.

This new “enhanced” form of cognitive behavioural therapy (CBT-E) improves the current leading treatment for bulimia nervosa as recommended by the National Institute of Health and Clinical Excellence (NICE).

CBT-E is the first treatment to be shown to be suitable for the majority of cases of eating disorders. This new treatment derives from an earlier form of CBT. Both were developed exclusively for patients with Bulimia Nervosa by Fairburn.

Sources:The American Journal of Psychiatry

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