SKIN CARE: NAIL

A nail consists of the nail plate and the tissues which surround and underlie it. The nail plate has three parts; the matrix which is concealed within the skin; the fixed portion which adheres firmly to the nail-bed, and the free edge of the nail. The active growth area is the epidermis of the matrix, which underlies the skin of the nail-fold. Sealing off the potential space between the nail and the nail-fold is the cuticle, which has an important protective function. Under normal conditions, the nail plate is firmly attached to the nail-bed. (This may, however, change as a result of various disease processes.) The nail plate exhibits various colour tones ranging from white to pink, which are the result of reflected light from the tissue beneath the colourless nail. The whitish-grey colour of the free edge is due to the air underneath it. Nail is composed of hard keratin, the same protein from which hair is derived. Like hair, the nail plate has no nerves or blood supply, and is a ‘dead’ structure. Under natural conditions nails would extend indefinitely unless cut or worn away with use. Unlike hair growth, which is periodic, nail growth is continuous. The daily rate of extension is about one third of hair, or approximately 0-1 millimetre. It takes about 100 days for the fingernail of a healthy young person to be restored after removal.

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THE G.I. FACTOR AND DIABETES

At 50 years of age, Helen had tried many times to lose weight. Her neighbours had started walking on a regular basis but she felt tired all the time and had no energy to do anything more than what she had to. Being 95 kilograms and only 168 centimetres tall ruined her morale. Her mother had diabetes and she knew being overweight put her at greater risk, but every time she lost weight she ended up regaining it. Finally, it was no surprise to her when she was diagnosed with diabetes. In fact it was some relief, here at last was a reason for her tiredness.

On her doctor’s suggestion, Helen saw a dietitian for help with her diet. At first glance what Helen was eating appeared reasonable. Breakfast was a slice of wholemeal toast or a wholemeal cracker with margarine and black tea. Lunch was a light meal such as celery, lettuce, a slice of cheese, a slice of cold meat, an egg and a couple of crackers, spread with margarine. For dinner she was having soup and a piece of steak with vegetables. She limited herself to a small cocktail potato. The meal was finished by a piece of fruit.

A closer look at her food record, showed that Helen’s diet was in fact poorly balanced. It was dominated by protein and fat foods and contained insufficient carbohydrate. It didn’t contain enough food to provide a good range of nutrients. What’s more, Helen herself was struggling with it and often felt hungry since she had cut lollies and biscuits out of her diet.

To improve things, we first looked at the frequency of eating. Helen kept to three meals a day because she had been brought up to believe that was better for her. She agreed to trying a small snack of fruit or a slice of bread between meals. Even though she wasn’t on medication for diabetes, the effect of spreading her food intake more evenly across the day, between small meals and snacks, could help to stabilise her blood sugar level and help her lose weight.

We then revised the amount of carbohydrate that she ate, and listed a range of low G.I. carbohydrate foods that were to be her first priority at each meal. The filling value of the carbohydrate left her with less space for the proteins that used to dominate her diet Helen’s new diet looked more like this:

Breakfast began with a fresh orange, juiced, and a bowl of oats with sultanas and low-fat milk Helen added a slice of Burgen™ or raisin toast if she was still hungry.

Lunch was usually a sandwich on Burgen™ bread with a slice of lean meat and salad and a piece of fruit or a muffin to finish. Sometimes she had a vegetable soup or pasta with a vegetable sauce and salad.

The proportion of foods on her dinner plate was rearranged, shrinking in the meat department and filling out on the vegetable side. She began to think of carbohydrate food as the basis of the meal and varied between pasta, rice and potato. Twice a week she made a vegetarian dish with legumes like a minestrone soup or a vegetable lasagne. An evening snack was usually a yoghurt or fruit.

After a month on her new eating plan Helen felt better—in fact she felt well enough to tackle some exercise. Taking a serious look at her day, she decided to commit the half hour after dinner to a walk, five nights a week.

Over the next six months Helen’s weight dropped from 95 kilograms to 80 kilograms. Her blood sugar levels were mainly within the normal range. She no longer struggled with hunger and felt good about the food she was eating.

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MANUAL MEASURES OF BODY MASS AND FAT MASS

Weight. Weight is a measure of the force of gravity acting as the total mass of an object. As such it reflects not only the overall size of the body but also the density of the combination of body tissues, including bone, muscle and body organs. Fat is lighter than water and therefore adipose tissue is lighter than muscle and organ tissue (which are mainly water) and both are lighter than bone. Increases in weight might therefore mean an increase in fat mass, muscle mass and/or fluid (remember, glycogen is stored with three times its weight in fluid). Over the long term, it’s true that changes in weight generally reflect changes in body fat, but in the short term the use of scales is not recommended as a measure of success of a fat loss program. Weight scales also vary significantly, from a sensitive bar balance or high quality electronic scale to the less sensitive but more often used bathroom-type scales.

The validity of weight as a measure of body fatness then is only fair, especially in certain types of individuals such as mesomorphic (muscular) males and elite athletes. Reliability of the measure on the other hand is quite high. Sensitivity is also reasonably high (i.e. around 0.8) detecting small changes in body mass. But, of course, this is not sensitive to fat as distinct from changes in other body tissue. Weight, therefore, is limited as a measure of fatness, except where combined with some other measures.

Myth-information. Weight loss through heat treatments such as saunas and steam baths represents fluid losses through sweat. These techniques have no permanent effect on fat loss.

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BABY AND CHILDHOOD URINARY TRACT DISORDERS: VAGINAL REGION INFECTIONS

In girls occasionally an irritation occurs in the vaginal region. Called vulvovaginitis, it may affect the vulva at the vaginal opening. There are many causes, ranging from a lack of hygiene, to infections from germs, to threadworms (which may have journeyed from the back passage and become lost in the vagina), to hormonal deficiencies. It sometimes indicates early diabetes.

There may be no symptoms at all. Or there may be a discharge from the vagina, or itch or irritation. The discharge may be whitish, or clear or stringy and slimey. Sometimes it is pussy if there is an infection present. A bloodstained discharge may indicate a foreign object has been pushed into the vaginal canal— this is not uncommon with youngsters.

Treatment

Any symptoms in this region should receive medical attention. With a few simple tests, the doctor can often diagnose the cause and order the correct treatment. Frequently, adequate cleanliness and hygiene will prevent these problems from taking place.

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BABY AND CHILDHOOD ILLNESSES: AUTISM

Childhood autism was first recognized in 1943 by Dr. L. Kanner, and since then has become a fairly well recognised problem. Only in the past few years has an increasing amount of interest been taken in the problem which affects about 5 children in every 10 000 under the age of 15 years.

It is believed that many of these children have brain damage, and more than half are severely mentally retarded. Autistic children have difficulty in relating and communicating with others, and their imaginative capacity is severely retarded. As a result the child tends to perform the same activities over and over, and will often repeat the same set of words frequently. Some children show reasonable levels of intelligence, and originally Dr. Kanner claimed that many were potentially of superior intelligence. Many seemed to have parents following professional occupations, even though they were cold rigid personalities. But this has since been cast into doubt by subsequent research.

Treatment

‘There is no medical treatment, but appropriate management and education can diminish behaviour problems and help bring out any latent abilities,’ the British Medical Journal stated recently in a leading article. The child’s future is closely linked with his ability to develop language, social awareness and useful skills.

‘Most autistic children need care all their lives,’ the Journal says, ‘but a few become independent, though eccentric adults. Very few develop a high level of skill in some special field, such as music, mathematics or art.’

There are now national societies which take a special interest in autistic children, and parents often gain much assistance in this manner. The Autistic Children’s Association of New South Wales is located at 545 Pacific Highway, Artarmon, Sydney, 2064.

DIRT EATING (PICA)

Some children seem to enjoy eating abnormal material that is not food. The range can be remarkable. It may include dirt, clay, snails, peeling paint, starch, and even ice! Some infants love playing with their bowel actions and may even eat this! A weird list of items have been recorded in the books of medical history. A craving for certain foods is more common, and it may include almost anything, from vegetables, to biscuits, sweets or fruits, to an abnormal extent. A few years ago an individual had a compulsive desire to eat ice, and devoured 9000 g a day, according to the Journal of the American Medical Association. Others have been known to eat newspapers and the pages from glossy magazines. One individual sustained a bowel blockage from the amount of newsprint in her intestinal system. If your child shows a propensity for eating odd objects please seek medical help. The child may be referred for assessment by a child psychiatrist.

Treatment

The case will be fully investigated. However, a large number are found to have an iron-deficiency anaemia. The simple use of preparations containing iron may completely reverse the strange compulsion, and the patient readily gets back to normal eating habits again.

‘Pica is quickly cured by therapy with iron, but this valuable information has been generally ignored,’ JAMA magazine recently reported. Do not scold your child—rather seek medical attention. The cure may be far more simple than you ever imagined.

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