Al-Najaf Medical BULLETIN - University of Kufa

Beaus line
Clinical presentation
A 25 - year-old y emeni male diagnosed as acute
myeloid leukemia (M2[as FAB classification]),
received doxorubicin plus cytosine arabinoside
protocol . After 3 cycles of chemotherapy(2
inductions and one consolidation), he noticed
abnormalities in his nails (figure1).
1.What is the name given for these lines?
2.What is the cause of such lines?
3.Mention other causes of these lines?
Answers
1. Beau's lines.
2.Chemotherapy.
3.Transverse grooves or lines seen on fingernails following
an exhaustig disease , usually is a sign of systemic
disease.These may be due to trauma, chemotherapy,
coronary occlusion , hypocalcaemia, or skin disease. The
lines are visible untle the affected area of the nail has grown
out and trimmed . It is normally seen in infants up to the end
of the first month of life .
Beau's lines are deep grooved lines that run from side to
side on the fingernail. They may look like indentations or
ridges in the nail plate . There are several reasons why
humans get Beau's lines . It is believed that there is a
temporary cessation of cell division in the nail matrix cased
by an infection or problem in the nail fold , where the nail
begins to form ,or it may be caused by an injury to that area .
some other reasons for these lines include trauma ,
coronary occlusion , hypocalcaemia , skin disease, or a sign
of systemic disease. It may also be caused by an illness of
the body such as diabetes, certain drugs such as those used
in chemotherapy, or even malnutrition . This condition of
the nail was named by a French physician , Joseph Honore
Simon Beau, who first described it in 1846.
?.
of hair and nails . Hodinsky MK, Sawaya ME, ScherRK,
editors , Philadelphia (PA) : Cefinition Livingstone; 2002
. p . 59.
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http://www.medicineNet.com
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Questions
Discussion
References
School backpack
How much load do school boys carry on
their shoulder?
More than 2.5 million elementary school
children in Saudi Arabia carry book bags on
their shoulders 5 days per week for the entire
school year on a typical days ,these dedicated
students struggle to maintain posture and
balance while carrying overloaded backpacks
that contain books and school supplies .
Research ndicates that backpack loads
represent a significant percentage of childs
body weight. Aheavy school bag , especially
when it is slung over one shoulder, can lead to
muscle strain , distortion of the natural curve of
the spine and rounding of the shoulders . The
heavy school packs carried bythe students were
previously linked to bodily pain . In fact ,
backpack weight measured as a predicting back
pain in adolescents. If such risks persist over
many schooling years, it can cause chronic
back problems that may extend into adulthood .
This has lead several studies to suggest that
children should carry no more than 10% of
theire body weight . Despite that , a
considerable proportion of school children
were reportedto carry backpacks that were
above 10% of theire body weight . the extent of
this problem has not been yet investigated ,
though anecdotal evidences for the heavy loads
of school bags have been surfacing in the media
for some times.
For our student you should know that :
He who hears,forgets;
He who sees , remember
He who dose , knows
(Chinese proverb from parson
Clinical neurology 1989)
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-
Cerebral Stroke Associated with Iron- Deficiency Anemia in
Toddlers
Dr. Jassim . Hashim CABP,FICM (paed)
Source: Maguire JL, de Veber G, Parkin
PC. Association between Iron
deficiency anemia and stroke in young
children.
Pediatrics: 2007; 120(5):1053-1057;
doi:10.1542/peds.2007-0502
Risk factors for ischemic stroke in
children include cerebral arterial
abnormalities, previous varicella zoster
infection, preceding trauma, recent
infection, and anemia. In a series of 212
children with a first ischemic stroke, a
previous medical diagnosis was
identified in approximately one-half,
including anemia in 40%. Sickle cell
anemia is also associated with stroke,
s o m e t i m e s p r e c i p i t a t e d b y
h y p e r v e n t i l a t i o n d u r i n g E E G
Hyperventilation is contraindicated in
patients with sickle cell anemia or
trait.Iron deficiency has been reported to
be a risk factor in several neurologic
disorders of childhood. IDA was
reported in 23% of children with breathholding
spells, and treatment with
ferrous sulfate controlled attacks in 88%
of cases, compared with 6% in those
receiving placebo. Iron has a specific
role in the etiology of breath-holding is
suggested by an immediate response to
therapy before correction of anemia.
Iron deficiency without anemia has been
linked to cognitive deficits and ADHD,
However, the causative role of low iron in
the pathogenesis of ADHD has not been
confirmed. A comparison of clinical
characteristics of children with lowest
serum ferritin levels (60 ng/mL)
disclosed no significant difference in
severity or frequency of ADHD or
response to Medications. Uncontrolled
trials of supplemental iron have shown
conflicting results.
Three mechanisms to explain an
association between IDA and childhood
ischemic stroke have been suggested: a
hypercoagulable state directly related to
iron deficiency and/or anemia;
thrombocytosis secondary to IDA; and
anemic hypoxia,
Whereby a mismatch between oxygen
supply and end-artery oxygen demand
leads to ischemia and infarction; while
cases in many study had elevated
platelet counts compared with controls,
no statistically significant interaction
between IDA and thrombocytosis was
found in some . IDA seems to be an
independent risk factor for stroke.
Editors' Note: the study deserves our
attention. Diagnosing and treating iron
deficiency before it leads to a cerebral
vascular accident or other complications
may be a stroke of good fortune for our
patients.
References
1. Sutcliffe TL, et al. Arch Pediatr
Adolesc Med. 2006;160:1114-1120.
2. Ganesan V, et al. Ann Neurol.
2003;53:167-173.
3. Millichap JG. Clin EEG and
Neuroscience. 2006;37:190-192.
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