Monday, December 30, 2019

Mnemonic for Antibodies in SLE & it's Clinical Importance

Hi everyone!

Here is a hack.

ANA = All Negative Absent = All Positive identified = Highest Sensitivity ( So best Screening Test ) 

Anti dsDNA = Disease Severity 

Anti Sm = Specific Most

Anti RNP = Raynaud & Polymyositis ( MCTD )

Sunday, December 29, 2019

Mnemonic for Dawn & Somogyi phenomenon

Hello everyone....

A diabetic patient who is taking NPH insulin regularly at early evening time presents with early morning headache. He also feels very stressed & tiredness. 
I have checked that he is hyperglycemic.

Suddenly I think about Dawn & Somogyi phenomenon. But I have a confusion between that 2 terms.
So I make a mnemonic…

Here it is ..
Dawn & Somogyi phenomenon
In both Early Morning High Glucose 
= Due to ⬆️ GH & Cortisol Surge 

What is the difference ??


Saturday, December 28, 2019

Sonographic diagnostic features of monochorionic monoamniotic twin pregnancy

1. Absence of dividing amniotic membrane
2. Presence of single placenta
3. Same gender fetus
4. Adequate amniotic fluid around each fetus
5. Both fetus moving freely 

Indications of long‐term oxygen therapy

Hi!

I was discussing the indications of long‐term oxygen therapy with a friend today...

Long‐term continuous oxygen therapy, ideally for ≥18 h/day is indicated when:

1. Daytime partial arterial oxygen concentration (PaO2) is ≤ 55 mm Hg at rest or a pulse oxygen saturation (SpO2) less than or equal to 88 percent.

2. Daytime PaO2 is 56–59 mm Hg and there is evidence for hypoxic organ damage (right heart failure, pulmonary hypertension or polycythaemia)

Friday, December 27, 2019

Fact of the day: AHN in old age

Hi!

Fact: New neurons proliferate as we age, in both physiologically and pathologically aging brains, even in the ninth decade of life.

Wednesday, December 25, 2019

Authors' diary: Battling jealousy

Hi!

I read comment on YouTube recently, "There are people who don't even share their notes and there are people like you who help others with their work..."

I know that feeling. It stems from a number of negative emotions. One of them is jealousy or envy - The intolerance in seeing someone else succeed more than you.

Treatment resistant depression notes

Hi! Quick notes for a friend :)

Treatment resistant depression: Major depressive episodes that do not respond satisfactorily to at least two trials of antidepressant monotherapy.



Things to consider:
Assess adherence
Identify comorbidities
Reassess diagnosis

Treatment strategies:
Augmentation (adding a treatment)
Switching treatment

Tuesday, December 24, 2019

Important Mnemonics for Oral hypoglycaemic drugs in Diabetes


Hello everyone .. 

I make mnemonics for some important side effects of oral hypoglycemic drugs. 

You must know that because you may prescribe it for 1 out of 11 adults in whole population the of world….!!

Side effects of Oral hypoglycaemic drugs along with it's class & mechanism of action 

#Mnemonic 1
Big Men ForminG Poor Diabetic neuropathy ( D/Dx B12 Deficiency ➡️ confirmed by doing  B12 LAB test.)

Biguanide = Metformin 
Inhibit mGPD 
It causes Vitamin B12 Deficiency & Lactic Acidosis (LA) 

#Mnemonic 2 
1st Key to SUccess is Lord "Ram"

1st Gen SUlfonylureas
Closes K+ Channel 
Ram = Disulfiram like reaction….

#Mnemonic 3 
Paragliding makes your heart failed or maybe a fracture or bladder injury 

Para = PPAR Y
Gliding = Glitazone activates it...





#Mnemonic 4
"Rosy red Blood don't reach to heart (MI) but goes into Pee = Red Pi ( Pee = Urine in Bladder Cancer )
MI (rosiglitazone) 
Bladder cancer (pioglitazone)

#Mnemonic 5
“Change your Daily Personal Passivity (DPP) otherwise your heart fails” 
DPP  = DPP-4 inhibitors 

#Mnemonic 6
“Candid Status is Very Good in Love Test”

SGLT-2 inhibitors can cause Vulvovaginal Candidiasis 

Drugs category & their Suffix 

Pramlintide = Amylin Analogue 

1st gen Sulfonylureas = “Amide”
2nd gen Sulfonylureas = “Ride” & “Zide”
Meglitinides = “Nide”

DPP-4 Inhibitors = “Gliptin”

Glitazones / thiazolidinediones = “Zone”

SGLT -2 Inhibitors = “Flozin”

#Mnemonic 7
Alpha glucosidase inhibitors = "Please Side your Car & Pay Toll"
Acarbose & Miglitol 



#Clinical Pearls 

Weight neutral = DPP 4 & Alpha Glucosidase inhibitors 

SGLT2 inhibitors & GLP-1 = Used in CVD
( Cardiovascular diseases) patients

In case of Renal failure you can only give 2 type of drugs orally = DPP 4 inhibitors & Glitazones 

Injectables can be given in renal failure.

3 times / day dosing = Pramlintide , Alpha Glucosidase inhibitors & Glinide 

Regular Insulin ( Short acting ) is preferred for 
DKA ( IV)
Hyperklaemia (Add Glucose)
Stress Hyperglycemia

Thank you :)

- Dr. Drashtant Prajapati



Monday, December 23, 2019

Therapeutics in Sickle Cell Anemia

Apart from Hydroxyurea, Analgesics and vasodilators like phosphodiesterase inhibitors, certain tantalizing novel drugs have been approved for Sickle cell anemia.... Let's take a closer look at them.

(1) Voxelotor (HbS polymerization inhibitor) binds covalently to N-terminal valine of alpha chain of HbS (around 30% of HbS in individual cell) stabilizing it's oxygenated form and causing left ward shift of dissociation curve without impairing oxygen delivery to tissues.

Consistently reduces hemolysis and viscosity with in 2 weeks of administration... FIRST EVER therapy targeting core defect.

Sunday, December 22, 2019

Benign vs Malignant pulmonary calcifications mnemonic

A nice mnemonic to differentiate benign and malignant pulmonary calcifications is:

Malignant calcifications are ***SuPER bad*** :P
S: Spiculated
P: Punctate
E: Eccentric
R: Reticular

I use those 3 starts (***) to remind me of punctate.(vs the other P of Popcorn in the benign lesions)

Bening ones are the rest:
Popcorn, laminated, concentric and diffuse homogeneous



-Murad

NB: these calcification types suggest benign vs malignant lesions and are not diagnostic per se.

Check the other amazing mnemonic by Drashtant in the comments section below  :)

Thursday, December 19, 2019

Inferior wall MI treatment mnemonic

Inferior wall MI is different than other MIs . It is associated with sinus bradycardias and AV block.

Lower back pain notes

Hello!

Here are my quick and dirty notes on Low back pain (LBP) mostly seen in ambulatory medicine! I will not be going into evidence-based medicine (EBM) physical examination (PE) findings but I have put a quick note for conditions you can test on PE so you can look them up.

Hepatorenal Syndrome: An Overview

Hello good folks! Let's discuss HepatoRenal Syndrome (HRS) in brief.

Cirrhosis + Ascites + Renal Failure = HRS, after excluding other causes of kidney damage.

How common is HRS?
1 in 10 patients of advanced cirrhosis or acute liver failure develop HRS.

How does HRS happen?
Abnormal haemodynamics, that's how. Pathogen, faulty immune system and mesenteric angiogenesis result in splanchnic and systemic vasodilation but renal vasoconstriction. Other factors maybe contributory.

Types and management
Type 1: Rapidly progressive, median survival about 2 weeks. Haemodialysis may be required.

Type 2: Slowly progressive, median survival about 6 months. Transjugular Intrahepatic Portosystemic Shunt (TIPS) maybe required.

Liver and/or kidney transplant maybe considered for both types.



Thanks for reading.
Ashish Singh.

Dihydropyridine vs non-Dihydropyridine CCBs mnemonic

Dihydropyridine vs non-Dihydropyridine CCBs were always a struggle to me because they are both CCBs but at the same time they have some differences.

I hope that the following mnemonic will help in reminding you which one is Dihydro and which one is not :D :

The mnemonic (remember DIE HARD movie and Bruce Willis)

I am a DIe Hard FAN

DIHydropyridine CCBs:
FAN
F- felodipine
A- amlodipine
N- nicardipine

So non-Dihydropyridine CCBs are Verapamil and Dilitazem.

The original FAN mnemonic was posted here:
http://woanchyi818.blogspot.com/2015/03/calcium-channel-blockers-ccbs.html

good luck :)

Murad

Sunday, December 15, 2019

Topical vs Oral antifungal mnemonic

Hey my friends, a common question in qbanks is when to use topical vs oral antifungals in Tinea infections.
Well, you can use the following mnemonic:

Tinea CAPitis => Imagine a CAP covering your head/scalp so you need a systemic treatment => Oral treatment (eg: Terbinafine) to reach it.
Scientifically, the systemic/oral treatment is needed to reach the hair shaft.

Tinea Corporis: Since Tinea Capitis is the oral one, Tinea Corporis is the topical one :)


Murad :)

Tuesday, December 10, 2019

Classification and causes of hyponatremia mnemonics + notes

Hi!

Classification and causes of hyponatremia mnemonics + notes:

1. Hyponatremia with low osmolality :
     (i) reduced effective blood volume
              (A) increased ECF volume -
                               - Edematous kidney (nephrotic syndrome)
                               - Cirrhosis of liver
                               - Failure of heart

              (B) REduced ECF volume -
                                - Renal loss of Na ( Diuretics, Ketonuria, Addison's disease)
                                - Extrarenal loss of Na ( sweating, diarrhea, vomiting, peritonitis, pancreatitis)

    (ii) Normal/ increased EBV
                - Inadequate ADH syndrome
                - Constant thirst
                - Renal failure (chronic)

2. Hyponatremia with raised osmolality :
( H & M)
- Hyperglycemia 
- Mannitol administration 

Note -
- Hyponatremia per se does not produce any significant clinical features. The low osmolality that it causes is responsible for various features.
- Slow correction of hypotonicity produces gradual rise in osmolality without any significant risk. But rapid correction of hyponatremia produces loss of brain water resulting in brain damage!
- The rate of correction should be around 0.6 mEq/L/hr. In severely symptomatic patients, total correction in a day should not exceed 8-10 mEq/L/hr.

That's all
Hope it helps
- Jaskunwar Singh

Wednesday, November 27, 2019

Attrition

In simple words, Attrition is the loss of tooth structure occlusally due to excessive forces by the occluding teeth, grinding of teeth, deep bite.

Tuesday, November 26, 2019

Aurora kinases

Hello friends, Let's talk about Aurora kinases today.... Aurora sounds so beautiful, right ?

Aurora kinases represent serine threonine kinases with instrumental role in cell division.

Specifically, Aurora kinase A is required for duplication and separation of centromere, and Aurora B is required for attachment of microtubules to centromere.

They are often over expressed in tumors resulting in defective cytokinesis during cell division, eventually causing aneuploidy and driving the carcinogenesis.

Now, it really gets interesting; usually when functioning of microtubules are perturbed say by paclitaxel, then spindle check point inhibitor is activated leading to cell demise by upregulation of P53, PUMA and other mediators.

But in case of Aurora kinase inhibition, cells keep on dividing especially in case of P53 mutated cells. Since centromeres will not segregate, it ultimately leads to tetraploid genome and four centromeres in a cell, causing catastrophic mitosis in subsequent cell cycle effectively tearing apart the genome.

They are significant because often when other tyrosine kinase inhibitors targeting EGFR, VEGFR, FGFR are used, tumors over express Aurora kinases, there by over riding the inhibition mediated by tyrosine kinase inhibitors.... So targeting them is key to maintain remission in patients already on kinase inhibitors.

Few examples of drugs in trials: Monastrol, Hesperidin.

It's called Aurora because of the similarity between the appearance of microtubule spindles during cell division and Aurora Borealis.

Pretty Majestic, right?

Submitted by Kirtan Patolia 

Risk factors for puerperal sepsis mnemonic

Hi!

Risk factors for puerperal sepsis mnemonic:
PUERPERAL SEPSIS

Maternal complications of diabetes in pregnancy mnemonic

Hi!

Maternal complications of Diabetes in pregnancy mnemonic:
PREGNANCy

Monday, November 25, 2019

JVP documentation

Hi everyone!

Someone questioned on how to document JVP. Just saying JVP is 8 cm is not enough - Say what is your reference for better documentation :)

Saturday, November 23, 2019

Cryoprecipitate

Hey! =)

What does cryoprecipitate contain? 
Cryoprecipitate preparations contain concentrated amounts of fibrinogen (factor I), factor VIII (antihaemophilic factor), von Willebrand factor, factor XIII (fibrin-stabilizing factor), and fibronectin.

Why is it called cryoprecipitate?

Wednesday, November 20, 2019

Monday, November 18, 2019

Hyperkalemia and hypokalemia causes mnemonics

Hi!

Pharmacologic treatment of pulmonary hypertension (notes and mnemonics)

Hi!

Vasodilator response: A favorable vasodilator response is defined as a fall in mPAP of 10 mm Hg or greater to less than 40 mm Hg with an unchanged or improved cardiac output, in response to an agent such as inhaled NO or IV epoprostenol.

Cardiovocal syndrome - Ortner syndrome

In 1897, Norbert Ortner described hoarseness caused by recurrent laryngeal nerve paralysis in patients with a large left atrium due to mitral valve stenosis.

Istradefylline

Istradefylline (Selective Adenosine 2A receptor antagonist), inhibits the adenosine's inhibitory effect on GABAergic transmission in direct nigro-striatal pathway while simultaneously inhibiting adenosine's stimulatory effect on GABAergic transmission in indirect nigro-striato-pallidal pathway, ultimately leading to stimulation of thalamo-stimulatory direct pathway and inhibition of thalamo-inhibitory indirect pathway.

Selinexor

Selinexor (Selective inhibitor of nuclear export) inhibits XPO1 (exporter protein 1).

XPO1 is often overexpressed in tumors leading to transport of tumor suppressor proteins like p16, p14, p27 from nucleus to cytoplasm and there by evading the apoptosis.

Luspatercept

Here is a submission by Kirtan on Luspatercept!

Luspatercept (recombinant fusion protein containing Activin receptor type IIB moeity) blocks excessive SMAD2/3 activity (Mothers against decapentaplegic homolog) lying downstream of TGF-beta signalling by binding endogenous TGF-beta family members, including Bone morphogenetic proteins (BMP), Activin, Inhibin, Lefty A/B, Artemin, Persephin, GDF, GDNF and MIS.

Acute type-II respiratory failure causes mnemonic

Hi!

Causes of Acute type-II Respiratory failure mnemonic:
DEPRESSION

Saturday, November 16, 2019

Thursday, November 14, 2019

Wednesday, November 13, 2019

Fact of the day - BUC in UGI bleed

Hi!

Blood urea levels are positively associated with upper GI bleed. But here's the fact:

Monday, November 11, 2019

Extra - articular manifestations of RA ( Notes and mnemonic )

Hi!

Extra- articular manifestations of Rheumatoid arthritis :

( mnemonic - NOVELA is FrickiN' Hot! )

How to read CSF analysis report?

Video by Jay!

Multiple Myeloma notes and mnemonics

Hi!

Multiple myeloma - everything P


- malignant Proliferation of Plasma cells derived from a single clone.
- Immunoglobulin produced is a "ParaProtein" (M- protein)
- POEMS syndrome

BONE MARROW INVOLVEMENT
- Pancytopenia

PERIPHERAL BLOOD
- plasma cell leukemia ( greater than 2,000 per mm3 )

BONE INVOLVEMENT
- punched-out lesions in radiographs of flat bones
- bone pain
- pathological fractures

RENAL INVOLVEMENT
- Bence -Jones proteinuria
- production of excess Amyloid protein
- hyPer- calci -emia and -uria

These three result in renal damage and renal failure.

IMMUNE SYSTEM INVOLVEMENT
- prone to infections, particularly in respiratory and urinary tract.

HYPERVISCOSITY SYNDROME
( mnemonic - HPRVSCST )
- Headache
- Postural hypotension
- Retinal venous congestion
- Vertigo
- Strain (blurred vision)
- Congestive cardiac failure
- subtype IgA
- nysTagmus

CLOTTING PROBLEMS
- purpura
- profuse bleeding ( epistaxis, gastrointestinal )

NEUROLOGICAL MANIFESTATIONS
- peripheral neuropathy
- compressive myopathy
- carpal tunnel syndrome ( nerve entrapment)
- Amyloidosis.

SERUM STUDIES
- total serum protein raised
- low albumin
- high globulin ( decreased A:G ratio )
- high beta-2 microglobulin ( greater than 5.5 mg/dL means poor prognosis; stage III)

Plasmacytomas in Paraskeletal soft tissues - poor prognosis; treated by palliative radiotherapy.


That's all
Anything more to add, you're most welcome :)
- Jaskunwar Singh

Sunday, November 10, 2019

How to calculate SVR and PVR using Ohm's law

Hi!

Ohms law: Current (I) equals the voltage difference (ΔV) divided by resistance (R)
Simplified, V=IR

In hemodynamics, what is voltage difference? The pressure difference or pressure gradient! (ΔP)

Friday, November 8, 2019

Drugs causing Thrombocytopenia mnemonic

Hi!

Drugs inhibiting platelet function/ causing Thrombocytopenia :-

ABCDE - HI

Sunday, November 3, 2019

Pulmonary hypertension notes

Hi!

Pulmonary hypertension (PH) is defined as a resting mean pulmonary artery pressure of 25 mm Hg or greater measured during right heart catheterization.


(How I remember the number 25 - PH: 2 letters, Hyper: 5 letters).

Classification of Pulmonary Hypertension mnemonic

"A heart lung chronic thrombotic unclarity"
1: pulmonary Arterial hypertension
2: PH due to left-sided heart disease
3: PH due to lung diseases and/or hypoxia
4: Chronic thromboembolic pulmonary hypertension and other pulmonary artery obstructions
5: PH with unclear or multifactorial causes

The transpulmonary pressure gradient (TPG): The difference between mean pulmonary arterial pressure (mPAP) and left atrial pressure (LAP, commonly estimated by pulmonary capillary wedge pressure PCWP).

A TPG of >12 mmHg would result in a diagnosis of “out of proportion” pulmonary hypertension - suggesting intrinsic pulmonary vascular disease in patients with left-heart conditions associated with increased pulmonary venous pressure.

Will update post as I learn more... 

-IkaN

Step 3 NBME Form 4 answers explanations

Publishing incomplete post form drafts :)

Platypnea-Orthodeoxia Syndrome in interatrial right-to-left shunt

Hi everyone! This is a short post :)

Platypnea (flat breathing): Dyspnea induced by upright posture and relieved by recumbency.

Orthodeoxia: Arterial oxygen desaturation accentuated by upright posture and improved by recumbency.

Peripartum heart failure associated with prolonged tocolytic therapy

Did you know?

What's Wrong With My Gallbladder, Doc?

A quick mini-post to help you make a quick diagnosis.



[Please click on the image to enhance it]

Please remember to practise caution as the presentations may overlap.

Thank you for reading.



Ashish Singh

Thursday, October 31, 2019

Post-LP Headache

Hey guys! 

Here's all you need to you know about that nasty headache some patients get, after a lumbar puncture (LP).

How common?
Up to one-thirds of all cases.

What are the risk factors?
None. Despite years of anecdotal advice to the contrary, none of the following has ever been scientifically shown to be a risk factor: position during or after the procedure; hydration status before, during or after; amount of CSF removed; immediate activity or rest post-LP.

When does it happen?
Within 24 hours of LP.

How does it present?
Let's SOCRATES the pain here.

Site: Frontal > Occipital
Onset: Acute
Character: Dull aching
Radiation: None
Association: Mild neck stiffness, nausea
Time Course: Lasts for 2 days to 2 weeks
Exacerbating factor: Sitting upright or standing, and so the relieving factor is lying down
Severity: Varies 

What is the pathology?
Thought to be continued leakage of CSF from the puncture site and intracranial hypotension. Other neuro-vascular mechanisms may be involved.

How do I prevent it?
Using the smallest practical needle and keeping the bevel facing up. Before withdrawing the needle, reinserting the stilette.

How do I treat it?
It's self limiting. Can use analgesia, as per WHO Pain Ladder. In extreme cases, can also involve an anaesthetist for an epidural 'blood patch'.



Know something you'd like to add? Let me know.

Thank you for reading. Have a nice rest of the day, you.



- Ashish Singh

Tuesday, October 29, 2019

Ashman beat

Hello!

What's an Ashman beat?

An aberrant PVC, usually of RBBB morphology, which follows a short RR interval and is preceded by a relatively prolonged RR interval.

The mechanism is pretty cool!

Monday, October 28, 2019

Retinoic Acid and Malignancy

Hello Awesomites !

This is going to be short post.
Relevant for exams.

All trans retinoic acid is used in APML (ACUTE PROMYELOCYTIC LEUKEMIA)

Cis retinoic acid and derivatives like 13-cis-retinoic acid (13-cRA) reduces second aerodigestive tract tumors in patients with resected head and neck cancers.
13-cis RA is used in Neuroblastoma.

Happy studying.
-Upasana Y.


Differentiation syndrome

Hello Awesomites !

AML (M3) also known as acute promyelocytic leukemia.
The drug is ATRA+As2o3 ( All trans retinoic acid +arsenic trioxide).

After few days from therapy :-
unexplained fever,
acute respiratory distress with interstitial pulmonary infiltrates,
and/or a vascular capillary leak syndrome
leading to acute renal failure.

Suspect :-

Differentiation syndrome (DS), formerly known as retinoic acid syndrome, is the main life-threatening complication of therapy with differentiating agents (all-trans retinoic acid [ATRA] or arsenic trioxide [ATO]) in patients with acute promyelocytic leukemia (APL).

The differentiation of leukemic blasts and promyelocytes induced by ATRA and/or ATO may lead to cellular migration, endothelial activation, and release of interleukins and vascular factors responsible of tissue damage.

 Roughly one quarter of patients with APL undergoing induction therapy will develop the DS.

Treatment -
Early therapy with intravenous corticosteroids. The use of invasive diagnostic techniques, such as bronchoscopy and bronchoalveolar lavage or lung biopsy, is not usually required in patients with suspected DS and respiratory distress with lung infiltrates.
Be careful with invasive procedure as these patients have concomitant coagulopathy (DIC like state)

The early administration of high-dose dexamethasone at the onset of the first signs or symptoms of DS is crucial, since it appears to dramatically reduce mortality of this complication.

 HAPPY STUDYING :)
-Upasana Y.

Saturday, October 26, 2019

Route of bisphosphonate administration mnemonic

Mini post!

IVZ: Intravenous zoledronic acid (once a year)

oRAl: Oral bisphosphonates are Risedronate and Alendronate

- IkaN

Denosumab

Hi! Long time no see :)

This post is on Denosumab!

MOA:
- Monoclonal antibody against the receptor activator of nuclear factor κB ligand (RANKL)
- Reduces bone resorption by inhibiting the development of osteoclasts

Route: SC
Dosing: Administered twice yearly

Saturday, September 28, 2019

Quinsy Complication

This post is written by Sweta Senthil.
I don't know why she targeted me to make this mnemonic but it makes sense to remember complication of Quinsy

So mnemonic is "OJAS Pee"

Oedema of larynx
Jugular Vein Thrombosis
Abscess of Lung/Pneomonitis
Septicemia, Spontaneous hemorrhage
Parapharyngeal Abscess

That's it!

Sunday, September 1, 2019

IOLs- most important optical zone

Most common answer would be the centre.

That however is not the case as the light rays pass undeviated right through the centre.

In fact, phakic IOLs have an opening right in the centre for aqueous to circulate.

The most important part is the pericentral area, as the refracted rays through this area get focussed on the macula.

-Sushrut

Wednesday, August 28, 2019

Bell's phenomenon

It is the motion of the eyeball during lid closure and is a reflex between the occulomotor and the facial nerves.  There are 4 types-

1. Normal- Upward and outward movement of
                           the eyeball.

2. Inverse- Upward but inward movement.*

3. Reverse- Downward movement.*

4. Perverse- Lateral movement.

*Some authors opine that inverse is downward and outward while reverse is upward and inward.

The Bell's phenomenon is of importance in ptosis and lag ophthalmos surgeries .

-Sushrut

T cells in traumatic optic neuropathy- summoning the devil😈

Traumatic optic neuropathy is a tough nut to crack. High dose steroids and surgical decompression were the empirical modes of management. There is an ongoing search to save the optic nerve in trauma.

The innate adaptive T cell response has been deemed to be protective in traumatic optic neuropathy. It supposedly acts against the self directed antigens in traumatic optic neuropathy. The response can be augmented or induced depending upon an individual.

Other modalities are monisialogangliosides, neurotropic growth factors, and gene transfer of anti inflammatory cytokines.

A new group of steroids, the 'lazaroids' (great name that!) or 21 amino steroids provide free radical binding capability inherent to the group sans the glucorticoid activity.

-Sushrut

Sunday, August 25, 2019

Being street-smart during interviews: Apps/Websites

We all like free money $$$, don’t we? Doctors, engineers or any other profession you can think of! These days, we are living in a world which is full of apps and nearly all of us have smartphones. What if I tell you that you can use your phone to make money just by doing what you normally do?
Well, these apps and websites are really useful to save money, get some of your money back, get cash and to redeem many offers!

1- Google rewards
A very simple app by Google in which you have to answer a survey and get money from that. For Iphone users, you can redeem each 2 dollars or let them accumulate (survey value can be as low as 10 cents up to 50- 60 cents or even more). For Android users, you can use the money to buy apps/rent movies ..etc in Play Store.
 It is said online that when you go to new places the app may send you more surveys. Keep your location service turned on. The process may take sometime but anyway, you lose nothing, it’s free :D
Go download the app from App store or Play store now!

2-Ibotta
Ibotta is one of the available rebate apps. Check the offers in the app, tick them and then buy the thing you need from available places- whether online via the app or in-store-. Nearly all the superstores (Walmart, Kroger, Target) and famous online stores (Amazon) are there. You can redeem your money after you accumulate 20 dollars via Vimeo or PayPal. You get money when you refer friends and you all may get money when you all work as one team!
Here is the link for the app, let us make one big team :D
https://ibotta.com/r/avalwqu.
(better to open the phone using your phone directly)


3- Sweatcoin
As this app advertises itself: “It pays to walk”. This amaaazing app converts your steps into “sweatcoins”. You can use your sweatcoins to redeem many offers through the apps. As of now, one of the offers is an iphone XS or a 1000$ cash if you collect 20000 sweatcoins in 2 years! Offers include small electronics, clothes, music services...etc.
This app can be your friend during the whole match journey as well as when you go to the gym, you ll collect these coins without even trying :D
Psst..one more thing, when you refer anyone, both of you will get 5 sweatcoins so use the link below to download it..Get 5 sweatcoins for free and refer your friends.
This app will literally encourages you to “move it move it”
https://sweatco.in/w/murad665752

4- MileagePlus X (from United)
One of the best apps to travel for free! When you collect 10K or 12.5K miles through this app, you can simply book a flight for free using the miles you earned!
Many merchants are included within this app (Starbucks, Airbnb, The Home Depot, Uber, Walmart, Under Armour..etc). Just buy a gift card through the app and use it to pay at these places whether in-store or online. Miles range from as low as 0.5 Mile per each dollar spent to 12 Miles per dollar with some offers time limited. Before buying from any store, check this app and see if you can get some miles :)
The app also has MileagePlus dining which will give you miles when you eat in participating restaurants! Treat yourself and your stomach and get some free miles :D


5- Google Express
This nice app from google will not let give you money per se but it will help you in comparing the price of one product between different stores (Walmart, Target..etc). It comes with a cool 20$ (up to 20$) off your first purchase through the app.

6- Retailmenot and Slickdeals
These 2 websites will have deals and coupons for different things. Check them, crop or copy the coupon, buy for less.
www.retailmenot,com
https://slickdeals.net

7--Honey (extension)
Add this extension to your browser and it ll look for any working coupon that your can use when you are doing your online shopping on Amazon.

Let me know if you know other apps that should be added to this list!

-Murad :)

Thursday, August 22, 2019

Human milk bank

Hello Awesomites!

Update for community medicine:-

Because some infants could not be fed by their mothers (early demise of mothers or chronic illness), humans have adopted substitute feedings.

1.Human breast milk bank (recent advance)

2.Infant formula feed

3.Fortified human milk for premature infants

The MoHFW launched the National Human Milk Bank at Lady Hardinge Medical College-the first government-run human milk bank, and at present, the country’s largest.

The human milk bank and lactation counselling centre, 'Vatsalya - Maatri Amrit Kosh', will collect, pasteurise, test and store milk donated by lactating mothers and make it available for infants in need.

Aanchal, the mother’s milk bank established in 18 district government hospitals of Rajasthan.

Beneficiaries will mainly be premature babies (born below 32 weeks of gestation) and IUGR (intrauterine growth restriction) infants.

Following is the link for further read and research :-

Key guidelines for human milk bank

Recent news article on human milk bank

Happy Studying!

Upasana Y.


Saturday, August 17, 2019

Breast feeding in special cases

Hello Awesomites!

-HIV positive mother
-Active Pulmonary TB
-Working mothers



CONTRAINDICATION OF BREASTFEEDING :

  • HIV, HTLV-1 and 2
  • Inborn error of metabolism LIKE GALACTOSEMIA AND PHENYLKETONURIA
  • Untreated case of tuberculosis
  • Herpes lesion on mothers’ breast
  • Mother on certain medication like anti-cancer drug or radioactive isotope etc.
WITH INCREASED BURDEN OF HIV AND TB,INDIA CAN’T AFFORD TO  CONTRAINDICATE THE BREASTFEEDING.


  1. IS THERE ANY RELATION BETWEEN BREASTFEEDING AND RISK OF TRANSMISSION?
  2. DO ART HAS ANY ROLE TO DECREASE THE TRANSMISSION?


ARV INTERVENTION
RISK OF HIV TRANSMISSION FROM MOTHER TO CHILD
NO ARV                 BREASTFEEDING +
30-45%
NO ARV                 BREASTFEEDING -
20-25%
3ARVS(ART)         BREASTFEEDING +
2%
3ARVS(ART)         BREASTFEEDING -
1%

HOW TO KNOW THE HIV STATUS OF CHILDREN LESS THAN 18 MONTHS?

 
METHOD USED - DNA PCR on a DRIED BLOOD SAMPLES OF INFANT
TEST PERFORMED -

  • 6 WEEKS
  • 6 MONTHS
  • 6 WEEKS AFTER CESSATION OF BREAST FEEDING (if being EBF)
  • 18 MONTHS

PEDIATRIC COMPONENT IN PPTCT


  • DURATION OF NEVIRAPINE PROPHYLAXIS TO HIV EXPOSED INFANT SHOULD BE MINIMUM OF 6 WEEKS.


  • INITIATION OF BREAST FEEDING WITHIN AN HOUR OF DELIVERY AS THE PREFERED OPTION


  • CONTINUE BF ATLEAST FOR 1 YEAR FOR THOSE WITH HIV -VE STATUS  AND 2 YEARS FOR HIV +STATUS OF CHILDREN


  • ENSURE INITIATION OF CO TRIMOXAZOLE PROPHYLACTIC THERAPY AT 6 WEEK OF AGE



MATERNAL COMPONENT IN PPTCT
“ART TO ALL PREGNANT AND BREASTFEEDING WOMEN LIVING WITH HIV “

TARGET POPULATION
ART REGIMEN
PREGNANT AND BREAST FEEDING WOMEN WITH HIV 
BUT NOT ON ART
TDF+3TC+EFV
PREGNANT WOMEN AND BREAST FEEDING WOMEN WITH HIV AND RECIEVING ART
THE SAME ART REGIMEN MUST BE CONTINUED 
  
AFASS
 

AFASS CRIETRIA is used to decide whether a HIV positive mother can breast feed or not provided that she has not started top feed yet.
(Why? Once the mother started to top feed the child, this criteria is not used. HIV positive mother in such case should continue top feed. Because mixed kind of feed is more dangerous than top feed alone)

  • Acceptable: The mother perceives no problem in replacement feeding.
  • Feasible: The mother (or family) has adequate time, knowledge, skills, resources and support to correctly mix formula or milk and feed the infant up to 12 times in 24 hours.
  • Affordable: The mother and family, with community or health system support if necessary, can pay the cost of replacement feeding without harming the health or nutrition status of the family.
  • Sustainable: Availability of a continuous supply of all ingredients needed for safe replacement feeding for up to one year of age or longer.
  • Safe: Replacement foods are correctly and hygienically prepared and stored, and fed preferably by cup.


QUESTIONS

  1. Where do you get your drinking water?
  2.  What kind of latrine/toilet do you have?
  3.  How much money could you afford for formula each month?
    Ps: calculate the amount based on the local costs
     
  4. Do you have a refrigerator with reliable power?
     
  5. Can you prepare each feed with boiled water and clean utensils?
     
  6. How would you arrange night feeds?
     
  7. Does your family know that you are HIV positive?
     
  8. Is your family supportive of milk feeding and are they willing to help

MANAGEMENT OF BABY BORN TO MOTHER WITH TUBERCULOSIS:-


  • Continue exclusive breastfeeding till 6 months of age & thereafter as in normal population.
  • Start ATT for mother immediately. Mother will be non infective within 2 months of regular ATT


  • Preventive Chemotherapy for baby (INH 5 mg/kg/day for 6 months)


  • Use face mask while around the baby, till 2 months after starting ATT.


  • BCG Vaccine at birth.Something is better than Nothing!


  • Re- immunized with BCG after stopping Preventive Chemotherapy. 
  • (Remember, it's not only mother, Anybody (with TB) around can infect the baby with Tuberculosis!)

Is ATT drug concentration in breast milk sufficient for the baby? NO

NAME OF THE GROUP
BREAST FEEDING
BARRIER METHOD
ISOLATION
BCG VACCINATION
IAP
TO CONTINUE
COUGH HYGIENE
1.IF MOTHER ON TREATMENT -NOT REQUIRED


2.IF MOTHER HOSPITALIZED, NON-ADHERENT TO THERAPY,MDR-TB - ISOLATION REQUIRED
AT BIRTH 
OR 


EVEN WITH INH PROPHYLAXIS
DOTS
ONLY IF MOTHER IS SPUTUM NEGATIVE
FACE MASK
IF MOTHER HAS ACTIVE DISEASE,NON-COMPLIANT AND HAS RECIEVED ATT PRIOR TO DDELIVERY 
POSTPONED
OR DONE
WITH INH RESISTANT OF BCG VACCINE 
AAP
ONLY IF MOTHER IS ON ATT
FACE MASK
MDR -TB AND NON COMPLIANT
GIVE BCG IN THESE MDR TB MOTHER
WHO
TO CONTINUE
FACE MASK
MDR -TB
INH THERAPY COMPLETED THEN AFTER 2 WEEK  OF COMPLETION BCG VACCINE GIVEN 
 THE DOUBT OF WORKING MOTHERS :-

For How long can expressed breast milk is stored? 


AT ROOM TEMPERATURE 
8-10 HOURS
IN A REFRIGERATOR
24 HOURS
IN A DEEP FREEZER (-20 degree)
3 MONTHS

HAPPY STUDYING ! 
-UPASANA Y.