Tuesday, January 31, 2017
Sunday, January 29, 2017
P- Pencil-in-cup deformity
Hello everyone !
This is a short post about Liposomal delivery systems. Hope this introduces you to the concept nicely.
∆ What are Liposomes ?
- They are vesicles made of Cell membrane phospholipids. In pharmacology, they can be used as Drug delivery systems.
∆ What advantage does a Liposomal preparation offer in comparison to a regular preparation?
- The Liposomal preparation consists of the desired drug loaded into the Liposomal vesicle. This vesicle is resistant to degradation in the gut and can be customized to open up in selective tissues.
- Thus , it increases Bioavailability of the drug and hence , the action of the drug is more predictable and sustained !
∆ Is this even used at all? Or is it just an extra thing we learn which is never used ?
(- I'm so glad you asked. )
Here's a list of drugs that have commercially available Liposomal preparations :
Remember : ABCD GIV
Doxorubicin And Daunorubicin
- Liposomal preparations have totally revolutionised the usage of Amphotericin B! Which is the drug of choice for a host of fungal infections and even Leishmaniasis.
- With the anti cancer drugs like Doxorubicin , innovative methods such as targeting the drug to a specific organ have been formulated so that the cytotoxicity is limited to the organ in question only ! Thus optimizing the absorption as well as the action !
What a marvellous delivery system , isn't it ?
I hope this post helped you!
- Chronic Helicobacter pylori infection results in lower gastric acid secretion by inducing atrophic gastritis, thus hinting to have an inverse association with EC.
- H. pylori infection reduces ghrelin synthesis due to loss of P/D1 cells in the fundus and body of stomach which decreases gastrointestinal motility and induces delay in gastric emptying, thus increasing the risk of GERD.
- Also the CagA positive strains induce fluctuations in the levels of somatostatin, gastrin, dopamine and other essential hormones, which might cause increased reflux symptoms and metaplastic changes in chronic cases.
- Upregulation of proinflammatory cytokines and impaired TNF-alpha levels might play a role in pathogenesis of esophageal and gastric carcinoma. Extragastric diseases such as Colorectal polyps, nonalcoholic fatty liver disease, dental caries, coronary heart disease, the parkinson's disease, and iron deficiency anemia are also associated with H pylori infection through multiple signaling pathways.
Inspite of much evidence, there have been arguments and debates on the underlying mechanisms in causing esophageal carcinoma. A meta- analytic study, on the other hand has recently concluded that CagA- positive strains of H. pylori have a protective role in EAC while there is no such clear association with ESCC.
- Jaskunwar Singh
Saturday, January 28, 2017
Hello everyone ! I'm back with another post on Opthalmology ! Hope you like it.
∆ Uses of Steroids in Ophthalmology -
1. Prophylactic - PC
- Post op Cataract - 6w
- Corneal grafting.
2. Therapeutic - Go from anterior to posterior. We use it in every layer of the eye !
- Lids - Intralesional for Chalazion
- Conjunctiva - Phlyctenular Conjunctivitis.
- Sclera and Episcleral tissue - Scleritis and Episcleritis.
- Cornea - Contra indicated - As it affects healing and may cause super infections.
- Uvea - Anterior and Posterior Uveitis. Purulent Uveitis - Endophthalmitis ; Panopthalmitis.
- Retina - Diabetic Retinopathy Intravitreal Triamcinolone.
- Nerve - Optic Neuritis ( Multiple Sclerosis ) - Methyl Prednisolone
3. Others :
- Secondary Glaucoma due to the Inflammatory etiology.
∆ Precautions :
- Avoid in any ulcer cases as it can delay healing of the ulcer or aggravate fungal or herpetic ones.
- Can cause Cataract - Posterior Subcapsular. (Generally when given systemically)
- Can cause Glaucoma ( Generally when used Topically. )
Hope you liked it !
Stay awesome !
"It is an extra-articular fracture of the distal metaphyseal region of the Radius (at its cortico-cancellous junction) with dorsal impaction and angulation, caused due to a fall on outstretched hand (FOOSH) resulting in displacement of the fractured part of bone distally as well as radially."
|Fall on outstretched hand resulting in displacements seen in Colles' fracture|
Displacements seen in Colles' fracture mnemonic- SLID
- Lateral shift and tilt
- Impaction of bone fragments
- Dorsal shift and tilt.
Clinical features: mnemonicise the features here.
Dinner Fork deformity- Normally the styloid process of radius is at a lower level than the ulnar styloid. In Colles' fracture, the dorsal displacement and impaction of Radius results in shortening of the bone and places the radial styloid at the same level or a little higher than the ulnar styloid. Hence the patient presents with such a deformity resembling a dinner fork.
- Jaskunwar Singh
Hello awesomites, I am kind of obsessed with fancy syndromes. So here is one of them.
Churg Strauss Syndrome (CSS) also known as Eosinophilic granulomatosis with polyangitis or allergic granulomatosis.
It is a rare autoimmune condition, that causes inflammation of small and medium sized blood vessels.
Manifests in 3 stages-
Early stage (Prodromal stage) : Present as
Sometimes with nasal polyps and sinusitis
(Remember 'A' is the first letter, so it should always come first)
Second stage : Abnormally increased eosinophils= Hypereosinophilia
Which causes tissue damage mostly lung and digestive tract.
Manifestations are Night sweats, weight loss, cough, abdominal pain, GI bleeding, fever, purpura
Third stage: vasculitis- which leads to infarction which further leads to atrophy
Further progression leads to complications.
But not all patients develops all three stages, or progress in the same order.
Pathophysiology - Its a Autoimmune disorder where different cell types are responsible for immune response especially Eosinophils, T&B cells, endothelial and epithelial cells. Mainly it is Th2 mediated reaction.
Complications can be life threatening -
M- Myocardial involvement is the most common complication and most common cause of death in CSS patients
G- GI bleeding, GI perforation, Glomerulonephritis, Glomerulosclerosis,
Treatment - Conventional treatment includes glucocorticoids like Prednisolone and immuno suppressive drugs like Azathioprine, cyclophosphamide.
Newer drugs direct against specific cytokines like mepolizumab have additional steroid sparing property angood tolerability. Use of Rituximab is under investigation and limited to few cases.
That's all. :)
Friday, January 27, 2017
It also has two components: Fracture of distal- third of Radius and dislocation of the distal radio- ulnar joint. Mnemonicise it from here.
The mechanism of injury is the same as in Monteggia fracture and dislocation (fall on an outstretched arm causes an axial load on a hyperpronated forearm; Hyperpronation injury). The more distal the fracture, greater are the problems encountered in wrist and hand movements and more are the deforming forces that cause muscular and soft- tissue injuries.
A must to mention here is about Anterior Interosseous nerve (AIN) palsy and Wrist drop.
A patient with Galeazzi fracture and dislocation may present with the AIN palsy (while PIN is common in case of Monteggia fracture and dislocation) that may cause paralysis of flexor policis longus and flexor digitorum profundus thus resulting in a loss of pinch mechanism between thumb and index finger.
Wrist drop may also be a presenting complaint that results from an injury to the radial nerve and also due to weakness of brachioradialis and extension of wrist and thumb. The patient cannot bear the weight of the hand.
Diagnosis:- X- rays of forearm (AP and lateral view)
Treatment:- Complete reduction and fixation is important to restore the functions of limb. Galeazzi fracture and dislocation is best treated with Open Reduction and Internal fixation (ORIF). In children, closed reduction is the procedure of choice due to skeletal immaturity.
The injury is caused by a fall on an outstretched hand with the forearm forced into excessive prone position (hyperpronation injury).
Types of Monteggia fracture and dislocation (Bado's classification) :-
Type I- Extension type- Angulation of proximal part of ulna anteriorly and dislocation of the head of Radius anteriorly. This type is seen in 60% patients.
|Bado type I lesion (most common)|
Type III- Lateral type- Fracture of ulnar metaphysis and dislocation of head of Radius laterally.
Type IV Combined type Fracture of ulnar as well as radial shafts with dislocation of radial head anteriorly.
Diagnosis of Monteggia fracture and dislocation:- Check for both components- the fracture as well as displacement coz there could be an isolated fracture of ulna as due to nightstick injury.
X- rays of the forearm (Antero-posterior and lateral view) are diagnostic.
Treatment- Conservative management in children with closed reduction (resetting of bones and casting) accompanies the high risk of displacement thus causing malunion.
Standard treatment procedure in Monteggia fracture and dislocation is Osteosynthesis of the ulnar shaft (Open Reduction and Internal fixation) in children as well as adults to improve stability of the radio-ulnar joint and mobilise so as to prevent stiffness.
- Jaskunwar Singh
Thursday, January 26, 2017
The term was first coined by Edith Louis Potter but it's a misnomer and more of a Potter sequence or the Oligohydramnios sequence. So here's the mnemonic of some of the clinical features: POTTER
P- Pulmonary hypoplasia
T- Twisted face (Potter facies)
T- Twisted skin (wrinkly skin)
E- Extremity (limb) defects
R- Renal agenesis (bilateral)
- Jaskunwar Singh
Wednesday, January 25, 2017
I'm back with another ophthalmology post. This one is more of a clinical post , something that would be important to you in any specialty! Hope you like it. :)
So our life is all about being a successful doctor at the moment. Cause we wanna be good at our jobs !
Everyone wants to succeed at the work place. But there are loads of occupational hazards or diseases that we end up acquiring or aggravating due to the kind of job we do.
In this post I'll be talking to you about what ocular diseases can occur in Association with certain occupations.
- Occur commonly in farmers, driving school teachers and construction workers.
- Due to exposure to sunlight for a long duration of time.
2. Fungal corneal ulcer or other fungal infections of the eye
- can occur commonly in farmers again. Because they are at a higher risk of vegetative trauma
3. Computer vision syndrome :
- seen in people working with electronic devices on an extensive level.
- the complains include dry eye , headache , eye strain , neck and shoulder aches.
- Simple tip for prevention - called the 20 20 20 rule.
Every 20 minutes look away from the screen for at least 20 seconds at an object about 20 feet away.
- Frequent blinking.
- Use of Lubricant for the eye.
- Use of anti glare screen/ spectacles.
4. Miner's nystagmus :
- seen in coal workers.
- Photophobia and night blindness may accompany the Nystagmus.
5. Glass blower's cataract :
- Occurs in glass makers.
- infrared rays cause damage to the lens producing this kind of cataract.
6. Welder's flash :
- seen in welders.
- It's a form of Photokeratitis
- Occurs due to UV rays
- causes abrasion , conjunctivitis and eye strain.
That's all for today !
Hope this helped.
Stay awesome !
Tuesday, January 24, 2017
I'm back with a short post. This one is about Glycogen storage diseases which, again, we all hate to remember :'D Hope you like it.
So Remember :
Very Pompously CAMe Her Tears.
1. Very = Von Gierke's
2. Pompously = Pompe's
3. C = Cori's / Forbe's
4. A = Anderson
5. M = McArdle's
6. Her = Her's (we'll at least Remember this one :'D)
7. Tears = Tarui's
So that's that.
Now how do we remember which is Muscular and which is hepatic ?
The Muscular get kissed under the Mistle Toe.
So the ones involving the Muscles are :
Mistle = McArdle
Toe = Tarui's.
Also remember :
Pompeii the city was a wh*re. So it went everywhere and hence Pompe's is both Muscular and Hepatic.
That's all for now. It may seem like a lot of crap to simply memorize these Glycogenosis but you'll realise they form an excellent aid for memory :D and are super important whether you want to do USMLE or Indian PG.
So c'mon ! Burn those Glycogens in your liver and get some Glucose into your head ;)
How do we define and on what basis do we label a newborn as an "at risk baby"? Well, it is very important to make a right approach to the risks and factors which affect the health of a newborn. So I just mnemonified the factors in a very simple way. Just remember the words: RISK APPROACH
R- Referral weight- check for the weight of the baby. It should not be less than 70% of the referral weight (taken to be approximately 2500g), i.e. a newborn less than 1800g body weight must be referred to a paediatric health care centre for further investigation.
I- Insufficient breastfeeding- check for maternal and infant factors affecting the supply of milk.
S- Spacing (between subsequent pregnancies) less than 2 years
K- Kilograms of weight loss during first 2 months after birth- 5-10% weight loss in the first 10 days of life in a breastfed baby is normal. Investigate into the matter if the baby loses excess weight.
A- Acute episodes of illness (congenital or environmental factors)
P- Plural birth (or twin birth) or Premature birth
P- Parental illness is a must to check to determine risk of inherited disorders and illness in the newborn.
R- Raised birth order (five or more)
O- One parent
A- Active mother- Ask about her occupation and if she is working and about her lifestyle.
C- Constant failure to gain weight during the first few months of life
H- History of previous pregnancy and death of any sibling, if any must be taken into consideration.
- Jaskunwar Singh
Hello everyone !
I'm back with another short post on biochemistry.
It's about the Glucose transporters which we all hate :D So let's get down to it.
GLUT - Short for Glucose Transporters , are channels present in our body that bring about glucose uptake. They are forms of Facilitated transport mechanism and basically occur across a Concentration gradient.
Now it's important for us to understand their location , function and regulation if we want a good understanding of Glucose metabolism. But this can get a little tedious , hence this post.
There are a total of 4 major GLUTs. Out of which one is dependent on insulin and the others are not.
So first we're doing insulin independent ones.
Kid's LiPs are
GLUT 1 -
Remember : BBB.
B - Blood ( The RBCs)
B - Baby (So fetal tissue)
B - BBB ( The Blood brain barrier itself )
GLUT 2 -
Remember : Kid's LiPs
Kid's - Kidneys
Li - Liver
Ps - Pancreatic Beta cells
GLUT 3 -
Remember : PiNK
Pi - Placenta
N - Neurons
K - Kidneys
Now we come to the Dependent one.
GLUT 4 -
Father Mother Depend.
Father - Fat
Mother - Muscles ( Cardiac / Skeletal)
Now how do we remember this ?
In general the Mother and Father are who we depend on ! But in biochemistry the mother and father themselves depend on insulin. ! And the baby ( BBB etc) are independent.
Got it ?
Hope this helped.
It's something I've struggled with.
Happy studying. !
So do you guys know about the VEAL CHOP mnemonic?
Variable decelerations - Cord compression
Early decelerations - Head compression
Accelerations - Oxygenation
Late decelerations - Placental insufficiency
Well, it has one kind of periodic FHR change pattern missing. That's the sinusoidal pattern associated with fetal anemia!
For those who don't know, let's run through them quickly :)
As you guys already know, GDM diagnosis can be accomplished with either of two strategies:
“One-step” 75-g OGTT or “Two-step” approach with a 50-g (nonfasting) screen followed by a 100-g OGTT for those who screen positive.
But what if, in the exam, you are asked to choose a screening test for GDM...
And the options contain both:
- One hour 50 gram glucose load test (1-h 50-g GLT)
- Two hour 75 gram oral glucose tolerance test (2-h 75-g GTT)
... Then which one do you choose?
Monday, January 23, 2017
Due to: Lack of Sphingomyelinase
Features: Progressive neurodegeneration, hepatosplenomegaly, cherry-red spot on macula
Histology: Foam cells
Mnemonic: No man picks cherries sphinging about his foamy neurons.
Hello everyone ! I'm A.P.Burkholderia , and I'm back with another post😀
Now a lot of people have been asking me why my name is that. Some have assumed it's my actual surname (Like our very own IkaN, but that's a whole 'nother story) while others have unraveled the mystery of the Burkholderian terminology (Like the ardent PSM-proponent Jay ). So before any more of you are boggled by this Burkholderian business I figured let's talk about why this organism is fancy enough to earn the charm of being my pen-surname. :P
So Burkholderia is a Gram negative rod. And it is one of a kind - Cause It's a Non Fermenter ! So if you were to make a TSI plate it would give you alkaline in the slant as well as the butt (LOL). Only few other organisms like Pseudomonas and Acinetobacter are non fermenters. So it's a total Aerobe and it can be checked with "High and Leifson Oxidation Fermentation media". Another cool name :D
It's got 3 different types :
Now I love how it's called "Mallei". In Hindi 'Malai' means 'Milk Skin'. I find that hilarious.
Also, 'Mai Lai' means 'I shall bring '. I find that really funny too. ( Burkholderia , Main Laiii !)
But other than that , it's a pretty serious bug.
It causes Cepacia syndrome in Cystic Fibrosis, which presents as a form of Bronchiectasis or Serious pneumonia.
It can cause Meiloidosis which has a presentation similar to TB and another one called 'Glanders'.
It shows a safety pin appearance when seen under the microscope on staining with Geimsa.
Other than this , it's a very hard big to get rid of.
It's almost resistant to all antibiotics and only the Carbapenems may work !
So this is why I love this bug.
It's cool , it's classy and it's hard to get. :p
Other than that , I love saying the name! *Burkholderia*
I might do a video some day on this :p and how to say it right.
Till then , Ciao!
Sunday, January 22, 2017
Saturday, January 21, 2017
Complications due to an attack of myocardial infarction mnemonic: DARTH VADER (I loved his character in Star wars you know :p )
D- Dressler's syndrome
H- Heart failure
V- Valvular defects
- Jaskunwar Singh
Hello everyone !
Another short post on a very important triad. Cushing's!
It occurs in response to raised Intracranial Pressure (ICP/ICT)
H - Hypertension
I - Irregular Breathing
B - Bradycardia
So just imagine :
Due to some reason you develop an increase in the ICT.
We know that blood flows from High Pressure to Low Pressure. Generally , the CSF pressure is lower than the BP.
However after a point , the ICT is bound to become equal to or even more than the systemic BP!
If that happens , the blood flow to the brain is decreased and the Brain can get ischemic (cause the Cranial pressure would be higher. So the body won't be able to pump the blood into it.)
Thus, in order to compensate for this , the sympathetic system is activated. The body's peripheral vessels undergo constriction to raise the BP. This would keep them at a higher pressure than the Cranium thus keeping the blood flow intact for a while at least. This causes the Systemic Hypertension.
In a way it's the last ditch effort to save the brain!
Due to sympathetic stimulation the respiratory centers get stimulated too and it's all weird so it causes Irregular Respiration.
Now you'd expect Tachycardia when there is so many Sympathetic juices flowing through your body.
But no. Things aren't as simple as that.
The aortic baroreceptors sense the increased BP and end up decreasing the Heart Rate. Resulting in Bradycardia. So in a way that's the 2nd phase of this Reflex!
The Reflex serves as a marker of raised ICT as that is the event that puts the whole cycle into place.
This generally occurs as the body's last resort to restore blood to the brain.
What a wonderful Homeostatic mechanism !!
Hope this helped !
Stay awesome !
Hello readers ! Today's blog is sweet and simple.
R-Right upper quadrant pain .
Friday, January 20, 2017
Here's a mnemonic for the reflexes seen in neonates and infants: GRASPMEN
G- Grasp reflex/ Glabellar tap
R- Rooting reflex (to assist breastfeeding)
A- Automatic walking reflex
S- Suckling reflex (during breastfeeding)
P- Plantar Reflex
M- Moro's reflex
E- Extrusion reflex
N- Neck (tonic reflex)
- Jaskunwar Singh
Hello everyone !
This is a short post about the manifestations of Tuberculosis in the eye.
TB is associated with a lot of findings in the eye.
We can classify them as :
1. Disease related.
2. Therapy related.
Let's look at the first one.
1. Disease related :
A. Extra Ocular structures -
I. Appendages :
Eyelid - Lupus Vulgaris. Lid granuloma.
Lacrimal apparatus - TB Dacryoadenitis. Dacryocystitis.
II. Orbit :
B. Ocular manifestations -
I. Conjunctiva -
Phlyctenular Conjunctivitis - due to hypersensitivity to Tuberculin. Seen as intense itching , discharge , redness and nodules.
II. Cornea -
III. Uvea -
Granulomatous uveitis ( Chronic anterior Uveitis ). Shows Mutton Fat appearance.
Choroiditis - Choroid Tubercles - classic of TB Uveitis. Tuberculoma may be seen. Miliary choroid nodules may be seen.
IV. Retina -
Eale's disease - may be a result of Hypersensitivity to Tuberculin. Although causality is not established clearly.
Sub retinal Tubercles.
2. Therapy Related :
A. Ethambutol - may cause Optic Neuritis - generally retrobulbar type. With Color Blindness.
B. INH - Isoniazid can cause retrobulbar optic neuritis, although this is much rarer.
C. Immune Reconstitution Inflammatory Syndrome - When a person recuperates from TB /HIV his immune system may become hyperactive and show Immunologically mediated uveitis.
Hope this helps !
Hello everyone !
Here's a way to remember the D/D's of Nodules at the Limbus.
Please Please Please ! Eat Spicy MCDonald's Tortilla.
Please - Pterygium.
Please - Pinguecula.
Please - Phlycten.
Eat - Episcleritis.
Spicy - Scleritis.
M - Melanoma.
C - Choristoma
Donald - Dermoid.
Tortilla - Trachoma. Tranta spots.
1. Out of these Pterygium , Pinguecula and Phlyctens are Conjunctival lesions.
Pterygium is a fold of conjunctiva that encroaches towards the pupil.
It can be vascular and nodule like. Can cause Foreign body sensation and decreased vision if it covers the pupil.
It may also cause Diplopia and a Squint due to its traction over the eye.
A pinguecula is milky like nodular swelling of the conjunctiva.
A Phlycten is a lesion in Phlyctenular Conjunctivitis which is an allergic or Hypersensitivity response to Tuberculin or staph Antigens. There is intense itching , discharge and nodules in the eye - called Phlyctens.
2. The lesions of Episcleritis and Scleritis are similar. They're both associated with systemic disease like Rheumatoid Arthritis , SLE, Sarcoidosis etc.
Scleritis is a more severe one of the two. There's marked redness and congestion of the eye along with multiple vascular nodules. The eye is very inflamed. There is intense pain and watering. It needs urgent treatment. It may causes various types of staphylomas.
Episcleritis is a more benign form. There is intense itching , nodular vascularity and discharge with some amount of congestion.
3. Tumors like Choristoma , Dermoid tumor and Melanoma mainly arise from the uvea. They're not very common.
4. Trachoma : presence of lesions in trachoma at the nodule may be prominent. You may also get 'Horner Tranta spots' in Vernal Keratoconjunctivitis which is an allergic Conjunctivitis.
Hope this helped !
Stay awesome !
Hello everyone !
This is a post about how to look for a normal pupil while doing an ophthalmological examination.
So here goes :
1. The Setting.
- Relax the Patient
- Take the patient to a semi dark room.
- Make the patient Fixate on a distant point to eliminate any error that Accomodation may produce.
- Place an obstruction between the two eyes.
- Always shine your torch laterally and bring it in only from the sides to avoid light shining directly on the other eye.
2. The Parameters.
Look for the following in the pupils :
- Shape ( for eg. You may get a Festooned pupil on adding your Mydriasis if the patient has adhesions)
- Number ( for eg. You may get Poly Coria which causes Diplopia )
- Location ( for eg. You may get Corectopia)
3. Reaction to light.
- Unless you've met the criteria above ( The setting) , you cannot say 'Direct and indirect reflex present' .
So unless you're in a semi dark room (and the other 3 criteria mentioned above) you would plainly shine the torch and look for constriction. This plainly shows the pupils are reactive to light.
4. Light Reflexes.
- Check for your direct and consentual (indirect) reflexes in both your eyes after meeting the listed Criteria in the *Setting* !
Hope this helps !
Happy studying !
Hello everyone ! I'm back with a short and sweet post on Argyll Robertson Pupil.
Mnemonic for Argyll Robertson Pupil (ARP) :
ARP Accomodation reflex present
PRA Pupillary reflex absent.
It's seen in conditions like Neurosyphilis for which it is extremely specific.
You could also see it in some form of strokes or Diabetic Neuropathy.
Another similar Pupillary reaction is Aedes pupil. The difference is Aedes is a dilated pupil while Argyll's is constricted. How to remember this ?
Mnemonic : AeDes.
So Aedes is tonically Dilated.
Hope this helped !
Thursday, January 19, 2017
This is the third one in the four-post series on Narcolepsy. Let's commence.
That's all! Do go through the other posts in this series.
Role of Orexins in Narcolepsy
Clinical features of Narcolepsy
Treatment of Narcolepsy
Role of Orexins in Narcolepsy
Diagnosis of Narcolepsy
Treatment of Narcolepsy
This is the first of the four-post series on Narcolepsy.
So let's start. The hypocretins were thought in the past to regulate feeding behaviour and energy metabolism, the word “orexin” is derived from the Greek word for appetite. But later through animal experimentation it was found that in mice, inactivation of two hypocretin receptors reproduces Narcolepsy.
First of all, let us learn that monoaminergic neuronal projections from Tuberomammilary nucleus(histaminergic), Locus Ceruleus(noradrenergic) and the Raphe nucleus(serotonergic) inhibit the Ventrolateral Preoptic Nucleus(VLPO) of hypothalamus.
Wednesday, January 18, 2017
There are two unique facts about IgG
2)Suppression of homologus antibody synthesis by a feedback process.
Well we can say body has complete control over the catabolism and to make it simpler let's say body and IgG both acts opposite to each other !.(Just a saying :p,Infact we know IgG works for body).For example In some diseases like chronic malaria ,kala azar or myeloma IgG level rises and as we know body has complete control and it acts against it So, IgG synthesis its gonna catabolised it rapidly !
Conversely,In hypogammaglobulinemia IgG given for treatment is metabolised slowly.
IgG has another unique property of suppressing the antibody synthesis which looks like it or performs similar kind of functions or simply homologus antibody.
Now let's say IgG is quite insecure about its true but dominating love -"Body". It doesn't want any competition so it kicks away all the antibodies which looks like it or perform similar function like him
(Such a insecure antibody it is !)and this unique property is utilised in the Iso-immunisation of a women by administration of anti-Rh(D) IgG during delivery.
It's the only maternal immunoglobulin that is transported across placenta and provides "Natural passive immunity"in new born (Not present in infants )
IgG2=23% (By the way 23 is also half life of IgG)
Hello readers, here is the continuation of the previous topic, Immunohemolytic anemias. Today we will discuss the next two types, its more like winter special.
B) Cold agglutinin type- Cold agglutinin derives their name from the fact that they show maximal activity at temperature lower than normal body temperature.
It is present in low titres in healthy individuals.
Physiological cold agglutinin develops naturally after birth as a result of change in expression of Red cell antigens and reacts maximally at 4°C.
While pathological cold agglutinin maximally reacts at around 28-31° C and tend to occur at very low titres.
Mnemonic is "Cold MILL"
C - Complement mediated hemolysis.
M - IgM is the causative antibodies
I - Cold agglutinin antibodies appear
transiently following Infections
[Mycoplasma pneumoniae, EBV,
HIV, influenza virus, CMV]
- I antigen is the most common
L - Chronic cold agglutinin AIHA is
associated with Lymphoid
(esp B cell neoplasm), leukemias
Mechanism- IgM binds to red cell where the temperature may fall below 30°C. It agglutinates red cells, and fixes complement rapidly. As blood recirculates and warms, IgM is released,but sufficient deposition of complements leads to phagocytosis of affected red cells in spleen, liver, bone marrow.
Clinical presentation- Exerts their pathological effects either via hemolysis and red cell destruction in RE system predominantly liver or by vaso occlusion due to agglutination.
-Mild anemia, purplish discoloration of fingers, toes, earlobes [ Acrocyanosis], mild hepatospleenomegaly,
Raynaud phenomenon in peripheral cold exposed parts.
C) Cold hemolysin type -
Also known as paroxysmal cold hemoglobinuria.
It's a rare fatal disorder causing intravascular hemolysis and hemoglobinuria when auto antibodies binds to P blood group antigens in cool, peripheral regions of body.
Paroxysmal Cold HemoGlobinuria:
P- P blood group antigens
C- Complement mediated lysis occurs.
IgGs auto antibodies binds to red cell in
cool peripheral regions, Complement
mediated lysis occurs when affected
red cell recirculates to warm regions,
because complement cascade
more efficiently at 37°C
G - Auto antibodies belong to class IgG
Symptoms of the patients aggravates on exposure to cold.
Winter is coming, we know what's coming with it.
Stay warm :)
Tuesday, January 17, 2017
This is my very first post, so am starting with my favorite subject Hematology.
Today's post is about Immunohemolytic anemias, commonly ignored type of anemia
Also referred as Autoimmune hemolytic anemias(AIHA)
Where antibodies are responsible for premature destruction of red blood cell.
Types- warm antibody type
- cold agglutinin type
- cold hemolysin type
Warm antibody type - It is the most common type of AIHA.
you can remember it by mnemonic
" WARM GRILLED "
W - Warm because, antibodies are active
A - Associated with other Autoimmune
disorders ( secondary causes like
R - Red cell hemolysis is mainly
M- Moderate spleenomegaly due to
hyperplasia of splenic phagocytes
G- Ig G class - most common causative
antibodies ( IgA sometimes too)
R- Rh blood group antigens are the main
I- 50% primary cases are Idiopathic
Secondary causes can be
L- Lymphoid neoplasm
ED- Exposure to Drugs.
Examples - penicillin, cephalosporins, quinidine, methyl dopa etc
Mechanism - A) Antigenic drugs-
Drugs such as penicillin binds to red cell membrane and they are recognized by the antidrug antibody. The antibody either recognizes the drug and bind to it or both drug and membrane protein,ultimately results in hemolysis.
B) Tolerance breaking drugs- In drugs such as methyl dopa, antibodies are formed against red cell antigens particularly Rh antigens.
Monday, January 16, 2017
0Hello readers! Being in medical field we are quite acquainted with the word "Stress out" .Todays article is just about a simple nasal spray that can prove to be a boon to entire human kind.(I think specially our field ! :p)
Everything in a brain is carried out by special substances called as "Hormones" .Even the simplest change in mood is concerned with hormonal changes.For example in first trimester of pregnency a rapid rise in estrogen and progesterone can cause mood swings in woman.Similary when there is depletion of hormones or its metabolites or less production of hormone this can leads to depression ,low -emotional state ,anxiety etc.Suicide can be triggered by serious illness ,can also be triggered by low self-esteem or emotional pain .
Scientists are developing a nasal spray that can prevent suicides! .This nasal spray consists of Thyrotropin releasing hormone(TRH) also known as thyroliberin . Thyrotropin is actually hormone released by hypothalamus ,it actually stimulate release of thyrotropin and prolactin from anterior pituitary.Recent findings have found out that TRH also shows anti-depressant and anti-suicidal effects.Thus preventing suicidal behaviour and depression.Researchers want to figure out ,a way to deliver it to a brain when it is given through nose .Brain is protected by Blood brain barrier (BBB),which is acting has a hinderence to pass TSH to brain.
Clinically it is related in spinocerebellar degeneration and disturbance of consciousness in humans.Pharmacological form is known as protirelin.
I hope scientists find it soon how to cross BBB :p
Exams are near and I am already freaking out :p
Keep smiling :)
Have a day with high level of TSH in brain :)
Hello awesomites !Today's topic is short ,simple and easy to understand.
Cancer is basically a disease where there is abnormal growth of cells in body and sometimes it is also malignant that is ,it can spread from one organ/site to another.These newly formed cells can disturb normal cycle of other cells .When a cell suffers DNA damage from cancer,a virus or radiation a group of protein complex MRN is sent to repair DNA.MRN is protein complex ,it consists of Mre11,
Rad50 and Nbs1 .In eukaryotes initial processing of double strand DNA breaks prior to repair by homologus recombination or by non-homologus joining.
When a DNA virus is present in the cell,MRN instead focuses on removing it.
If both DNA damage & a DNA virus are present in a single cell .The MRN complex is unable to manage both threats at once and ends up ignoring the virus .
These new findings imply that scientist might be able to form a virus that targets and kills only cancer cells.
Saturday, January 14, 2017
Hello awesomites !!! Today's topic is something that really has created revolution in the entire human race - "Artificial skin"
Skin is the largest organ of our body .It consists of three parts Epidermis ,dermis and fatty layer.Epidermis serves as the protective layer of the skin ,it prevents the entry of the pathogen into body with the help of sebaceous and sweat glands along with long chain fatty acids ,and dermis consists of all the nerves ,artery and veins that supply skin.Fatty layer maintain the body temperature.
A damage to the skin through burns causes loss of large number of plasma and it provides free entry to pathogens into body. Artificial skin was discovered by Loannis yannas & his colleague surgeon Dr John burke.
Artificial skin was discovered to replace bandages ,which cannot seal large damage areas .Patients with extensive burns often die as bandages cannot heal their wounds completely.Even if patient survives some scars are left behind on skin.Artificial skin consists of collagen polymers .Collagen is protein found in skin . Artificial skin helps patient to grow skin without forming any scars.It has been commercially prepared under name as "IntegraTM".IntegraTM is also used in plastic surgery and also in chronic skin wounds .
Ahh! That's it :)
Keep smiling :)
Have a nice day!
Friday, January 13, 2017
Hello awesomites today I am gonna tell you something that is really -really interesting and fascinating !.
We all know how crucial is open heart surgery in some conditions ,here is one of the alternative method of open heart surgery.(For some conditions)
Alternative method :-
For the 1st time a new catheter technology was used in place of open heart surgery.
Cardioband is a low impact method to fix leaky mitral or tricuspid valve in heart .The catheter technology offers a minimal invasive alternative to heal a leaky valve.It enables the tightening of a leaky annulus in the heart .
During this procedure,the band is placed around the open valves using catheter.It is served with anchors & tightened using a wire until the valve is fully closed.Until now ,only treatment of leaky tricuspid was open heart surgery.
Now patient previously thought to be inoperable will have chance to be treat.
University Zurich hospital successfully performed first tricuspid surgery using cardioband .
Have a happy day
While studying the Monteggia and Galeazzi fracture and dislocation today, I googled and came up with a mnemonic. GRUesome MURder helps us remember which bone is fractured and which one is dislocated.
R: Radial fracture (lower- third)
U: Ulnar dislocation
U: Ulnar fracture (upper- third)
R: Radial dislocation
Also in Monteggia fracture, bone of medial side is involved.
- Jaskunwar Singh
Thursday, January 12, 2017
Hello readers ,Here is something new information about human saliva !.
Human saliva and pain killer :-
Human saliva contains a painkiller that is naturally produced by human body .It is called as -"Opiorphin" in very low concentration.
Opiorphin prevents the breakdown of chemicals called as enkephalins . Apart from this opiorphin inhibits 3 protease.-
b)Ecto-amino peptidase .
This extends the duration of enkephalins.
The enkephalins activates opiate receptors .Activated opiate receptors blocks pain signals from reaching brain!!. opiorphin is 6 times more potent than morphine .Unlike morphine opiorphin is not addictive and prolonged use may not lead to tolerance .
Current status in research:
Painkiller was successfully tested on rats.Further research is still needed before it's use on humans .Research include modifying molecular structure to avoid rapid degeneration in intestine and it's poor BBB(Blood brain barrier !).Modification includes transformation of N-terminal glutamine into pyroglutamate .
Wednesday, January 11, 2017
Hello awesomites ! Today's blog is about new drug -Tideglusib.
Tideglusib is actually Alzheimer's drug and is also used in paralysis of supranuclear palsy!
However this drug is currently in news because of its ability to stimulate repair of teeth .
Use of this drug can cause end of dental fillings .
Mechanism of action of drug
The mechanism is roughly known .It acts in 2 ways
1)It stimulates stem cells in the pulp of the teeth to generate new dentine and heal small cavities.(Dentine is hard dense bony tissue that forms your teeth)
2)Inhibits an enzyme called as GSK-3 which prevents formation of dentine !,
Progress in research:
Drug is successful tested on mice .They soaked biodegradable sponges in the drug and then placed them in cavity .The sponges melts away over time,leaving only the repaired tooth but for use in humans ,the drug is still under research.
Keep smiling :)
Tuesday, January 10, 2017
Hello awesomites ,really tired of all the bookish knowledge so for time being I switched my self to internet,and came across some of the rarest and the most interesting diseases of all the time !
Here is the first one -Ectopic cordis.
What is -Ectopic cordis?
It is the disease where the heart is located at abnormal position that is places other than thorax or sometimes partially at thorax.It is a congenital disorder
It is caused due to improper maturation of the mesoderm and ventral body wall durig embryonic development.Lateral wall is responsible for fusion at midline to form ventral wall any change in this process may lead to -Ectopic cordis.
Depending upon situation of the heart in patient ,ectopic cordis is classified into 4 parts :-
1) Ventricular septal defect .
2)Atrial septal defect.
3)Absence of tricuspid valve.(Tri-cuspid atresia)
4)Fallots tetralogy. (http://www.medicowesome.com/2017/01/teratology-of-fallot.html)
Unfortunately the only treatment is surgery !
Not all the surgeries are successful .
Patients of ectopic cordis hardly can live for long years as there are more chances of infections to heart .
That's it for today.
Internet is interesting:)
Monday, January 9, 2017
A good friend of mine asked me to review the concept of SAAG. So let's dive into a "Puddle" of ascitic fluid. :P
As you guys all know, SAAG stands for Serum-Ascites Albumin Gradient and it helps to differentiate the causes of ascites. What it means is pretty self explanatory, it is the difference (gradient) between the levels of albumin (a plasma protein) in two compartments i.e. Serum and Peritoneal fluid.
Hello readers today's blog is small one -Fallot's tetralogy .
What is Fallot's tetralogy?
It is a congenital disorder of heart .It is caused to foetus may be because of alcoholic mother or who has diabetes or may be due to rubella infection caused during pregnancy.It is caused due to deletion of chromosome 22
Signs and symptoms:-
As the name suggest ,there are four signs
All four of them are related to heart .
Mnemonic is PVR -f cinema.
-Ventricular septal defect .
-Right ventricular hypertrophy
-Over-riding of aorta ,due to which blood from both the ventricles may enter aorta.
Due to defect in heart ,there is low oxygen supply to tissue this may lead to cyanosis when there is high amount of pulmonary stenosis but when there is moderate amount of pulmonary stenosis this may lead to pink tit that is pinkish colouration of skin.There is also clubbing .
Open heart surgery is only treatment for fallots tetralogy .
The appropriate time for surgery depends on the pulmonary stenosis .
However patient should be on life long medication for healthy life
That's all :)
Have a happy day.
Flagella: Within the host cell vacuole, legionella are nonmotile, whereas in the later stages of infection and cell lysis, legionella are flagellated and highly motile. Motility enables Legionella to escape from a spent host and facilitates its attempt to find a new host by dispersion into the environment.
Sunday, January 8, 2017
Hello everyone ! I hope you'll have been enjoying the Top 10 Series that we've started. This is a short post on the insertion of Extra ocular muscles in the eye.
So there are 4 Extra Ocular muscles whose insertion on the sclera we need to be aware of ( in terms of distance from the Limbus). The Recti.
I'M Low Standard
I = Inferior Rectus. 5.5
M = Medial Rectus 6.6 (or 6.5 but just remember 6.6 for easiness)
L = Lateral Rectus 6.9 (Loser)
S = Superior Rectus 7.7
So basically it starts with 5.5 , 6.6, 6.9 and finally 7.7.
3 of these are the same number repeated (5.5 , 6.6 and 7.7) but LR is a loser. Hence it does not follow the rule and is a badass hence does a 69. :p
Hope this helped !
Adverse drug reactions of Sulphonamides mnemonic-
S- Stevens- Johnson syndrome
U- Urinary crystals formation and bleeding
L- Lyell's syndrome (TEN)
H- Hepatic/ Hematologic
O- Ocular side effects
N- Neonatal jaundice/ Nausea and vomiting
A- Antimetabolites (inhibit folic acid synthesis)
M- Miscarriage (pregnancy and fetal abnormalities)
S- Serum sickness
- Jaskunwar Singh
Saturday, January 7, 2017
When do you really attain adulthood?
18. That's when you are legally declared an adult. Right? Oh so you already got the answer. Hey no wait.. we are medical professionals and students of science. So talking in a legal way doesn't always seem right, because from a scientific perspective, adulthood is still an unsolved mystery. Let me tell you about it here..
Friday, January 6, 2017
Hey,Hello! awesomites ,this blog is just a small review of some old and new things I learned about Parkinson's disease.
The very first thing I learned is:- parkinson's disease and parkinsonism are two different terms !!!.
-Parkinsonism is a complex term it includes many symptoms while parkinson's disease is a progressive neurodegenerative disorder .
-Parkinosons disease is actually cause of parkinsonism .
Let's start with Parkinson's disease
-Main cause is decrease dopamine secretion in body mainly due to injury to substantia nigra which sends dopamine secreting nerve fibers to caudate nucleus and putamen.
Signs and symptoms:
- Characteristics features is tremors .Tremors occurs during all walking hours and therefore it is a type of involuntary tremor in case of cerebellar disease there is an intension tremor because tremors are seen when patient perform any work.
-Also festinant gait is found
-Akinesia is also seen
-Lead-pipe rigidity is seen earlier in hands and legs followed by neck and trunk.
-Any serious injury that affects dopamine secretion !
-Also some medication which decreases dopamine secretion or blocks dopamine receptors.
-Apart from that certain drugs also induces Parkinson's disease like drugs used to treat schizophrenia and other neuroleptic drugs like
Apart neuroleptic drugs,others drugs like prochlorperazine,metoclopramide.
Also calcuim channel blockers causes Parkinson's
Drug induced Parkinson's remains same ,it doesn't progress
Categories of drugs used for treatment of parkinsonism:-
Thursday, January 5, 2017
Today I am gonna give some brief review about how to treat constipation .So let's start with basics
Why constipation occurs ?
-Water serves as a transporter of stools ,decrease in concentration of water in intestine can lead to constipation ,it may be either due to increase absorption from the extracellular space or decrease water content in body.
-Decrease bowel moment
How to treat constipation?
-As now we know cause of the constipation ,we can treat constipation either by :-increasing water content or decrease loss of water from intestinal lumen
And also by increasing bowel moments so less water or salts are absorbed (Yet some drugs uses another mechanism.)
Drugs used :-
1)We can use Dietary fibers which will just form a bulk in intestine and will increase water content of faeces ,also due to bacterial degradation some osmotic active substances are produces which further increases water content Hey but there is one drawback ,it may causes gas :D.
-They permit water and lipid to penetrate stool .
-They are either given orally or rectally!
(Yes a drug acting on intestine can also given rectally)
-Again there is one drawback ,prolong use can cause impair absorption of fat soluble vitamins ( A,D,E,K)
3)Osmotic laxatives (Laxative is term used for drugs for treatment of constipation)
-Colon can neither concentrate /dilute fecal fluid so fecal fluid is isotonic throughout the colon
-Generally we use non-absorable sugars /salts eg:-Magnesium citrate & sodium phosphate.
-Osmotic laxatives are commonly used but should not be used in patient with renal insufficiency.
-But patient using sodium phosphate must take adequate water to compensate fluid loss due to it
,It may causes hyperphosphatemia,hyper natremia , hypocalcemia,hypokalemia.
-So should not be used in cardiac patients
a) Anthraquinones:It after hydrolysis produces bowel moment in 6-12hrs if given orally or within 2 hrs if given rectally.!
-It may causes melanosis coli.
b)Diphenylmethane derivatives : It increases bowel moments in 6-10hrs when given orally and in 30-60mins when given rectally.
-It has minimum systemic absorption
5) Opioid receptor antagonism
-Now this is an interesting type of drug mechanism rather than increasing motility it "decreases" motility .
Still it is used in prevention of constipation ?!
Yes ,by decreasing motility it prolonges the transient time required for absorption of water and salts from surrounding
Eg:-Methylnaltrexone & alvimopan.
Wednesday, January 4, 2017
Mostly on lesser curvature of antral end of stomach and rarely on lower end of stomach.
1)Increase in acid secretion and peptic content in stomach .
2) Irritation to mucosa.
3)Poor blood supply .
4)Poor secretion of mucus.
5)Infection by H.pylori.
We give anti-ulcer therapy for peptic ulcer treatment
Following are goals of anti-ulcer therapy
a) Relief of pain.
c)Prevention of complications.(like bleeding ,perforation)
d)Prevention of relapse.
(I have made some lame tricks for memorising drugs name:D ,if you have some mnemonics please comment !)
1) Decrease acid secretion :It includes total 4 categories ,they are described below .
-Esomeprazole.(Read it as Es-omeprazole)
(Read it as Dex-rabeprazole!)
(Read it as Propan-the-line).
(Antacids) .It includes 2 categories
-Sodium bicarbonate .
-Magnesium hydroxide .
-CBS (Colloidal bismuth subcitrate!).
Tuesday, January 3, 2017
Let me ask you a question.. how much focused you are during your study time? Well, as a medical student you try your best to focus on what is written in the book and in making your own notes. You are not aware of your surroundings anymore. Someone comes nearby and calls you or sits just beside you but still your eyes are on those words and difficult medical terms of the diseases and syndromes and the drugs used to treat them. This is called Change blindness, a perceptual phenomenon that occurs when you don't notice a major change in the environment because you are too focused on one particular thing.
Let me give you another example. A young guy is standing in a long queue at a place while some people arrive from the opposite side. He starts staring on a cute little child who was looking at him too. They share smiles, and eye contact for several minutes while the mother carrying the child moves on. The guy just stands still there and is not aware of the surroundings when other people behind shout at him because he is not moving forward or letting them go. All of a sudden he realizes where he is and so walks ahead. This transient moment is the change blindness. :D
Note: Even maintaining an eye- contact with someone, even a child in this case may prove strenuous for the brain especially during reasoning and verbal processing and so is itself a distraction (distracting the young guy from the queue and instead focusing on that child). That is why we periodically avert our eyes during conversations.
During this particular moment this guy activated his visual association area (visual cortex) while looking at that child which meant he was just paying attention to the perceptual details (the depth of eyes of that child, cuteness, innocence, love).
On the other hand, the older adults may notice changes and patterns happening around while doing a particular task as well. Reduced focus (mental distractions) in the aging brain is responsible for the abstract thinking in them that is needed for problem solving and creative work.
In other words, the healthy aging people show thinking patterns that allow them to make connections among pieces of information that are right in front of them as well as information they have have encountered in the past. For example, an older adult involved in a conversation might pick up information on current road conditions from a television nearby, whereas a younger adult might be paying a closer attention to the conversation itself. Later on, the older adult might make use of the information from the TV broadcast while planning a route home.
The study suggests that older adults tend to have more focused attention in the morning and more of the abstract thinking later in the day. College students on the other hand tend to have their peak attention in the afternoon or evening and are less focused in mornings.
Inability to remember details of major events or just the location of objects begins in early midlife (the 40s) which does not mean the brain function is deteriorating, instead it may be the result of the changing focus of brain on the particular information during the process of memory formation and its retrieval. The experiments on this study have concluded that the middle- aged and older adults don't really show the same level of visual cortex activation as the young do when they recall the information. Instead, their medial prefrontal cortex is activated, a part of the brain that is involved in learning associations between events and the corresponding adaptive responses. The mPFC likely relies on the hippocampus to support rapid learning and memory consolidation.
- Jaskunwar Singh
- Based on the mechanism of injury (type) :
A. Contusion (blunt trauma)
B. Lamellar laceration (due to a sharp object or blunt trauma)
C. Superficial foreign body (organic matter or metals)
D. Mixed (combined injuries)
- Based on the visual acuity (grade) :
A. >20/40 (0.5)
B. 20/50 - 20/100 (0.4 - 0.2)
C. 19/100 - 5/200 (0.2 - 0.025)
D. 4/200 - Light Perception (0.02 - L+ P+ )
E. No Light perception
- Based on the pupillary defect :
A. Relative afferent pupillary defect (RAPD) positive
B. Relative afferent pupillary defect (RAPD) negative
- Based on the Zones of violations :
Zone I- External (superficial injuries of bulbar conjunctiva, cornea and sclera)
Zone II- violation of the Anterior segment (structures in anterior chamber and the pars plicata)
Zone III- violation of the Posterior segment (structures posterior to the posterior lens capsule- retina, vitreous and optic nerve)
- Jaskunwar Singh
Hello readers,today I am gonna tell you about some blood indices -there meaning, normal values, and units ! . Hopefully they will be useful . I always use to mess up them during my very first year :(
1)Mean corpuscular volume (MCV):It denotes the volume in a single RBC .It correspond to size of RBCs ,so when MCV is in normal range it denotes normocyte .When MCV increases , RBCs are known as macrocytic eg : megaloblastic anemia and when it decreases ,cell are microcytic eg: iron deficiency anemia.
MCV can be calculated by automated hematology analyzer or by using hematocrit value
MCV:-Hematocrit (%) ×10/RBC count
(million /cubic mm).
Unit of MCV is femtolitre(fL)
Normal value is 80-95 fL
2)Mean corpuscular hemoglobin(MCH):-
It's the quantity or amount of hemoglobin present in one RBC. It's normally expressed in picogram or microgram .
Normal range is 27-31 pg
MCH :-Hb (gm per 100mL)/Total RBCs in blood(million per cubic mm) . I think no need to tell MCH decreases in anemia :D
3)Mean corpuscular hemoglobin concentration: It is concentration of hemoglobin in one RBC.It is actually the amount of hemoglobin expressed in relation to volume of RBC.(It's actually
Combination of above two terms )
So we express it in gram /dL
Normal value is 33-36 gm/dL
When RBC size decrease , RBC is known as hypochromic
In pernicious anemia RBCs are macrocytic and normochromic While in iron deficiency RBCs are microcytic and hypochromic.
We don't have hyperchromic RBC because content of RBC is limited !
Soo here's a nice memory aid I came across...
If you write two A's (AA) It does look like an M!
B for cluster B, B for Bad!
C and Sea sounds similar for Sad xD
Mnemonic for personality disorders
Monday, January 2, 2017
Hello awesomites ! Some days back I revised my concepts on regulation of blood pressure so would like to share with you ,so lets start it .This is short -term regulation of blood pressure.
Changes in blood pressure is normally detected by 9th cranial nerve from carotid sinus and by 10th cranial nerve from aortic arch both of them carries signal to NTS (nucleus of tractus solitarius) present in medulla oblongata which in turn co-ordinate 3 centres present in medulla oblongata.
- Cardio inhibitory centre .
- Cardio stimulatory centre.
- Vasomotor centre.
Now suppose there is increase in blood pressure ,let's see microscopically what changes we are gonna seen in nerve endings of 9th and 10th nerve.
An increase in blood pressure will stretch carotid sinus and aortic arch ,which in turn will cause stretching or spreading of nerve endings ,which will increase influx of the sodium ions . Ultimately increase in depolarisation wave will cause stimulation of NTS (Even decrease in depolarisation wave will stimulate NTS ,which happens during decrease in blood pressure).Now as we know there is increase in blood pressure , NTS-our main character in this process will control these 3 centres to control blood pressure. Let's see what it do to these three centres present in medulla oblongata.
1)Cardio-inhibitory centre : This centre will be stimulated which in turn send fibers to SA node and AV node via right and left vagus nerve respectively.Leading to decrease in heart rate ,obviously cardiac output will decrease so will be blood pressure!.
2)Cardio-stimulatory centre: This centre will be inhibited which causes decrease in heart rate and cardiac output via it's fibers (post-ganglionic) which passes to lateral horn of spinal cord and then post-ganglionic fibers goes to sympathetic ganglion from where post-ganglionic sympathetic fibers acts on heart causing decrease in heart rate and cardiac output.
3)Vasomotor centre:This centre do's more work compared to above two mentioned centres .It acts on three areas ,
Let's see how it reacts when there is increase in blood pressure.
a) On arteries :It causes vasodilation leading to decrease in Total peripheral resistance which is directly proportional to diastolic pressure hence causes decrease in diastolic blood pressure.
b )On veins :It causes vasodilation leading to decrease in venous return which is directly proportional to EDV and which in turn causes decrease in Cardiac output and hence decrease in systolic blood pressure.
c )On adrenal medulla: Decreases release of epinephrine and nor-epinephrine which is responsible for decrease in HR,so decrease in blood pressure.
Woahh! Was such a long blog!
I think it's not necessary to mention occlusion of carotid artery causes false phenomenon of decrease in blood pressure so opposite effects will be seen:)
Sunday, January 1, 2017
Hello awesomites ! Today I am gonna talk about a drug named as "Metoclopramide".
Basically it's a anti-emetic drug.First let us know what is emesis !.In simple words emesis means vomiting.Chemoreceptor trigger zone (CTZ) is located in area postrema and the nucleus tractus solitarius (NTS) of medulla oblongata.They both act as a important relay areas for afferent impulses arising in g.i.t.,throat and other viscera.
Metoclopramide is a Pro kinetic drug
It acts on GIT causing increase in peristaltic movement with relaxation of pylorus .
Mechanism of action includes :
a)D2 antagonism:It Decreases dopamine concentration and obviously acetylcholine concentration increases !.Which causes activation of ACh receptors leading to increase in LES tone and gastric pressure .
b)5-HT4 agonism:Activates 5-HT4 receptors on primary afferent neurons (PAN) of the ENS,via excitatory interneurons.
Gastric hurrying and LES tonic effects are mainly due to this action which is synergised by bethanechol and attenuated by atropine .
c)5-HT3 antagonism: At high concentrations it can block 5-HT3 receptors present on inhibitory myenteric interneurons and in NTS/CTZ .Increase in ACh concentration is also seen in minor condition
Long term use can cause parkinsonism-since decrease in dopamine , galactorrhea and gynecomastia .
It hastens use of many drugs like aspirin and diazepam by its action
~Jaskunwar Singh & Ojas