Неврозы – Neuroses

Firstly, it performs an essential protective role. Because of its resilience or ability to resume its previous shape after deformation, it can withstand considerable trauma without permanent damage. This mechanical barrier is mainly due to the arrangement and nature of the collagen and elastic fibres in the dermis. It also constitutes an effective barrier to the passage of substances into or out of the skin. This chemical barrier is provided by the layered cells of the epidermis, which impede the loss of water and body salts and prevent the penetration of external substances.

Secondly, the skin is a most effective and essential sensory organ. This is a result of it being richly supplied with nerve endings, which provide an effective sensory defence against potentially harmful stimuli. It also acts as a ‘relay station’ between external influences and internal organs, via a network of nerve fibres. Of equal importance, is its role as an organ of expression: for instance we may express anxiety by sweating, fear by pallor, anger by redness, pain as a grimace, or happiness with a smile.

Thirdly, the skin acts as a remarkable thermostat. This is mainly achieved by its blood vessels and sweat glands. The metabolic processes of the body continually produce heat, which must be dissipated to maintain a constant body temperature. Under normal environmental conditions this may be achieved by varying the diameter of the blood vessels in the skin, resulting in changes in the volume of the blood flow. This blood flow can be varied 100-fold from maximum constriction to maximum dilation of the vessels. Increased blood flow is accompanied by increased heat loss, whereas a reduced blood flow retains heat.

If, however, blood flow alterations are insufficient to regulate the body temperature, then the sweat glands are activated. This will occur with extreme external temperature increases, excessive exertion, or the fever accompanying an illness. The sweat bathes the skin and cooling results from its evaporation.

Fourthly, the skin plays an active part in the body’s defence against such micro-organisms as bacteria, fungi, and viruses. The surface of the skin is never sterile. It is host to a permanent resident colony of various bacteria which are relatively innocuous. Their presence, however, inhibits the growth of more dangerous organisms on the skin. Further protection is provided by the dryness of the skin’s surface. Most organisms are relatively intolerant to dry conditions, much preferring humid or moist environments. The continual shedding of the superficial epidermis also discourages bacterial invaders. Sebum, the oily secretion produced by the active sebaceous glands, contains fatty adds which have a strong anti-bacterial and anti-fungal action. A thin coating of this on the skin provides a further protection.

Finally, the skin is an important barrier against damaging ionizing radiation, such as ultra-violet light. For skin unprotected by hair or clothing, the only significant defence against the destructive effects of U.V.L. is melanin. Without melanin the epidermis would be a thin transparent membrane, allowing

U.V.L to damage the sensitive structure of the dermis. Melanin is a complicated large protein produced by special cells, melanocytes in the basal layer. From there it is distributed throughout the epidermis. The amount of melanin in the epidermis governs the colour of a person’s skin: the more melanin, the darker the skin colour. There is no difference though in the number of melanocytes in white and in black skin. The difference is simply one of activity, reflected in the amount of melanin or pigment these cells produce. Various factors may influence this, including sun exposure, pregnancy, various hormonal disorders, and drugs.

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Hypoglycaemia is a condition in which the sugar level in the blood fails below normal levels. From the Greek words hypo meaning under and glycaemia meaning blood sugar—hence blood sugar level below normal.

These days, hypoglycaemia is a popular diagnosis for all sorts of problems which cannot be attributed to a more specific diagnosis. There has been considerable publicity about hypoglycaemia which is often blamed for many non-specific health problems ranging from tiredness to depression. Unfortunately, it is often wrongly blamed which can delay a proper diagnosis and correct treatment.

Nevertheless, genuine hypoglycaemia does occur in a few people, and the G.I. factor has a role to play in treating some forms of this condition. The most common form of hypoglycaemia occurs after a meal is eaten. This is called reactive hypoglycaemia.

Normally, when a meal containing carbohydrate is eaten, the blood sugar level rises. This causes the pancreas to make insulin which ‘pushes’ the sugar out of the blood and into the muscles where it provides energy for you to carry out your regular tasks and activities. The movement of sugar out of the blood and into the muscles is finely controlled by just the right amount of insulin to drop the sugar back to normal. In some people, the blood sugar level rises too quickly after eating and causes an excessive amount of insulin to be released. This draws too much sugar out of the blood and causes the blood sugar level to fall below normal. The result is hypoglycaemia.

Hypoglycaemia causes a variety of unpleasant symptoms. Many of these are stress-like symptoms such as sweating, tremor, anxiety, palpitations and weakness. Others affect mental function and lead to restlessness, irritability, poor concentration, lethargy and drowsiness.

The diagnosis of true reactive hypoglycaemia cannot be made on the basis of vague symptoms. It depends on detecting a low blood sugar level when the symptoms are actually being experienced. This means a blood test.

Because it may be difficult (or almost impossible) for someone to be in the right place at the right time to have a blood sample taken while experiencing the symptoms, a glucose tolerance test is sometimes used to try to make the diagnosis. This involves drinking pure glucose which causes the blood sugar levels to rise. If too much insulin is produced in response, a person with reactive hypoglycaemia will experience an excessive fall in their blood sugar level. Sounds simple enough, but there are pitfalls.

Testing must be done under strictly controlled conditions and capillary (not venous) blood samples collected correctly. Home blood glucose meters are not sufficient for the diagnosis of hypoglycaemia in people without diabetes.

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Body Mass Index (BMI). BMI (sometimes also called ‘Quetelet’s index’) was developed to account for the influence of height on body mass. The measure is weight (in kg) divided by height (in m) squared, i.e. BMI = wt(kg)/ht(m)2. Recommended ideal range for BMI is 20-25 kg/m2. Overweight is regarded as over these upper levels and the different levels of obesity are defined.

BMI has as its main advantage the ability to be used in large scale population studies. It requires only two measures; height and weight, which can both be measured accurately by a person with minimal training. It suffers similar deficiencies to weight in that it is less valid in those with a mesomorphic build, and particularly athletic men. The validity of BMI, although higher than weight, is lower than is necessary for a good measure of body fatness. Validity has also been found to be higher in women than men and to be significantly influenced by body build.

Comparisons with other anthropometric measures, at least in large populations, show the usefulness of BMI measures. Its reliability is relatively high, but as with weight, this can be influenced by fluid content. Sensitivity could be expected to be similar to that for weight as height is not expected to change significantly, except with age. The BMI therefore is useful for large scale population studies and, in combination with other measures, is useful for individuals. Some researchers have called for the total abandonment of BMI. However, according to Lohman. ‘. . . BMI needs to be included with skinfolds or bioelectric impedence and other laboratory body composition measures of muscle, bone, and fat’.

The limitations of BMI, as with weight, need to be understood in working with individuals, i.e. there is a need to apply other assessments (including a practised ‘calibrated eyeball technique’) to raw BMI data.

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This means the kidney structure is affected by disease. It also goes by the name acute glomerulonephritis. It may be preceded by a seemingly simple infection of the throat, or skin, by a germ called the haemolytic streptococcus. By the time kidney symptoms occur, the original infection has usually cleared up.

Symptoms are often vague to start with. The first may be blood in the urine, and the patient might not seem very ill. Sometimes the amount of urine passed is less than normal, and the patient may seem to gain weight quickly as fluid is retained. There may be slight headaches, feeling off colour, tummy upsets and a mild fever.

Sometimes as the disease progresses, more serious symptoms may occur, as the blood pressure rises and adversely affects the brain. The child may become restless and vomit, and mental vagueness, convulsions, visual disturbances and coma are possible. These complicated forms are uncommon, but if any of these symptoms take place, urgent medical attention is essential. Sometimes as the disease worsens, the heart may be affected and the kidneys become more severely involved.

Treatment

Prompt medical attention is essential with any abnormal urinary symptoms. Blood in the urine needs immediate investigation by the doctor. Although a large number of children appear to recover completely, a certain number develop a longer illness, chronic nephritis. Often hospitalization is necessary.

The important fact is for the parents to be aware of the seriousness of kidney disorders and make certain the child receives prompt attention if showing any of the sinister symptoms that may indicate kidney disease.

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The outside world is a hostile place, as a baby soon discovers. Germs abound and are ever ready to pounce upon anybody who is susceptible. Babies are extremely prone, and so are infants and children of school age.

Fortunately babies receive a fairly high level of immunity (in built protection) from their mothers, and for their first several months are fairly resistant to these onslaughts. Breast-fed babies continually receive protective factors from the mother, which add to this normal protection and keep it going.

But sooner or later this comes to an end, and the baby then has to face these hostile enemies, who are ready and waiting for a new victim.

In recent years, researchers have developed an astounding array of protective methods for keeping baby free from many of the more serious potential invaders. These are readily available to all babies in this country in the form of immunization. This gives each baby a flying start in life; it ensures a high level of immunity, right throughout life, from some of the terrible life-threatening germs that are still around.

Many infectious diseases are spread simply from person to person. Often this happens by droplet infection. A person with the disease may cough or sneeze, in so doing imparting an enormous number of germs into the surrounding air. Anyone who comes into this radius may pick these germs up and, if personal resistance is low, subsequently contract that illness. In those of a young age group, when their normal body resistance is not high (after mum’s immunity is no longer available), then there is a high level of susceptibility to these germs.

Many are caused by viruses—extremely minute germs. Others are caused by germs called bacteria—these are ones that are larger. We often have suitable treatment in the form of antibiotics that will effectively counter bacteria. But the viruses still have doctors baffled, and at present very few antibiotics are available that will destroy them.

As a general rule, children are more susceptible to the infectious diseases than adults. In older persons, there has been built up a fairly high level of immunity, often from a previous attack of the disease or from constant contacting of small doses of the germs over a long period of time.

In most cases, a reasonable-sized infection yields a fairly high level of resistance to subsequent bouts. It does not give total protection for every infection; but if subsequent attacks do occur, they are usually far less severe.

Many of the childhood infectious diseases are fairly mild. Many may be treated at home with fairly simple measures available to most parents. Others need the doctor’s attention.

As a general rule, never fail to call the doctor if your child appears to be ill, is not obviously responding to your home medications, or if the condition is worsening.

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