I am a 21 yrs old college going girl, I developed flat brown spots on the skin of back of my hands since last three months, their borders are sharp, which become darken with sun exposure. I have consulted a skin specialist. He told me that you are suffering from freckles and lentigines and advised me treatment. What is your opinion about this problem.

Freckles (ephelides) and lentigines are flat brown spots. Freckles first appear in young children, darken with ultraviolet exposure and fade with cessation of sun exposure. In adults, depending on the fairness of the complexion, flat brown spots (lentigines) often with sharp borders, gradually appear in sun-exposed areas, particularly the dorsa of the hands (back of hands).

They do not fade with cessation of sun exposure. They should be evaluated like all pigmented lesions. If the pigmentation is homogeneous and they are symmetric and flat, they are most likely benign. Solar lentigines, so called liver spots, improve in over 80 percent of individuals treated with topical (local application) of 0.1 percent tretinoin once nightly for 6 to 10 months but any treatment should be taken by the consultation of a doctor.

My mother is about 60 yrs old, since last ten to fifteen years she is suffering from anxiety neurosis and depression. Sometimes she becomes panicky and mood swings are also present. Although, most of the time, her problems remain controlled with medicines. I want to know the causes of these disorders, why it occurs.

Psychiatric disorders of biologic origin may be secondary to identifiable physical illness or caused by biochemical disturbances of the brain. A wide variety of psychiatric disorders eg. psychosis, depression, delirium, anxiety as well as nonspecific symptoms are caused by organic brain disease or by derangement of cerebral metabolism resulting from illness, biochemical aberrations (usually neurotransmitter dysfunction), nutritional deficiencies or toxic agents.

Neurotransmitter functions have been correlated with the major psychiatric disorders, cholinergic deficiency is present in some dementias and adrenergic imbalance is important in some psychoses. Serotonergic mechanisms are significantly involved in affective disorders, aggression, autism and the anxiety disorders particularly obsessive compulsive disorders and panic disorder.

My 15 yrs old daughter starts menstruation one year back. Since the beginning of menstruation, just before the menstruation she usually complains of disturbance of bowel habit, usually suffers from constipation. Sometimes she complains of heaviness in breasts and pain also. I want to know about this problem, why it occurs and whether these are normal symptoms or not.

Two noticeable symptoms are fairly constant in most women at or just before menstruation. One is a tendency to disturbance of bowel habit, usually resulting in constipation though the other extreme is more rarely seen and the other is a feeling of fullness or heaviness in the breasts even amounting to pain.

Some of these premonitory symptoms when observed by an intelligent woman invariably give her warning of an impending menstrual period and serve the useful purpose of giving her time to adjust her social activities accordingly. They also warn her to take the necessary hygienic precautions against the menstrual flow. This premenstrual tension is probably due to an increased water and sodium retention and may cause a slight weight gain of one to two kilogram.

My mother is about 60 yrs old and suffering from Chronic diarrhoea and severe undernutrition. She is suffering from uncontrolled diabetes also. Since last few days she is suffering from tremor, mental depression, confusion and sometimes she becomes agitated also. We have consulted a doctor for this problem. After examination and investigations, he told us that she is suffering from magnesium deficiency and advised treatment. What is your opinion about this problem.

Disorders of magnesium metabolism are occasionally responsible for otherwise puzzling clinical features and are susceptible to therapeutic control. The most frequent cause of magnesium deficiency is prolonged diarrhoea or vomiting, which has been treated with parenteral fluid without magnesium supplements.

It is associated with chronic diarrhoea and severe undernutrition, such as occurs in protein-energy malnutrition and the malabsorption syndrome. Uncontrolled diabetes mellitus, aldosteronism, hyperparathyroidism, the diuretic phase of acute renal failure and chronic alcholism lead to magnesium deficiency from excessive urinary loss.

It occasionally follows long continued diuretic therapy. Clinical features are predominantly neuromuscular, with tremor, choreiform movements and aimless plucking of the bedclothes. Mental depression, confusion, agitation, epileptiform convulsions and hallucinations also occur. The diagnosis can be confirmed by finding the concentration of magnesium in the plasma to be less than 0.75m mol per litre.

 Magnesium deficiency is best treated parenterally, 50m. mol of magnesium chloride may be added to one litre of five percent of glucose or other isotonic solution and given over a period of 12 to 24 hours. The infusion should be repeated daily until the plasma concentration remains within the normal range but any treatment should be taken only by consultation of a doctor.