What is Cerebral edema ?

Cerebral edema is the swelling of the brain caused by excessive amount of cerebrospinal fluid in the spaces of the brain. Cerebral edema is a health condition that warrants immediate action.

If medical intervention is not given right away, it could lead to brain damage and even death. Cerebral edema is categorized into various types. They are the following:

Vasogenic cerebral edema

What is vasogenic edema? It is caused by increased permeability of the cerebral capillaries endothelium to plasma proteins such as albumin. It is caused by breakdown of the blood-brain barrier. The proteins and fluids get into the extracellular space leading to swelling of the brain. Conditions leading to vasogenic cerebral edema include head trauma, ischemia, hypertension, and tumor. ^{(1, 2, 3)}

Cytotoxic cerebral edema

What is cytotoxic edema? It is caused by exhaustion of the cell membranes, but without causing any damage to the barrier. The blood brain barrier is intact. However, the abnormal level of potassium and sodium in the membrane would lead to sodium and water retention.

Hydrostatic cerebral edema

It is caused by disturbance of the auto-regulation of the cerebral blood circulation.

Osmotic cerebral edema

It is caused by dilution of blood. It causes abnormal pressure creeping into the brain, which allows water to flow in. it is common in people with hyponatremia and hemodialysis. ^{(3, 4)}

Interstitial cerebral edema

It is caused by acute hydrocephaly (water on the brain). The cerebrospinal fluid brain barrier ruptures.

Diffuse brain edema

What is diffuse brain edema? It is a result of head trauma, anoxia, malignant hypertension, and high altitude. ⁽⁴⁾

Image 1: A radiologic study of patients with cerebral edema.
Picture Source: i.ytimg.com

Picture 2: An image showing the normal structure of the brain.
Photo Source: study.com

Cerebral Edema Causes

• Severe trauma to the head such as after a heavy fall or a car accident.
• Stroke (clotting of blood hinders the oxygen to reach the brain).
• Brain haemorrhage causing increased pressure in the skull. Haemorrhage in the brain can be caused by high blood pressure, injury to the head, malformation of the blood vessel in the brain, or side effects of medications.
• Infection affecting the brain such as encephalitis and meningitis.
• Brain tumor
• Infectious diseases like mumps, malaria, Kawasaki disease, and typhus. ^{(4, 5, 6, 7)}

Signs and Symptoms

What happens if your brain swells? There will be a significant change in the patient’s consciousness level. Other notable signs include the following:

• Nausea
• Confusion
• Numbness
• Lack of coordination
• Dizziness
• Headache
• Vomiting
• Neck stiffness
• Changes in the breathing pattern
• Difficulty walking and talking
• Seizures
• Memory loss
  Stupor – near consciousness or insensibility (5, 7)

Cerebral Edema Diagnosis

If a person is experiencing any of the aforementioned symptoms, the doctor will immediately assess the extent of the symptoms. He will also perform diagnostic procedures and lab works such as CT scan, MRI, and neurologic examination.

The doctor will conduct a thorough examination of the head and neck. Blood works are needed to thoroughly identify the root cause of swelling. (8)

Treatment guidelines

Cerebral edema treatment varies depending on the root cause of the problem. Usually, minor cases of cerebral edema such as the ones caused by slight concussion and altitude sickness resolve in just a few days. Cerebral edema management focuses on ensuring that the brain will receive ample amount of blood and oxygen while the treatment is going on.

Brain swelling after head injury will subside if it receives a combination of medical and surgical intervention. Brain swelling recovery is high if the patient receives the necessary treatment right away. Not receiving prompt treatment could lead to brain damage. The treatment approach includes the following: ^{(7, 8, 9)}

• Oxygen therapy – The patient is put on a respirator or other breathing apparatus to make sure that the blood is receiving enough oxygen. The respirator is adjust into its therapeutic level to make sure that the swelling in the brain subsides.
• Hyperventilation – Controlled Hyperventilation can help in reducing the reducing intra cranial pressure.
• IV fluids – Intravenous fluid along with medications given via IV route will help normalize the blood pressure level. However, the right amount of fluid should be regulated by the doctor to make sure that the brain swelling will not get worst.
• Altering the body’s temperature – Swelling of the brain can be relieved by lowering the body’s temperature. This hypothermic approach to cerebral edema is difficult to perform, but is highly therapeutic when done correctly.
• Medication – The doctor will thoroughly assess the inflammation in the brain. He will prescribe drugs to alleviate the swelling. Some medications help to slow down the body’s response to swelling as well as dissolve clots. To get rid of the excess fluid in the brain, osmotic diuretics are used. An example of osmotic diuretic is mannitol.
• Surgical approach – The purpose of the surgery is to remove a part of the skull so as to relieve intracranial pressure. The surgery will help remove the swelling in the brain and repair any damaged veins and arteries. If the edema is caused by tumor, the growth is removed surgically.

It is important to determine the root cause of cerebral edema. If the root cause is not treated, then there is a high possibility that the problem will happen over and over again. ^{(5, 8, 9, 10)}

Cerebral Edema in DKA

Diabetic ketoacidosis is a serious disease. Cerebral edema is DKA’s life threatening complication. In fact, it is one of the causes of diabetes-related deaths in children. The edema occurs a few hours of treatment with IV fluids and insulin.

Cerebral edema takes place because of the severity of dehydration, acidosis, and hypocapnia (reduced carbon dioxide in the blood) at the presentation of diabetic ketoacidosis. ⁽¹⁰⁾

How to reduce brain swelling naturally?

Positioning

Positioning is important in people with cerebral edema. The head of the patient should be elevated. However, if the patient is suffering from stroke, head elevation is discouraged because a reduced blood flow into the brain could worsen the condition of the patient.

Through proper positioning, excess blood and fluid in the brain will be drained out using the force of the gravity. ⁽⁵⁾

Sleep and relaxation

Make sure you get ample sleep at night. Find some time to relax. Mental and emotional stress should be managed in a healthy way. ⁽⁵⁾

References:

1. www.sciencedirect.com
2. www.livestrong.com
3. www.healthgrades.com
4. https://en.wikipedia.org
5. www.medscape.com
6. www.webmd.com
7. www.ncbi.nlm.nih.gov
8. www.medicalook.com
9. www.epainassist.com
10. Treatment of Cerebral Edema Mario Brock, Alexander Hartmann

What is Gingival hyperplasia ?

It is an abnormal growth of the gingival tissues. It can be caused by various reasons. To come up with proper care and treatment, the root cause of the problem should be established. ⁽¹⁾

Symptoms

• There is a noticeable inflammation and tenderness in the affected area.
• There is a possibility of gum bleeding.
• Plaques are built on the teeth causing them to push into the gums.
• In severe cases, the gum overgrows leading the gums to cover the teeth.
• The gums are swollen and firm to touch.
• The commonly affected areas are the labial gingival mucosa and interdental spaces. ^{(2, 3, 6)}

Gingival Enlargement Classification

• Localized – The symptom is limited to the gingiva in relation to a tooth or group of teeth.
• Generalized – It involves the gingiva throughout the mouth.
• Marginal – The problem is only limited to the margin of the gingiva.
• Diffuse – The problem includes the margin of the gingiva as well as the gingival mucosa and mucobuccal fold. ^{(4, 5, 6)}

Image 1: An image of a patient suffering from severe form of gingival hyperplasia
Picture Source: mddk.com

Image 2: A before and after image of a patient with gingival hyperplasia who underwent gingivectomy
Picture Source: ehealthhall.com

Causes of gingival hyperplasia

1. Drug induced gingival hyperplasia – Some medications can cause gingival hyperplasia. The gum tissues are firm, pale pink in color, and non-tender. The tissues do not bleed that easily. In severe cases, the gingiva can entirely cover the crown of the teeth, which leads to periodontal disease. It can also lead to tooth eruption and problems in the alignment of the teeth. For the condition to subside, the drug causing gingival hyperplasia should be stopped. Examples of drug inducing gingival hyperplasia are calcium channel blocker like nifedipine (cardiovascular drug), phenytoin (anticonvulsant drug), and cyclosporine (immunosuppressant drug). ^{(6, 10)}
2. Hereditary gingival fibromatosis – It is a rare condition that usually develops during childhood. It is characterized by slow growing enlargement of the gingiva. The gingiva is pale pink, firm, and non-tender. In some cases, the symptoms are not obvious until the patient reaches adulthood.
3. Systemic cause – Some systemic and physical conditions can cause localized and generalized enlargement of the gingiva. Examples are hormonal imbalances, pregnancy, and leukemia.

What you should do if your gums are enlarged?

If you notice that your gums are more than their usual size, then the best thing to do is to set an appointment with your dentist. This is to thoroughly evaluate the condition of your teeth and gums. The dentist will conduct a thorough dental check-up and will take out your past medical history to detect any previous conditions that can trigger gingival hyperplasia.

In severe cases, blood work and biopsy are needed to find out the root cause of the enlargement of the gingiva. Is gingival hyperplasia contagious? Fortunately, it is not a contagious disease. You cannot acquire it from anyone else and you cannot pass it to someone else. ^{(5, 8, 9)}

What are the consequences of gingival hyperplasia?

Enlargement of the gingiva can be very unsightly. Nobody wants to have protruding gums. The primary issue is aesthetic, but along with enlargement of the gums comes other problems such as inflammation and bleeding. If the condition is not treated right away, the surrounding structures will be severely affected, especially the teeth and the bones.

An enlarged gingiva can trap tartar, bacteria, and other substances that can irritate the gum tissues. It can accelerate tooth decay and can cause further irritation, swelling, and infection. ^{(5, 8, 9)}

Diagnosis and Treatment

It is important to come up with proper diagnosis. If the doctor is suspecting a pathologic condition, a biopsy should be ordered. If it came out to be gingival inflammation, the doctor will do the best he can to improve the oral hygiene of the patient.

A periodontal therapy is all that it takes to correct the problem. If the enlargement of the gingiva is caused by medication, the doctor will stop the administration of the drugs and change it to something that will limit the growth of the gingiva. Additional treatment might be needed to totally reverse the overgrowth of gingiva. ^{(4, 5)}

Surgical approach

If the enlargement of the gingiva is not managed using conservative approach, the best option is to surgically remove it. The overgrowth is removed using a scalpel or laser. The surgery may need to be performed numerous times, especially if the enlargement of the gingiva recurs.

A pressure device that looks like a mouth guard can also be used at night to somehow limit the growth of tissues. The patient is strongly advised to visit the dentist regularly to prevent further infection and limit the effect of inflammation on the soft tissues.

For moderate to severe enlargement of the gingiva, a procedure called gingivectomy with carbon dioxide is done. This is helpful, especially if the gingival hyperplasia does not resolve despite stopping the use of medication that causes it. A short course of antibiotic as well as proper oral hygiene do help in improving the condition of the patient.

For drug induced gingiva hyperplasia, a diode laser can help. A low level laser therapy is also helpful in the adjuvant management of gingival hyperplasia. ^{(3, 6, 7)}

How to reduce the severity of gingival hyperplasia?

• It is important to practice a good oral hygiene on a day to day basis to significantly reduce the possibility of developing gingival hyperplasia.
• The patient should undergo frequent professional cleaning and be taught on various ways to improve brushing techniques.
• For drug induced gingival hyperplasia, the doctor will change the drug so as to significantly reduce the risk of gingival hyperplasia.
• If the enlargement of the gingiva is caused by systemic condition, the underlying cause should be treated.

Gingival hyperplasia is something that should be corrected as soon as you notice it. It is not only distracting to the eyes of the people who see it, but it can also affect your self-esteem, confidence, and health as a whole. Consult your doctor right away to correct the problem while it is still in its early stage. ^{(5, 7, 8)}

References:

1. ttps://gbpdental.com
2. https://en.wikipedia.org
3. emedicine.medscape.com
4. mddk.com
5. www.dermnetnz.org
6. www.medicinenet.com
7. www.webmd.com
8. www.nature.com
9. www.pharmacytimes.com
10. Drug Induced Gingival Enlargement: A review By Rajesh Hosadurga

Pregnancy is a delicate stage for every woman. Bleeding may occur, which can be worrisome. Bleeding in any form is a big issue. A subchorionic hemorrhage or also known as subchorionic hematoma is a bleeding that occurs during pregnancy.

What is it and why do subchorionic hematomas occur?

It is the accumulation of blood within the fold of the outer fetal membrane situated right next to the placenta (chorion) or between the placenta and the uterus.

Subchorionic bleeding usually resolves on its own, but some cases require immediate medical attention, especially in women with sensitive pregnancy. About 1% of pregnant women experience subchorionic hemorrhage and most of them occur during first trimester. ^{(2, 4, 5, 6)}

Image 1: An ultrasound view of what appears to be a huge black hematoma (subchorionic hematoma) right beside the fetus.
Picture Source: www.babyq.com

Photo 2: An ultrasound view of the patient’s abdomen indicating a clot between the chorion and the amnion.
Picture Source: www.obimages.net

Subchorionic Hematoma Symptoms

• Spotting or bleeding, especially during the first trimester
• Subchorionic bleed detected during a routine ultrasound
• Most causes of subchorionic hemorrhage don’t have noticeable signs and symptoms. The patient will not notice it until the doctor performs a routine ultrasound. ^{(1, 4, 5)}

Unusual signs and symptoms that warrant immediate medical attention include the following:

• Heavy and profuse vaginal bleeding, which could lead to miscarriage, uterine rupture, the placenta separates from the uterus, a preterm labor, ectopic pregnancy, and molar pregnancy. An ectopic pregnancy means that the egg fertilizes outside the womb while a molar pregnancy pertains to a mass of tissue in the womb.
• Severe bleeding can also lead to dizziness and abdominal pain. ⁽⁵⁾

Are there any potential risk for subchorionic hematoma pregnancy?

A subchorionic hematoma bleeding usually dissolves on its own. However, a subchorionic hematoma size that is larger than usual does have a serious effect to the mother and the baby’s health. It could lead to placenta separation from the uterine wall, which will increase the chance of miscarriage and even the possibility of pre-term labor.

If you are experiencing bleeding, be it a simple spotting, you need to inform your doctor right away. ^{(7, 8)}

What causes bleeding during pregnancy?

The exact subchorionic hematoma causes are unknown, but some conditions are linked with it. These include the following:

• Fertilized egg’s separation from the uterine wall
• Trauma to the mother’s abdomen
• Side effects of medications
• Blood coagulation problem during pregnancy ^{(9, 10)}

Diagnosis and Treatment

To properly diagnose the condition of the patient, the doctor will consider the symptoms along with an ultrasound scan. Women usually complain of vaginal bleeding on the early stage of pregnancy. The doctor will order an ultrasound, either abdominal or transvaginal to have a perfect view of the location and condition of the fetus.

If you notice that you have vaginal bleeding, you need to call out for help right away. As for the preventive subchorionic hematoma treatment approach, the patient is put on a strict bed rest with no bathroom privilege. She is also strongly advised to avoid sexual intercourse until the condition heals. ^{(7, 8, 9)}

A part of the subchorionic hemorrhage treatment is taking progesterone or dydrogesterone, avoid standing for a long period of time, and avoid performing strenuous exercises. It is also important to have a religious follow up with your doctor. Prenatal care is important.

Any hematomas are not normal and so it is important for the patient to be closely monitored by a health care professional. Some physicians prescribe blood thinners to bleed the clot out. Examples of blood thinners are heparin, aspirin, Coumadin, and lovenox. To aid in the development of pregnancy, hormone therapy in the form of estrogen and progesterone are given to the patient.

Subchorionic hemorrhage miscarriage rate is 1% to 3% and they are caused by large clots. On a lighter note, most pregnancies progress with no complications at all. The hematoma bleeds itself or naturally absorb by the body. ^{(4, 5, 10)}

What to keep in mind?

• Women suffering from subchorionic hemorrhage/hematoma are at greater risk for abruption placenta (separation of the placental from the uterus). It is a dangerous situation requiring immediate medical attention. It could lead to fetal death if not addressed promptly.
• Subchorionic hemorrhage can cause miscarriage. How? The blood clot does have a possibility to release completely from the uterus causing miscarriage. ^{(2, 3)}
• An intermittent vaginal bleeding throughout the pregnancy can be experienced by women suffering from subchorionic hemorrhage. It is caused by a blood clot that is bleeding out. Aside from bleeding, the patient can also experience abdominal cramping.
• Pregnant women should take good care of themselves. It is important to drink plenty of fluids and allow yourself to rest. Do not do any activities that can contract the uterus or irritate the baby inside your womb. ^{(6, 7)}
• A lot of pregnant women are diagnosed with subchorionic hematoma. If you are one of them, then don’t be afraid because you are not alone. There are support groups all over the internet. They gather online and share their experiences. They offer hope and support to women who are going through the same dilemma.
• Be proactive in the treatment and management of your condition. If you feel like something is not right in your body, then you should not hesitate to contact your doctor.

A subchorionic hemorrhage/subchorionic hematoma is less likely harmful in the long term. However, it is important to keep you and your baby’s health monitored throughout your pregnancy. The doctor will have the best view of your hematoma via ultrasound.

The size of the subchorionic hematoma has something to do with the outcome of the treatment. Smaller hematomas have better prognosis. If the hematoma is extremely large, there is a possibility of pregnancy complications such as miscarriage and preterm labor.

The key to success is diagnosing the condition at an early stage. The earlier you seek treatment, the better the outcome. ^{(5, 7, 9, 10)}

References:

1. www.healthline.com
2. emedicine.medscape.com
3. www.newkidscenter.com
4. www.home-remedies-for-you.com
5. www.mdedge.com
6. www.momjunction.com
7. https://en.wikipedia.org
8. howshealth.com
9. www.subchorionichemorrhage.info
10. Manual of Obstetrics edited by Arthur T. Evans

Tonsils are lymph nodes located on each side of the back of the throat. They play an important role in preventing infection.

They also play a crucial role in the oral cavity and lymphatic system. Certain diseases and infections can be prevented with the help of tonsils.

However, there are instances when the tonsils become infected and irritated. An infected tonsil is medically known as tonsillitis. Some people have holes in the tonsils. It is also called crypts on the surface of the tonsils. ^{(1, 2, 12)}

During the mastication process, the foods are not all swallowed. Some of them are stuck in the holes of the tonsils or crypts. As time passes by, the food particles stuck in the crypts increases, which possess a health hazard not only to the tonsils but to the entire oral cavity. Eventually, the debris become hard as stones leading to a condition called tonsillar stones. The holes in the tonsils serve as a breeding ground for all types of organisms including disease-causing bacteria. ^{(2, 3, 4)}

The tonsils protect the sensitive tissues of the lungs and intestines from harmful substances. Tonsils are made from lymphocytes, which are cells that help fight and prevent infection. Tonsils function like nets. They trap the incoming bacteria so that they will not invade the body.

However, there are instances when tonsils can’t perform their job well. Instead of helping the body, they end up as a hindrance. That is why sometimes the tonsils are removed, especially if the patient is experiencing recurrent infection. ^{(1, 4, 6, 7)}

Image 1: A closer view of the holes in the tonsils with white spots.
Picture Source: www.healtreatcure.org

Photo 2: Outlined the different types of tonsils and their locations.
Image Source: img.tfd.com

Image 3: A comparison between a healthy tonsil and a swollen tonsil.
Photo Source: entkidsadults.com

Photo 4: Tonsils with multiple holes.
Picture Source: www.healthedition.org

Image 5: A patient with large tonsil stones.
Photo Source: i.ytimg.com

Types of tonsils

• Adenoids (pharyngeal tonsils) – It is a single tonsil found on the roof of the pharynx. Children have big adenoids but as they grow up, the adenoid tonsils become smaller until such time that it is virtually invisible. If the adenoids tonsil gets too large, it will cause chronic respiratory disorder and snoring. ⁽⁵⁾
• Tubal tonsils – a normal person has two tubal tonsils, one situated in each opening of the Eustachian tube. These tonsils are hidden deep at the back side of the oral cavity.
• Palatine tonsils – They are located at the back of the throat, one on the right side and one on the left. They are the tonsils prone to inflammation. The appearance and shape changed. They can become enlarge and there is also a possibility of holes or crypts.
• Lingual tonsils – They are located at the root of the tongue. You cannot see these tonsils in your mouth during examination in front of a mirror. ^{(2, 5)}

Causes of holes in tonsils/crypts on tonsils

1. Cancer – Patients with throat cancer usually have holes in their tonsils.
2. Strep throat – it increases the possibility of having holes in the tonsils. Strep throat is caused by Streptococcus bacteria. It gets in the throat leading to the inflammation of tonsils (tonsillitis). The throat becomes sore and eventually the patient will have white pockets on the surface of the tonsils after the infection. ^{(3, 6)}
3. Mono – It is a severe viral infection affecting the tonsils. If not treated right away could lead to holes in the tonsils. Pockets are likely to develop if the infection is recurrent.
4. Smoking – Cigarette smoking can cause holes in the tonsils, especially if there is an ongoing infection in the tonsils. Cigarette contains a lot of chemicals that can irritate the tissues in the throat. Chronic cigarette smoking will eventually lead to holes in the tonsils.
5. Holes in the tonsils with white spots and pus – if your tonsils are infected such as in the case of tonsillitis, a white pus will most likely accumulate in the holes of the tonsils. The holes will be filled with mucus, bacteria, food particles, and calcium deposit. You will also notice whitish chunks on the tonsils, especially on the surface of the tonsils and back of the throat. You will then notice tonsil stones. If the tonsils are severely affected, the patient will complain of discomfort and intense pain.
6. Scar formation – The formation of scar is a body’s healing response, especially from skin deep cut. However, scars are made from fibroblast, which looks different than that of healthy cells. If your tonsils have cut, there is a tendency of scar formation. The scarred tissues in the tonsils may form holes. ^{(2, 7, 9)}

Symptoms of tonsil stones

• Bad breath (halitosis)
• Pain when swallowing
• Recurrent infection of the tonsils (tonsillitis)
• A feeling of foreign body at the back of the throat
• Metallic aftertaste in the mouth ^{(6, 7, 8)}

How do you get rid of tonsil stones and holes in tonsils?

What is the best way to get rid of tonsil stones? What you can do to prevent holes in tonsils from getting infected? The treatment for tonsil stones primarily depends on the size of the tonsil and its possibility to create harm to the patient.

Usually, tonsil stones that are asymptomatic require no treatment at all. However, if the tonsil stones create discomfort to the patient, it can be dislodged using picks or swabs. Gargling of salt water can also help improve the condition of the patient.

If you are going to consult your doctor, he/she will usually prescribe antibiotics. However, some antibiotics may have adverse effects to the patient. If the tonsil stones grow out of control causing severe pain and discomfort, the doctor will then suggest to have the tonsils surgically removed. The procedure is called tonsillectomy.

It is performed under general anesthesia and the patient will have discomfort and sore throat a few days after the procedure. ^{(1, 2, 10, 12)}

What you can do to prevent holes and stone formation in the tonsils?

• Maintain a good oral hygiene. Take care of your teeth and oral cavity. Make sure you brush your teeth at least two to three times a day.
• Observe proper brushing technique. When brushing, you should include not just the teeth, but also the tongue and the palate.
• Use dental floss regularly to remove dirt that cannot be reached by the regular toothbrush.
• Stay away from vices, especially smoking tobacco products.
• In the case of recurrent tonsillitis, the best remedy is to have the tonsils removed. ^{(1, 2, 11)}

References:

1. https://www.webmd.com/oral-health/guide/tonsil-stones-tonsilloliths-treatment-and-prevention#1
2. http://www.healtreatcure.org/tonsils/holes-in-tonsils-white-spots-large-small-strep-throat-get-rid/
3. https://medlicker.com/1281-holes-in-tonsils
4. http://howtocure.org/tonsil-holes/holes-in-tonsils-causes-pus-collect-food-no-pain-strep-holes-behind-tonsils/
5. https://www.wowremedies.com/holes-in-tonsils-causes-treatments/
6. https://www.medhealthdaily.com/holes-in-tonsils/
7. https://healthfully.com/cure-holes-tonsils-5158949.html
8. http://healthncare.info/holescrypts-tonsils-strep-throat-pictures-treatment/
9. https://www.healthtap.com/topics/what-causes-holes-in-tonsils
10. https://www.drgreene.com/qa-articles/treating-tonsil-stones/
11. http://treatmd.org/tonsils-holes/holes-in-tonsils-causes-white-chunks-normal-sore-throat-strep-how-to-get-rid/
12. http://www.parents.com/baby/health/other-issues/tonsils/

What is a popular urticaria?

It is a disorder manifested by chronic or recurrent papules (a small, raised swelling) secondary to hypersensitivity reaction.

The papule can be surrounded by a wheal. The itchy red bump is about 2 cm in diameter. In some cases, a fluid-filled blister appears. They are commonly seen in uncovered areas of the body such as the legs, forearms, and face. Urticaria is extremely itchy that you find it irresistible to scratch.

Depending on the severity, popular urticaria can become crusted and infected. Popular urticaria is not a true urticaria. The condition will usually resolve in a few hours to days. Severe cases can last for weeks. Children are more susceptible to papular urticaria than adults. ^{(1, 2, 3)}

Papular Urticaria Symptoms

• Appearance of small, raised patches of the skin, which is firm and reddish to brownish in color.
• Extremely itchy cluster of bumps that appear, disappear, and reappear in different spots of the body.
• Symmetrical distribution of lesion which is localized in a specific area ⁽³⁾

Papular Urticaria Pictures

Photo 1: A patient with clinical manifestations of papular urticaria
Image Source: www.skincareguide.ca

Image 2: A severe form of papular urticaria
Picture Source: www.derm101.com

What causes papular urticaria?

A papular urticaria is commonly associated with allergic reaction to insects, especially insects that live on dogs and cats such as fleas and mites. Fleas are seen by the naked eye whereas the mites are too minute, which is somewhat difficult to notice. A papular urticaria can also be caused by allergic reaction to caterpillars, carpet beetles, and bird mites. Some forms of urticaria appear with no apparent reason at all.

A perfect example is prurigo simplex disease. What is Prurigo simplex skin disease? It is a chronic papular urticaria in adults. The cause is unknown but is believed to be a variant of atopic dermatitis. A thorough skin assessment is done to properly diagnose papular urticaria. In some instances, a skin biopsy is needed to properly diagnose papular urticaria. ^{(4, 5, 7, 8)}

Emotional stress can trigger papular urticaria. The same thing goes for people with digestive disorders. It is important to watch what you eat. Some foods have strong reaction to your skin. If you have a hypersensitive skin, it could be triggered by some food groups.

Don’t you know that genetic factors have something to do with the development of papular urticaria? Those who have a family history of papular urticaria are most likely to experience not only papular urticaria but other types as well.

Papular Urticaria Treatment

What is the best treatment for papular urticaria? What you can do to efficiently manage the condition? The treatment for papular urticaria is a combination of medical, home remedies, and preventive approach. A patient with papular urticaria suffers from extreme itching and so the primary goal is to relieve the itch.

A topical steroid cream along with antihistamine tablet help reduce itching, reduce the spots, and improve the overall condition of the patient. To reduce the infection and at the same time prevent secondary infection, an antiseptic cream is applied on the affected part. ^{(4, 6)}

When it comes to preventing papular urticaria, you need to determine the factors that cause the rash. Make sure you clean your house on a regular basis. To get rid of insects, you should spray an insecticide. If you have a carpet, make sure you regularly spray a carpet spray that contains pyrethroid.

Do not forget to vacuum the carpet regularly. As much as possible, you should keep your pet outside. If you have a hypersensitive skin, you should wear a full covering clothing so that you will have a barrier against insects. ^{(7, 8)}

What you can do at home to prevent papular urticaria?

• Identify and eradicate the cause – You should carefully examine the beddings of your pets to check for fleas and mites. If there are fleas and mites, you should apply a medicated powder not only to your pets but also in the beddings including household carpets and soft furnishing.
• Check for any bed bug infestation – If your papular urticaria has been going on for quite some time now, then you need to examine your bedding. It could be caused by a bed bug. There are over the counter products that will kill bed bugs. If it does not work, then the best thing to do is to contact your pest control firm.
• Make it a habit to wear a protective clothing, especially when going outdoor to play. The same thing goes if you are to get in contact with your pets.
• When exposed to outside environment and most of your skin is exposed, you should apply an insect repellent. ^{(6, 9, 10)}

Natural Home Remedies

Home remedies for papular urticaria are focused on the symptomatic relief. Papular urticaria can be very itchy. You should not scratch the rash because it could lead to infection, especially if you have long nails. To somehow alleviate the itch, you should apply a calamine lotion or cream.

Keep the affected area clean and dry. On the positive note, papular urticaria is self-limiting. The patient will outgrow the condition eventually. As the condition recurs, you will develop tolerance and the symptoms will eventually resolve on its own. ^{(5, 7, 8)}

​Herbal remedies

• Peppermint oil – It provides fast relief for papular urticaria. It is best taken via oral route.
• Herbal teas – Tea herbs such as peppermint and parsley can help alleviate the symptoms of papular urticaria. It relieves itching and prevents infection.
• Water with turmeric powder – dissolve a turmeric powder in a lukewarm water and drink first thing in the morning. It gradually improves the symptoms of papular urticaria.

Treating papular urticaria requires a holistic approach. In other words, it should be a combination of home remedies, natural treatment, and medical approach.

The patient is strongly advised to drink a lot of water and follow a healthy diet. Exercising can also improve not just the symptoms of urticaria, but also the general condition of the body. Make it a habit to live a healthy lifestyle because it is the first line of defense against infection. ^{(3, 6, 9)}

References:

1. www.dermnetnz.org
2. emedicine.medscape.com
3. www.healthline.com
4. www.pcds.org.uk
5. www.derm101.com
6. www.webmd.com
7. www.dermcoll.edu.au
8. www.dermquest.com
9. https://parentinghealthybabies.com
10. www.mdedge.com

The ultraviolet rays of the sun can extremely damage not just the skin, but the lips as well. When going outdoor, many of us wear sunscreen and sunblock.

However, many of us also forget the importance of protecting our lips. Little did we know, we end up experiencing burnt lips. Children are prone to sunbunt lips primarily because their skin are not fully developed yet.

More so, people with fair skin are prone to sunburn because their body has low melanin. ^{(1, 2)}

What are the symptoms of sunburned lips?

• Reddening and swelling of the lips
• Dry and warm lips from dehydration and exposure to too much heat
• The lips sore and tender to touch
• The lips crack and in severe case bleed
• Bleeding could result to scab formation
• The lips will eventually peel ^{(2, 3)}

Photo 1: A closer look at the lips with severe sunburnt
Picture Source: heydoctor.org

Image 2: Lips with sunburnt blister
Picture Source : www.healcure.org

How to get rid of sunburnt lips?

• Having a sunburned lips swollen can be extremely painful. You will be cautious going out because you feel like you are no longer attractive, not to mention the pain and discomfort.
• Sunburnt lips treatment is vast. Sunburned lips healing time depends on the severity of the condition and the efficacy of treatment.
• If you are out in the sun and you feel a burning sensation on your lips, you should immediately get out of the sun. That way, you will be able to prevent further damage of the lips.

What are home remedies for sunburnt lips?

Sunburnt lips remedy is simple. You can get rid of sunburnt lips right in the comfort of your home. One of the symptoms of sunburnt lips is drying and chapping of the lips. It indicates that your body is dehydrated. To hasten the healing of sunburnt lips, you should drink plenty of water.

Drinking a lot of water, especially on the first three days of sunburn helps hydrate the body and gets rid of excessive heat in the body. ^{(3, 4, 5, 6)}

What to put on sunburnt lips?

You should apply a cool compress on the lips. It helps cool the lips and significantly reduce the duration of sunburn. Get a clean washcloth and soak in cool water. Place the cloth over the sunburnt lips for a few minutes and repeat when necessary.

You can also place a peach ice cream on sunburnt lips to cool down the lips and hasten healing. Stay away from the sun as it can further irritate the burnt lips. If you can’t avoid going out in the sun, make sure you apply a lip balm containing SPF.

If you are looking for ways on how to cure sunburnt lips of severe type, your best option is aloe vera gel. It has moisturizing property that helps sooth severely burned lips. Applying petroleum jelly, especially the one enriched with vitamin E can deeply moisturize the lips.

Treatment for sunburnt lips include taking over the counter medication such as anti-inflammatories like ibuprofen and acetaminophen. These drugs alleviate pain and inflammation.

What to do for sunburnt lips?

If there are scabs, do not peel the dried parts for it could lead to bleeding. It also lengthens the recovery period. If the sunburnt lips get severe despite desperate measures, then you should immediately see your dermatologist. ^{(4, 5, 7, 8)}

Sunburned lips Vs Cold Sore

What is the difference between sunburned lips and cold sore? A sunburned lips is caused by severe exposure to ultraviolet rays of the sun. Cold sore is a painful blister on the lips caused by herpes simplex virus 1. It will not only occur on the lips, but as well inside the mouth and face. A sunburned lips are sometimes mistaken for a cold sore because it could have blisters too. ⁽⁷⁾

A sunburn blister on the lips is caused by severe skin burn. A small sunburnt lip blister may heal on its own, but you can hasten the healing process using the right sunburnt lips blister treatment.

The recommended treatments for sunburnt lips blister include the following:

• Keep it clean – Make sure you keep the blister clean at all times. When washing, you should use antibacterial soap. Do not use soap containing strong chemicals as it could further irritate the sunburned blister on the lips.
• Take medications – A sunburnt blister on the lips is extremely itchy and painful. To alleviate the pain and discomfort, you should take over the counter medications like aspirin and ibuprofen.
• Apply antibiotic creams – Antibiotic creams, especially the ones prescribed by dermatologist help speed up the healing process. They prevent further infections.
• Apply Aloe Vera gel – this is one of the most effective natural treatments for sunburnt lips and other skin conditions. Aloe Vera has anti-inflammatory and moisturizing property. It reduces inflammation, alleviates pain, and soothes the skin. If you don’t have aloe vera at home, you can easily find aloe vera gel products at the leading stores.
• Keep the lips moisturized – A sunburnt lips can be extremely dry. It could lead to chapped lips. To prevent further drying and irritation of the lips, you should apply a moisturizing cream. Choose a product specially formulated to moisturize the lips. Not all moisturizing products can help soothe the lips. Sometimes, they can trap heat which could lead to further irritation of the lips. To be safe, you should always ask the advice of your doctor. ^{(8, 9, 10)}

Sunburnt lips are not only disgusting to look at. They can also cause extreme pain and discomfort. So, when going out in the sun, you should not only protect your skin, but also your lips. The lips are part of the skin. In fact, they are sensitive to extreme temperature.

It is strongly advised to put on sunscreen on the skin and lips. As the famous saying goes, “prevention is better than cure.” Always remember that if the sunburnt lips get out of control, you have to immediately consult your doctor. The doctor will thoroughly assess the extent of the infection and will come up with the best treatment approach. ^{(2, 5)}

References:

1. http://www.healcure.org
2. www.healtreatcure.org
3. www.treatcurefast.com
4. www.bustle.com
5. www.healthyandnaturalworld.com
6. www.livestrong.com
7. diyremedies.org
8. www.womenshealthmag.com
9. health.howstuffworks.com
10. www.medhealthdaily.com

Diarrhea pertains to the passage of loose, watery stools. A severe form of diarrhea is called explosive diarrhea.

Symptoms of explosive diarrhea include severe abdominal pain, severe flatulence, bouts of loose bowel movement, fever, nausea with or without vomiting, and bloating. ⁽¹⁾

Image 1: A patient suffering from explosive diarrhea along with abdominal pain.
Picture Source: www.belmarrahealth.com’

Picture 2: Natural remedies for explosive diarrhea.
Photo Source: www.homeremediess.com

Explosive Diarrhea Causes

What makes you have explosive diarrhea? What causes sudden uncontrollable diarrhea? Well, there are a few factors leading to the sudden release of loose, watery stool. These include the following:

• Diet – Some foods can trigger diarrhea. This is most likely the reason if you experience explosive bowel movements after eating. If you have a hypersensitive stomach, then you need to be extra careful with the foods you eat, especially when dining out. People with lactose intolerance are prone to having diarrhea. The same thing goes for people with sensitivity to sorbitol, fructose, and mannitol. ^{(1, 2)}
• Infection – Explosive bowel movements in adults and children can be caused by infections, be it viral or bacterial in nature. If you suffer from a viral infection, the intestines and the stomach get inflamed. There is no cure for viral cause. It usually resolves on its own, but you need to drink plenty of fluids to prevent dehydration. On the other hand, bacterial infection caused damage to the intestines. Hence, it should be treated using antibacterial drugs. Parasitic infection can also cause explosive diarrhea. If your immune system is weak, then you are most likely become a target of parasitic infection. Such type of infection is caused by drinking contaminated water and improper food preparation. ⁽³⁾
• Toxins – The toxins in the environment can be one of the culprits for diarrhea. Toxins can be introduced to the body through inhalation or in the forms of food and water. Once ingested could lead to explosive diarrhea.
• Side effects of drugs – Some medications can cause explosive diarrhea. As a matter of fact, laxatives cause diarrhea, especially when not used as prescribed. Antibiotics cause diarrhea too.
• Traveler’s diarrhea – As the name suggests, it is a form of diarrhea experienced by people traveling to countries like Latin America, Africa, Asia, and Middle East. It is primarily caused by unsanitary food preparation and contaminated water. Travellers usually complain of bouts of diarrhea along with nausea, vomiting, stomach pain, and weakness.
• Health conditions – Some medical conditions cause explosive diarrhea. Examples are ulcerative colitis, irritable bowel syndrome, Crohn’s disease, inflammatory bowel disease, and colon cancer. ^{(2, 4, 5)}

Differentiation between Normal diarrhea Vs Explosive diarrhea

An explosive diarrhea is a severe form of diarrhea. The typical diarrhea is characterized by mild abdominal cramping and loose bowel movement. It resolves in a few days. On the other hand, explosive diarrhea causes severe abdominal pain, bouts of loose watery stools, and large amount of flatulence. The patient can also suffer from nausea and vomiting. ^{(1, 3)}

What are the complications?

Explosive diarrhea can be dangerous, especially in children and older patients. It is important to treat it right away before it can cause any adverse effect to the body, which includes the following:

• Dehydration – If you have explosive diarrhea, your body is not just losing water but also essential nutrients. Hence, if you are suffering from diarrhea, you should increase your intake of fluid and essential nutrients. Signs and symptoms of dehydration include excessive thirst, drying of the skin, especially the mouth, muscle weakness, easy fatigability, and lack of urine or dark colored urine. ^{(6, 7)}
• Haemolytic uremic syndrome – This is a complication of a diarrhea caused by E. coli. It is a serious condition that if not treated could lead to kidney failure. Clinical manifestations include fever, nausea with or without vomiting, easy bruising, decrease in urine output, and presence of blood in the stool. ⁽⁹⁾

Explosive Diarrhea Treatment

• Increase your fluid intake – To avoid dehydration, the patient is strongly advice to increase his fluid intake, especially water and natural fruit juices. In case of severe dehydration, the patient is hospitalized and put on intravenous therapy to replenish water and electrolytes.
• Increase your intake of banana – This fruit contains pectin, which helps replenish electrolytes in the body. It is also rich in fiber, which helps absorb excessive fluid in the intestines.
• Increase your intake of probiotics – Increase your intake of good bacteria so as to fight the bacteria causing diarrhea. Examples of probiotics are yogurt, kimchi, and other preserved products. ^{(5, 8, 10)}
• Consume foods that can thicken the membranes – you should increase your intake of foods that can harden your stool such as fenugreek seeds, potatoes, white rice, and certain types of bananas.
• Increase your intake of foods that aid in digestion – Some types of teas can help in easy digestion such as ginger and green tea. However, ginger tea should not be given to patients with high blood pressure. ⁽⁹⁾
• Increase your intake of pectin rich foods – Pectin can coat the stomach and ease the intestines. Examples of pectin rich foods are bananas, blueberries, and apple cider vinegar. The good thing about apple cider vinegar is that it has antibacterial property, which is effective in the treatment of diarrhea that is bacterial in origin. ^{(7, 9)}

When you should see your health care provider?

Explosive diarrhea usually resolve after a few days. If you have been suffering from diarrhea for more than three days, then you need to see your doctor. You have to be very cautious, especially if the patient is a child or an elderly. You should not underestimate diarrhea because it could lead to a life-threatening condition, especially in the case of severe explosive diarrhea.

Some cases of diarrhea could resolve on its own, especially if it is caused by drugs or certain foods. However, if the diarrhea has been going on for days along with fever, nausea, vomiting, weakness, and abdominal pain, then you need to see your doctor.

You should check the quality of the stool. If it is foul-smelling and has blood stains, it could indicate infection. Watch for any abnormalities and inform your doctor right away. The doctor will order for a stool and culture examination and will come up with the best possible treatment. ^{(6, 7, 10)}

References:

1. www.healthline.com
2. www.doctorshealthpress.com
3. www.phaa.com
4. www.livestrong.com
5. www.healthhype.com
6. www.belmarrahealth.com
7. www.healthyandnaturalworld.com
8. www.collectivewizdom.com
9. https://en.wikipedia.org
10. Advanced Health Assessment & Clinical Diagnosis in Primary Care – E-Book By Joyce E. Dains, Linda Ciofu Baumann, Pamela Scheibel

Bacteria are single-celled organism. They don’t have nucleus or membrane organelles, although some have plasmid, an extra circle of genetic material.

It gives bacteria a greater advantage over other bacteria such as resistance to particular type of antibiotic. They are microscopic in size and can live and thrive in different types of environments. They are found in various parts of the earth such as soil, ocean, rock, artic snow, plants, animals, and even in the human body.

The number of bacteria is ten times more than the cells in the human body. A lot of bacteria can reproduce by binary fission and a single bacterium can replicate rapidly. ^{(1, 2, 3)}

Bacteria vary in size and shape. Some are round while others are rod-shaped. In fact, some bacteria have unusual shapes. The three main shapes of bacteria are coccus (spherical). Bacillus (rod), and spirilla (spiral). Less common shapes are spirochaetes (corkscrew) and vibrios (comma).

The shapes are subdivided according to the arrangement of bacteria. ⁽²⁾

Picture 1: A photo showing the three common shapes of bacteria
Photo Source: monag9a.files.wordpress.com

Image 2: Shapes and arrangement of bacteria
Picture Source: www.kullabs.com

Picture 3: The basic morphology of bacteria

What are the three main arrangements of bacteria?

The common arrangements of bacteria are diplo (the cells remain in pair after division), strepto (cells remain in chains after division), and staphylo (cells remain in cluster and then eventually divide into various planes.) less common bacterial arrangements are tetrad (cells in group of four divide in two planes) and sarcinae (group of eight and eventually divide in three planes).

Some bacteria have unusual forms. They are called pleomorphic. ^{(4, 5)}

Typical shapes and arrangements of bacteria

Cocci bacteria

Their shapes are round, oval, and spherical. They are commonly known as spherical shaped bacteria. The cells of cocci bacteria can be arranged in diplo, strepto, tetrad, sarcinae, and staphylococci. A perfect example of cocci shaped bacteria is Staphylococcus aureus.

They are typically found on the skin and in the respiratory tract. Some of them are harmless while others can be very harmful to your health. An example of harmful cocci bacteria is methicillin-resistant Staphylococcus aureus (MRSA. It is resistant to certain types of antibiotics. If the infection is severe, the person could die. Other examples of cocci bacteria are Staphylococcus epidermidis and Streptococcus pyogenes.⁽⁶⁾

Bacilli bacteria

It is a rod shaped bacteria and is one of the common bacterial shapes. Their typical arrangements are monobacillus, diplobacilli, streptobacilli, and palisades. What is meant by a palisade arrangement of cells? It means that the cell of bacteria is arranged side by side instead of end to end. The cells are partially attached too. An example of a bacillus shaped bacteria is Escherichia coli or E. coli.

They are typically harmless and reside in the human body. In fact, some of them helps in the normal functioning of the body such as aiding in food digestion, absorption of nutrients, and production of vitamin K. Some strains are harmful as they can cause urinary tract infection (UTI), intestinal diseases, and meningitis. Other rod shaped bacteria examples are Bacillus cereus (causes food poisoning) and Bacillus anthracis (causes anthrax).

There is another bacterial shape called coccobacillus. They resemble both of the coccus and bacillus bacteria. They are short and slightly oval in shape. ^{(2, 8)}

Spirilla bacteria

These bacteria are spirilla shape. They are twisted and occur in two forms: spirilla and spirochetes. They look like long, twisted coils. Their cells are elongated and rigid. They can have flagella, a long protrusion that aids in the movement of bacteria. A perfect example of spirillum bacteria is Spirillum minus (responsible for causing rat-bite fever). ⁽⁹⁾

Spirochetes bacteria

These are spiral shaped bacteria. They are twisted and occur in two forms: spirochetes and spirillum. Their cells are long, spiral in shape, and tightly coiled. They look like spirilla bacteria, but spirochetes are more flexible. Examples of spirochetes shaped bacteria are Treponema pallidum (causes syphilis) and Borrelia burgdorferi (causes Lyme disease). ^{(1, 10)}

Vibrio bacteria

They are somewhat similar to that of the spiral shaped bacteria. However, vibrio bacteria are comma shaped bacteria. They have slightly twist or curved cells. They too have flagellum, which aids in their movement. Most of these bacteria cause disease and they are mostly associated with food poisoning. An example of vibrio bacteria is Vibrio cholera, which causes cholera. ⁽⁴⁾

How do bacteria reproduce?

They reproduce through the process called binary fission. It pertains to the division of single cell into two identical daughter cells. The binary fission process starts when the DNA of bacteria splits into two. It will then elongate and will eventually split into daughter cells.

The DNA of the daughter cells are the same to that of the parent cell. In other words, the DNA of daughter cells is clone of the parent cell. Some bacteria can divide rapidly, especially during favorable environment condition such as the right temperature and nutrients. For example, the E. coli can divide every 20 minutes. In just a few hours, one bacterium can multiply into thousands, if not millions of bacteria. As the number of harmful bacteria increases, the more the human body become ill. ^{(6, 7, 8)}

Why some bacteria are resistant to antibiotics?

Bacteria have survival mechanisms. Some of them have the ability to form endospores, which make them resistant to physical and chemical conditions such as radiation, ultraviolet rays, and disinfectants. The ability of the bacteria to form endospores makes it extremely difficult to destroy them.

A perfect example of endospore-producing bacteria is Bacillus anthracis, which causes anthrax. ⁽¹⁰⁾

How to get rid of harmful bacteria?

1. Boiling water – Bacteria in drinking water can make you ill. To eliminate the bacteria in water, you have to boil it for a few minutes.
2. Structured silver – It can eliminate bacteria in and on the body. It can kill drug-resistant bacteria but does not affect the good bacteria (probiotic).
3. Chlorination – A chlorine is added to the water to get rid of bacteria.
4. Prescription medicines – Antibiotics are effective in destroying disease-causing bacteria.

There are other ways to get rid of harmful pathogens. The treatment approach depends on the type and nature of bacteria. ^{(6, 8, 9)}

References:

1. www.quora.com
2. www.thoughtco.com
3. www.microbiologyinfo.com
4. microbiologyonline.org
5. https://en.wikipedia.org
6. www.brighthub.com
7. www.sciencelearn.org.nz
8. www.ncbi.nlm.nih.gov
9. www.shutterstock.com
10. Germs, Genes, and Bacteria: How They Influence Modern Life (Collection) By David Clark, Greg Gibson, Anne Maczulak

Stitches play a huge role in any surgical procedures, be it a surgeon, dentist, or veterinarians. Stitches are made to close up cuts, gashes, and surgical incisions.

There are different types of stitches, but most surgeons use dissolvable stitches or also known as absorbable sutures. Stitches that dissolve can both used externally and internally. ⁽¹⁾

How dissolvable stitches differ from non-dissolvable stitches?

• A dissolvable stitch is naturally decomposed by the body.
• You don’t need a follow-up doctor’s visit to remove the stitches.
• Dissolvable stitches are produced using natural materials such as processed collagen, hair, and silk.
• Some dissolvable stitches are made from synthetic materials, but the body is able to break them down. ^{(2, 3)}

Photo 1: A comparison between absorbable/dissolvable stitches and non-absorbable stitches.
Picture Source: www.dolphinsutures.com

Image 2:  before and after photo of a patient who undergone caesarean section who’s incision is closed using absorbable sutures.
Photo Source: www.insorb.com

How long does it take for stitches to dissolve?

How much time does a dissolvable stitch need to disappear? Well, it varies depending on several factors. Usually, a dissolvable stitch starts to dissolve in seven to fourteen days (1-2 weeks).

Some takes months for the stitch to completely disappear. If your body is slowly reacting to the stitches, then you can ask your doctor to have it removed provided your wound has healed completely. ^{(3, 4)}

The popularity of dissolvable stitches

Dissolvable stitches are gaining popularity these days as more and more surgeons prefer to use them over non-dissolvable stiches. Both external and internal dissolvable stitches can be dissolved by the body, which means that it require les doctor visit. The stitches can be removed by the patient at home provided there are no dissolvable stitches infection. ⁽⁵⁾

How the body dissolves stitches? Well, it functions the same way as it would fight off infection. The cells react to the wounds and sutures by increasing the flow of blood in the affected area. As a result, the body will fight off the infection and supplies the growing tissues with oxygen and essential nutrients.

The blood contains phagocytes, the cells that attack the body. What these cells do is they attack the suture making the dissolving process easy and fast. ^{(2, 6)}

Dissolvable stitches are usually used in caesarean section, dental surgery, and surgeries that require internal sutures. They are best used for internal surgical incisions because they need adequate supply of blood to be absorbed and dissolved easily. They can be used externally too, but there is a possibility that some parts of the stitch will not be completely dissolve.

What do dissolvable stitches look like? What are dissolvable stitches made of? Different types of materials are used in producing dissolvable stitches. Let us take a look at the different types of dissolvable stitches.

Catgut absorbable suture

It is made from purified collagen tissues of the intestines of cows. It is perfect for immediately regenerating tissues. Some places permit the use of catgut in humans while others use it in vet operations. Catgut is classified into two: plain and chromic.

Plain catgut provides wound support for seven to ten days while chromic provides wound support for 17 to 21 days. Catgut is perfect for soft tissues such as subcutaneous fat, peritoneum, and closure and ligation of the uterus. ^{(7, 8)}

Hincryl absorbable suture

It is perfect for obstetrics and gynecologic procedures. Hincryl is used in hesterectomy, especially in closing the vaginal vault after uterus removal. It is also used in closing the uterus after delivering a baby in cesarean section.

Hincryl absorbable suture is also useful in general procedures like closing of muscles of the abdominal wall, closure of the chest wall, and repair of ventral an incisional hernias. It is also useful in pediatric procedures and plastic procedures. ⁽⁹⁾

Hinglact 910 absorbable sutures

They are used for soft tissues, ophthalmic procedures, ligation, and surgery involving the urinary tract. They are also useful in general surgeries.

Hinocryl

It is a synthetic monofilament absorbable suture. It is used for soft tissue approximation and ligation. It is ideal for microsurgery and ophthalmic procedures. It is also used in gastrointestinal suturing. ⁽¹⁰⁾

There are other types of absorbable or dissolvable stitches, but the ones mentioned above are the commonly used. There are a few variations depending on the brands but their functions are most likely the same.

Can I make dissolvable stitches dissolve quicker?

Having stitches in the body can be very discomforting. The body treats it as a foreign object. Most likely, patients would find a way to make the stitches dissolve the quickest possible way. Dissolvable stitches usually dissolve within seven to ten days after the surgical procedure.

However, the duration varies from one person to another. It also depends on the location of the wound, thickness of the sutured skin, and the overall condition of the patient. From a medical standpoint, it is improper to make dissolvable stitches dissolve quicker.

If you do so, there is a tendency that the wound will not completely heal increasing the possibility of re-opening the wound. Allow natural healing and let the stitches loosen on its own. ^{(2, 5, 7)}

Taking care of dissolvable stitches

• Keep the stitches clean at all times. When cleaning, you should start at the center of the incision and move your way out. Do not scrub or put pressure on the incision.
• If you see scabs on the sutures, do not attempt to remove them. Scabs are a sign that your wound is already on its healing phase. You might be tempted to remove the scab but doing it won’t help. You should not pick your scab. ^{(5, 8, 9)}
• Wash the incision using gentle soap and clean water.
• Do not apply any creams or ointments unless instructed by your doctor.
• Avoid swimming and other strenuous activities until your wound is fully healed.
• Check your incision regularly and watch for any signs of infection. If you notice any unusual changes, then you should inform your doctor right away. This is to treat and prevent secondary infection. ^{(4, 10)}

References:

1. science.howstuffworks.com
2. www.nhs.uk
3. woundcaresociety.org
4. www.wonderpediamagazine.co.uk
5. www.dolphinsutures.com
6. www.verywell.com
7. https://healthunlocked.com
8. www.theguardian.com
9. www.chemistryislife.com
10. www.dentalfearcentral.org

The color of the stool says something about a person’s health. The stool comes in different colors and it is surprising to see something out of the ordinary. However, what is considered normal stool color can be unique to every person.

Just because the stool color is unusual does not necessarily mean that it is a symptom of a disease. The color of stool is usually dependent on the types of foods you eat. People usually freak out when they see orange-colored stool. They thought that it is a symptom of a serious

Image 1: Different shades of poop and their health implications.
Picture Source: www.mistybluecancercare.org

Photo 2: Foods rich in beta-carotene, which could cause orange diarrhea.
Image Source: www.bellybytes.com

Image 3: An obstructed bile duct could cause orange diarrhea. In the photo, the bile duct is obstructed by a tumor.
Picture Source: www.eherb.com

What causes orange diarrhea?

1. Foods – Orange stools are most of the time caused by certain types of foods such as too much consumption of carrots, apricots, collard greens, kale, cilantro, winter squash, sweet potatoes, and turnip greens. ⁽³⁾
2. Digestive problems – Orange stool with mucus is a cause for concern because it could be associated with digestive problems. Some medical conditions can turn the color of the stool into orange. Orange stool is an indicator that the stool is not exposed to or has not been absorbing enough bile salt. Bile is naturally yellow and plays an important role in turning the color of the stool into brown. What could be the culprit why the bile is not properly absorbed? Well, yellow orange diarrhea due to bile absorption problem could be linked with cysts, gallstones, and tumors. It could also be a sign of irritable bowel syndrome (IBS), especially when the waste material is passing through the GI track too quickly. ⁽²⁾
3. Gastroesophageal reflux disease (GERD) – Orange stool symptoms can be linked with GERD. Gastroesophageal reflux disease is a condition in which the stomach acid comes up into the esophagus. If the color of your poop is orange and you are experiencing other symptoms like heartburn, chest pain, abnormal coughing, and sore throat, then they are indicators of GERD.
4. Side effect of supplements – Supplements containing a high level of vitamin A and beta carotene can make the color of your poop turn to orange. If you see any changes in your stool color, then think of the supplements you have been taken lately. Even antacids can cause orange to yellow orange poop.
5. Parasitic infections – Infections caused by parasites cause unusual changes in the color of your poop. It could turn the poop orange. Parasitic infection is even more suspected if the changes in the color of stool comes with other accompanying symptoms like diarrhea, nausea and vomiting. ^{(3, 5)}
6. Side effects of medical procedures – some medical procedures cause orange stool such as MRI and CT scan. Do not worry because the color of the stool will return to its usual color after a few days or until the test is completed.
7. Liver-related diseases – Diseases of the liver can affect the production of bile and obstruct the bile duct leading to orange colored poop. Various factors leading to the obstruction of the bile duct include cyst, inflammation, gallstones, and tumors. ⁽⁴⁾

When should you see your doctor?

An orange stool isn’t really a cause for concern unless the diarrhea gets severe or the color of the stool remains orange for a long period of time along with other alarming symptoms. An orange stool that has been going on for a long period of time is an indicator that something is possibly not right in your system.

For this reason, you need to consult your doctor. The more you need to see your doctor if your diarrhea gets severe or if you feel extremely weak and dizzy. These are signs of dehydration and you need to seek immediate medical attention. ^{(5, 6, 7)}

How to diagnose orange diarrhea?

The doctor will thoroughly assess your condition to find out what really is causing orange diarrhea. The doctor will ask details about your diet, especially if you consumed colored foods lately like orange and red colored foods. If the doctor cannot directly link your diet in the color of your poop, then additional test should be done.

The doctor will order for blood test and stool test. If the doctor is suspecting digestive problems, then the doctor will refer you to a gastroenterologist (a specialist in gastrointestinal disease). The gastroenterologist will perform diagnostic procedures such as CT scan and MRI, especially if the doctor is suspecting bile duct blockage or problem in the gallbladder. ^{(6, 7, 8)}

How can you prevent orange diarrhea?

• If the cause of orange diarrhea is diet, then you need to modify your diet. Limit your intake of foods rich in beta-carotene such as carrots, although carrots are very good for health. If you are not bothered by the color of your poop, then there is no reason for you to modify your diet.
• If the orange diarrhea is caused by Gastroesophageal reflux disease, then you need to strictly adhere with the treatment methods recommended by your doctor.
• For you to have a healthy and regular bowel, you need to consume foods rich in fiber. As much as possible, you should limit your intake of foods rich in artificial coloring.
• You should avoid taking medicines that can cause alteration in the stool color.
• Keep your body healthy. Avoid vices such as excessive smoking, tobacco use, and drinking alcoholic beverages. Doing this can help improve the overall health condition. Chocolate and caffeine intake should be minimized too. ^{(9, 10)}

Orange diarrhea is usually harmless and will subside after a few days. However, if the orange diarrhea does not subside and continues to worsen as days pass by, then you need to seek medical help. Diarrhea along with other alarming symptoms like dizziness, abdominal pain, constipation, heartburn, and weakness are all indicators that something is not right in your body.

Consult your doctor the soonest time possible to thoroughly assess your condition and determine the underlying medical attention. The doctor is the most capable person to help you with your concerns. ^{(1, 5, 7)}

References:

1. https://www.medicalnewstoday.com/articles/319464.php
2. https://www.verywell.com/what-causes-orange-stool-1942943
3. http://scarysymptoms.com/2012/01/orange-diarrhea-some-causes-are-serious/
4. https://www.healthline.com/health/orange-poop
5. http://www.healthhype.com/orange-bowel-movement-is-it-normal.html
6. https://safesymptoms.com/orange-diarrhea/
7. https://www.belmarrahealth.com/what-causes-orange-poop/
8. https://helpyourback.org/health/orange-diarrhea-what-causes-it-and-how-to-treat-it/
9. https://www.curehacks.com/orange-diarrhea/
10. https://www.badgut.org/information-centre/a-z-digestive-topics/the-scoop-on-poop/