Saturday, March 11, 2017

Fact of the day: Paradoxical undressing in fatal hypothermia

Hypothermia causes paradoxical undressing.

This typically occurs during moderate to severe hypothermia, as the person becomes disoriented, confused, and combative. They may begin discarding their clothing, which, in turn, increases the rate of heat loss. It is estimated that twenty to fifty percent of hypothermia related deaths are due to paradoxical undressing.

Why does this happen?

Friday, March 10, 2017

Fact of the day: Psychosomatic symptoms love to travel

Hey Awesomites

Yes, you read it right. The symptoms of psychosomatic disorders flit from one body part to another, and just too easily and quickly ( they love to travel a lot ;p ) . Just as one symptom is discovered, it disappears and another one emerges in some other part of the body.

The psychosomatic symptoms have been linked to a chameleon. Every time a medicine tries to pin them down,  they become something different.

That's all
- Jaskunwar Singh

The colours of a chameleon are not more numerous and inconstant than the varieties of the hypochondriac and hysteric disease.
 - Robert Whytt

NYHA Classification Mnemonic

Hey guys, this post will help you to remember the definitions of the four NYHA classes.

So first just remember two phrases-
"Patient with a heart disease" and "in ordinary or accustomed activities". For convenience I will use letters A and B to refer to these phrases respectively. Now I will just fill in the gap between them.

1. NYHA Class I:
A--- will not get dyspnea ---B.

2. NYHA Class II:
A--- will get dyspnea ---B.

3. NYHA Class III:
A--- will get dyspnea in less than ---B.

4. NYHA Class IV:
A--- will get dyspnea at rest.

This system of classification has its flaws since the definition of "ordinary and accustomed activities" is entirely subjective. Like for example if a rich businessman gets breathless after walking 1 km, you may label him as NYHA Class II, but the same case in a hard working labourer will have to be labelled as NYHA Class III.

And another thing that NYHA has recently clarified NYHA Class III a bit further, it has included self-care activities in it's spectrum. As a supposition, if a 56 year old male person gets breathless while shaving or bathing then it is NYHA Class III.

-VM

Authors' diary: Medicowesome secret project


We initially introduced the secret project very mysteriously and kept the details highly confidential just for fun! Let me tell you more about it...

Thursday, March 9, 2017

Grave's ophthalmopathy features mnemonic

Hey Awesomites

Grave's disease, a common cause of primary hyperthyroidism causes some epic features of ophthalmopathy apart from lid retraction and lid lag. Mnemonic: EPIC

E- Exophthalmos
P- Periorbital Edema
I- Involvement of ocular muscles (diplopia)
C- Conjunctival irritation and chemosis

- Jaskunwar Singh

Amiodarone- induced thyroid dysfunctions

Hello

Amiodarone, a potent class III anti- arrhythmic drug is contraindicated in thyroid patients or those with subclinical disease. The reason lies in the pharmacokinetic profile of this drug.

The drug has a structural resemblance to triiodothyronine (T3) and thyroxine (T4). In the body, it is metabolized by dealkylation to Desethylamiodarone (DEA), the intrathyroidal concentration of which is higher than the parent drug.

Normal daily recommended intake of iodine for adults is approx. 0.15mg (150mcg).  Each 200mg tablet of amiodarone contains about 74.4mg of iodine with 7.4mg (10%) being released as free form. This is roughly 50- fold higher than the normal. Therefore, total body stores may remain increased for upto 9 months after stopping the drug.

High iodine content of this drug inhibits  local type-1 5'- deiodinase activity (blocking conversion of T4 to T3) and type- II 5'- deiodinase activity in the pituitary. As a result, TSH is increased initially (mild elevation) and then return to normal or may even decrease in euthyroid patients after weeks, while T4 is normal or raised, and T3 levels decrease.

The increased delivery and uptake of iodine by the thyroid gland may cause increase in hormone production and release, a condition called type-1 Amiodarone- induced thyrotoxicosis (AIT) . In other cases, excessive thyroid tissue destruction due to destructive thyroiditis may lead to type-2 Amiodarone- induced thyrotoxicosis. These are hyperthyroid states!!
Discontinuation of the drug is recommended, if not, then high doses of thioamides and corticosteroids may work in AITs.

Amiodarone may also cause hypothyroidism (AIH) in  patients depending upon the iodine status of individuals and prior thyroid disease. Wolff- chaikoff effect is shown by thyroid cells due to failure of thyroid hormonogenesis. Levothyroxine is the drug of choice.


Thats all
- Jaskunwar Singh

Wednesday, March 8, 2017

Fact of the day: Burning the heart to ashes

An interesting fact about heart I read today:

The heart is resilient, literally. When a body is burnt, the heart is the last organ to oxidize. While the rest of the body can catch flame like a polyester sheet on campfire, it takes hours to burn the heart to ash because it's deep inside!

That's all!

Did you know? According to Hindu mythology, when Arjuna cremated the body of Lord Krishna, his whole body turned into ashes, except his heart which was still burning. Arjuna washed the ashes and burning heart into the river.

- Jaskunwar Singh

Munchausen's syndrome

Hello

"Psychosomatic disorders are conditions in which a person suffers from significant physical symptoms (causing real distress and disability), that is out of proportion to that which can be explained by medical tests and physical examinations."

Karl Friedrich Von Munchausen, the "Baron of Lies" gave his name to the syndrome. Munchausen's syndrome (now more correctly called factitious disorder in DSM- 5 classification of somatic symptom and related disorders ) refers to patients who imitate illness (may be in an exaggerated form ) for medical attention and care and may even expose themselves to life- threatening operations, amputations, unnecessary medications and toxic treatments.

Lets take an example: A woman presents to hospital with a headache and a dilated pupil. On investigations, scans were normal and no other systemic abnormality seen. Then, a nurse walks into her room and finds the patient self- administering dilating eye drops into the affected eye.

The person has an awareness of the lies they are telling but they surely do it to seek medical care and attention, being unaware of their own motivation and uncontrolled behavior.

Upto one- third of patients in neurology ward suffer from psychosomatic illness and most often, an emotional cause is suspected.


Thats all
- Jaskunwar Singh

Parinauds syndrome notes, mnemonic and a video

Parinauds syndrome notes + mnemonic + video!

Is it okay to wish a man "Happy Women's Day"?

Hello awesomites!

Happy women's day to everyone - Male and female!

Tuesday, March 7, 2017

Study group discussion: PGE and congenital heart diseases

We had a discussion on this question on our study group today :)

PGE causes clinical worsening in an infant with?
A. PS without VSD
B. Hypoplastic left heart syndrome
C. Obstructive TAPVC
D. Obstruction in Aorta

Let's work this out - choice by choice!

Acute intermittent porphyria mnemonic

Acute intermittent porphria - AIP - That's the mnemonic!

Asbestosis and Silicosis mnemonics

Here are a few mnemonics to help you not mix these conditions up!

Monday, March 6, 2017

Hyperthermia in Pontine Haemorrhage

Hey guys!

This post will be focused on the pathophysiology of Hyperthermia in Pontine Haemorrhage( which may manifest as the Locked-in Syndrome, remember that super-awesome House episode? <3 )

1. First try the easy simple reason. Hypothalamus has been basically cut off from the body below pons and there has been Haemorrhage. Therefore, there will be a Sympathetic outflow causing peripheral vasoconstriction. Meanwhile the internal visceral organs are still functioning and consequently producing heat. So without hypothalamus, the body's ability to produce heat has transcended it's ability to lose heat.

2. The next reason is a bit "cooler", literally. Our body hates Hypothermia more than Hyperthermia, thanks to evolution. (Ice Age!!!) Now there is no central thermoregulation but peripheral one is still intact. And the peripheral thermoreceptors are much more sensitive to lower temperatures or basically cold environment. Once again, without the Hypothalamus, the body is defending itself too vigorously against Hypothermia as to contribute ironically to Hyperthermia.

3. This reason is the only one which you should know since this will explain how Baclofen, a GABA-B Agonist works to treat this Hyperthermia. Remember the Medial Forebrain Bundle, it connects Hypothalamus to a lot of structures, one of them being Nucleus Raphe in the Pontine reticular formation. This is a very crucial portal in control of Sympathetic nervous system outflow by Hypothalamus. Simply speaking, if the body is hot, Hypothalamus will send inhibitory (GABAergic and Dopaminergic) signals to this nucleus and if the body is cold, it will send excitatory (Glutaminergic and Serotonergic) signals. And apparently this connection is lost in Pontine Haemorrhage, so we substitute it with a drug.

P.S. Now you can guess how Bromocriptine and Apomorphine cause Hypothermia. :)

-VM

Fact of the day: Blood coagulopathies in Familial Hypercholesterolemia

Hello

It is known since long that familial hypercholesterolemia is associated with increased risk of cardiovascular disease as a consequence of atherosclerotic plaques in blood vessels. But Its NOT due  to high cholesterol levels in blood !!

The cause of such consequences lies in genetics. Genetic aberrations in patients with FH include variations in Prothrombin gene which increases coagulation and clot formation. This ultimately blocks the arteries by forming plaques!

Heart patients with FH also have higher concentrations of Fibrinogen and Factor VIII in their blood in addition to other factors, compared to healthy ones.

People with familial hypercholesterolemia tend to live a longer life than those with low cholesterol levels, suggesting a minor role of high cholesterol in pathogenesis of the disease.

However, cholesterol is still associated with other systemic diseases, though recently LDL has been considered 'good' too!


That's all
- Jaskunwar Singh

Sunday, March 5, 2017

Fact of the day: Proton pump inhibitors and osteoporosis

Chronic PPI usage is associated with an increase occurrence of bone fractures, at present, the likely mechanism of this affect, is not at all clear.

The assumed mechanism is that long-term PPI use leads to decreased intestinal absorption of calcium resulting in negative calcium balance, increased osteoporosis, development of secondary hyperparathyroidism, increased bone loss and increased fractures.

An acidic environment in the stomach facilitates the release of ionzed calcium from insoluble calcium salts, and the calcium solubilization is thought to be important for calcium absorption. 

That's all!
Happy studying!
-IkaN

Saturday, March 4, 2017

Facts and Fallacies: Almonds for Migraine

Hello

Some people who suffer from migraine are found to be deficient in magnesium and certain  vitamins. This proves to be one of the factor for causing such attacks!

Almonds are rich in magnesium and vitamin B2 ( riboflavin ) and contain salicin, an anti-  inflammatory agent and ingredient in aspirin. So 10- 12 almonds a day, equivalent to 2 aspirins helps in preventing acute attacks of migraine.

However, for those who are allergic to salicin, almonds may even trigger migraine attacks! Therefore prior testing is important in such cases.

Many recent updates and drugs have become available to treat the attacks but no single one is effective in long- term. For those deficient in magnesium and allergic to salicin,  infuse magnesium sulfate solution i.v.  over 3- 5 minutes.


That's all
- Jaskunwar Singh

Thursday, March 2, 2017

The story of Medicowesome (With Q&A)

Here's the video to the many questions people have asked me till date:
How did Medicowesome start? How do you manage blogging and studying? etc etc.

Pediatric milestones mnemonic

Another awesome video by Shilika!

Fact of the day: Multi- vitamin supplements beneficial for schizophrenics

Hello

Recent studies suggest that high- doses of vitamin B help in reducing the symptoms of schizophrenic patients and those with other neuropsychological disorders, when added to the normal treatment in early stages. (Source)


- Jaskunwar Singh

Wednesday, March 1, 2017