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

Aetiology

  • Age 
  • Hard and Abrasive diet 
  • Chewing Habits 
  • Opposing porcelain crowns
  • Lack of posterior support- cause of anterior teeth attrition
  • Bruxism and Clenching
Clinical Manifestations
Occluding surface attrition causes small polished facet on a cusp tip or ridge or incisal edge
In severe cases, reverse cusp in place of cusp tips and inclined planes. This causes dentinal exposure and loss of vertical dimension of teeth.
Precipating Factors
  • Deficient masticatory capabilities of teeth
  • Cheek biting
  • Caries- because of the increased vulnerability of exposed dentinal surfaces 
  • TMJ Problems
  • Jutted out appearance of restoration and flattening of surrounding occlusal surface. %
Treatment : Pathologic
  • Advice the patient to wear splints 
  • To manage localised anterior teeth wear: use dahl technique
  • The more traditional way of dealing with a full arch or full mouth rehabilitation is to use conventional crowns eg, onlays of a full crown


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.

Friday, August 16, 2019

Lamotrigine: A depression mood stabilizer

Lamotrigine is used primarily as an anticonvulsant for the treatment of generalized and partial seizures and is effective for treating focal epilepsies in the presence or absence of secondary generalization.

Friday, August 9, 2019

Photophobia vs blepharospasm

Both have the same presentation of tight lid closure.

In dark, blepharospasm won't be completely abolished while photophobia would.

Anaesthetisation(topical) reduces greatly the blepharospasm but not photophobia.

-Sushrut

Tuesday, August 6, 2019

Definition of generalized convulsive status epilepticus

Hi everyone,

Historically, the International League Against Epilepsy (ILAE) and others defined status epilepticus as a single epileptic seizure of >30 minutes duration or a series of epileptic seizures during which function is not regained between ictal events in a 30-minute period.

However, a 30-minute definition is neither practical nor appropriate in clinical practice.

Glucagon-like peptide-1 (GLP-1) receptor agonists

Hello everyone!

Let's talk about glucagon-like peptide-1 (GLP-1) receptor agonists today!

Sunday, August 4, 2019

Tetralogy of Fallot: The Basics

Hey guys, this post highlights the important points discussed in the accompanying video.


Fuch's s in Ophthalmology

Following this are ascribed to Fuch

1. Fuch's heterochromic iridocyclitis
2. Fuch's corneal endothelial dystrophy
3. Gyrate atrophy of the choroid
4. Ciliary body adenoma

-Sushrut

Leptospirosis

Rats, rains, ricefields?
Ringing any bells?
Sewer workers coming in with jaundice and fever?
Still no?
Assam/Odisha/Kerala floods?
This spirochete called Leptospira is the culprit.
Most common species is L. interrogans and L. biflexa.
It is epidemologically important as high case fatality rate (CFR) between 5-20%
It affects 1.03 million people anually.
Endemic in states of Kerala, Tamil Nadu, Karnataka, Gujrat, Odisha and Andaman Islands.
Males suffer more than females.
More common post monsoon, natural disasters like floods and cyclones.
Transmission- water or soil contaminated by the urine of infected animals or by direct contact with infected animals such as cattle, buffalo, goat, sheep and pigs carriers of infection.
Rodents harbour leptospira in their renal tubules LIFELONG!!! and are considered reservoir hosts.
Leptospira forms biofilms for survival in renal tubules of reservoir and carrier animals.

Vascular endothelial damage is the primary lesion in leptospirosis ,after entry in the host.

CLINICAL  PRESENTATION
1. Anicteric phase- symptoms unnoticed. Sudden onset of remittent fever, chills, severe myalgia, intense headache and B/L conjunctival suffusion.
Mild proteinuria with few casts and cells in urine, cough and chest pain.
2. Icteric phase-  severe form of disease, where lepto from blood vessels trasfered to organs.
C/F- fever, myalgia, headache, conjunctival suffusion, acute renal failure-oliguria, anuria, nausea, vomiting, diarrhoea, abdominal pain, hypotension.
Elevated transaminases, leucocytes, erythrocytes in  urine, albuminuria, increases in blood urea and creatinine.

LIVER+ KIDNEY= WEIL'S DISEASE
HEPATIC- mild to severe jaundice, tender hepatomegaly, hepatic encephalopathy
RENAL-  acute tubular necrosis(ATN) , interstitial necrosis, renal failure.
RBC casts are common in urine microscopy.
PULMONARY- cough, respiratory distress, basal and mid zone opacities, hemorrhagic pneumonitis, interstitial and intra alveolar hemorrhages
CVS- shock, arrythmias
CNS-meningitis, irritability and restlessness, seizures, encephlitis, focal neurological deficits macular, maculopapular erythmatous skin irruptions
Pregnancy with leptospirosis BAD PROGNOSIS.
LAB- elevated WBC, Neutophilia, high ESR, thrombocytopenia, increased BUN and increased creatinine phosphokinase
D/D- falciparum malaria, dengue, scrub typhus, typhoid, viral hepatitis, acute encephlitis syndromes and pyelonephritis.

Diagnosis-
Dark ground microscopy, immunofluorescence, culture, histopathological staining assay.PCR
microscopic agglutination test (MAT) ELISA, IHA

Treatment and prevention:start treatment clinically
susceptible to penicillin, doxycycline, cephalosporine, tertracycline, macrolides, fluroquinolones.
DOC OPD pts. T. Doxycycline 100mg BD for 7 days, IPD severely ill- Crystalline penicilline 20Lakhs unit,6hrly. pregnant and lactating- ampicilin 500mg 6hrly
corticosteroids in gradual doses in severe hemorrhagic is considered.

prevention- rodent control, health education,personal protection, animal vaccination

Thats all folks!

Stay awesome:)

Dr. ShilPill

Thursday, August 1, 2019

No Vitamin A in Stargardt's disease

In lipofuscinoses like Stargardt's, fundus flavimaculatus, and Best's disease spectrum, Vitamin A and related compounds are avoided as the metabolites of those is what causes the disease in the first place. Usually, Vitamin A is prescribed empirically by general ophthalmologists for degenerative diseases of the retina.

-Sushrut

Wednesday, July 31, 2019

Age related macular degeneration- some facts

1. Dry AMD is the most common form, but wet AMD is responsible for 90% of the cases of visual loss.

2. Type 1 choroidal neovascular membrane is 'occult' and type 2 is 'classic'. This might be counter intuitive to remember.

3. In the genome, except for chromosome nos 7,11,13,21, and the Y chromosomes, all the other harbour genetic loci for AMD!

4. Hypermetropic eyes are at a greater risk of AMD. This, again is counterintuitive as myopic eyes are usually more prone to degenerative conditions.

5.Another, (sort of) counter intuitive fact is that 'hard' drusens do not lead to macular degeneration while 'soft' drusens precede macular degeneration.

6.Beta carotene, a treatment modality for AMD increases the risk of carcinoma of the lung in smokers as well as non smokers. Zinc causes genitourinary complications- UTIs, prostatic hyperplasia, and in women,stress incontinence. Also, zinc is ineffective in the prevention of advanced AMD. These results are from the two RCTs- AREDS 1 and 2 .

-Sushrut

Calcium channel blockers for vasospastic angina

Hey everyone!

I was reading about calcium channel blockers for vasospastic angina and it was a good refresher to know that even though they belong to the same class, they act by different mechanisms.

Dihydropyridines block slow calcium channels.

They vasodilate coronary arteries, reduce coronary resistance, increase coronary blood flow, and may enhance the development of coronary collaterals.

The vasodilatation and increase in coronary artery blood flow result from the blockade of calcium influx as well as an increase the levels of nitric oxide and bradykinin.

They can cause reflex tachycardia.

Verapamil has different physiologic effects from the dihydropyridines because of a different interaction with the calcium channels.

Verapamil is effective in angina because it decreases myocardial oxygen demand by acting as a negative inotrope and chronotrope and by lowering the systemic blood pressure.

Changes in contractility are minimal in patients without heart disease; however, verapamil can exacerbate heart failure in patients with cardiac dysfunction due to its negative inotropic activity.

Diltiazem is a potent coronary but a mild arterial vasodilator, producing improved blood flow through coronary epicardial vessels, collaterals, and normal and ischemic myocardium, as well as lowering mean arterial pressure.

That's all!

-IkaN

Inferior wall MI and Bezold-Jarisch reflex

Hello everyone!

Acute myocardial infarction (AMI), especially of the inferior left ventricular wall, is often associated with transient hypotension and sinus bradycardia.

Ever wondered... Why?

Tuesday, July 30, 2019

Kleihauer–Betke test

Kleihauer–Betke test: KB test.

1) Why do we do this test?

- To calculate Fetal RBCs in blood. This helps us to measure amount of Anti-D required to neutralize it.

2) How do we do it?

- Basically, we are going to take blood sample and add acid to it and measure red blood cells under microscope.

3) How do you differentiate Fetal and Maternal blood?

- Fetal RBCs are acid resistant. Adding acid in the preparation leads to lysis of the Maternal RBCs.

4) What are important points regarding this test that should be kept in mind while solving MCQs?

- Do not confuse it with APT test. APT is done in Alkali and it is a Qualitative test. It helps in differentiating Maternal and Fetal blood only. On the other hand, in KB test (Also know as Acid dilution test), we use Acid and we quantify Fetal blood.

- Minimum dose even after KB test is 300 microgram.

5) How do we calculate amount of Anti-D required to neutralize Fetal RBCs?

- If 20 RBCs in HPF are seen, then it means 1 ml Fetal blood is in circulation.

-‎1 ml fetal blood requires 10 microgram of Anti-D for neutralization

6) What if they don't mention "Fetal RBCs" and instead, mention "Fetal blood" in the question?

- Here is a trick. Always remember, 1 ml Fetal blood has 0.5 ml Fetal RBCs.

Applied calculations:

Q1) A Multigravida with twin pregnancy has 20 ml Fetal RBCs. How much Anti-D will be required to neutralize it?

(Take a deep breath. You don't need to worry about twin pregnancy. All the important points are already covered in above segment)

- 20 ml Fetal RBCs = 40 ml Fetal blood.
- ‎1 ml Fetal blood = 10 micrograms Anti-D

Answer = 400 micrograms Anti-D

400 micrograms is the enough amount of blood given to neutralize 40 ml fetal blood or 20 ml Fetal RBCs.

(Done easily? Perfect ! Let's level up.
I want you to go through blog once again before heading down.)

Q2) This time patient comes with same clinical presentation but with 20 ml fetal blood.

- 1 ml fetal blood = 10 micrograms of the Anti-D
- ‎20 ml Fetal blood will require 200 micrograms Anti-D.

Perfect. We calculated correctly but my question is - Will you administer 200 micrograms Anti-D to the patient showing 20 ml Fetal blood to neutralize it?

Answer is big 'NO'.

Go back to bullet (4) point 2:

Minimum amount is still 300 micrograms after KB test. So you cannot administer 200 micrograms. You have to give 300 micrograms.



I hope this blog is better than my previous blogs. Any important points you have regarding KB test, do comment in comment box

That's it

-Demotional bloke

Interesting retinal peculiarities

1. The respiratory rate of the retina is twice that of the brain.

2. The retina does not require insulin for glucose to enter the cells!

3. In the retina, glycolysis occurs despite having sufficient oxygen supply.

4. The retina is not just a sensory organ. Much of the image processing occurs at the retinal level itself.

-Sushrut

Sunday, July 28, 2019

D-lactic acidosis in short bowel syndrome

Hello everyone!

D-lactic acidosis is an unusual form of lactic acidosis.

Which patients develop D-lactic acidosis?
1. In patients with jejunoileal bypass, small bowel resection, or other causes of the short bowel syndrome.
2. Patient who receives or ingests a large amount of propylene glycol
3. Patients with diabetic ketoacidosis

In this post, I'm going to specifically talk about D-lactic acidosis in patients with small bowel syndrome.

How do patients with D-Lactic acidosis present?

Increased anion gap metabolic acidosis.
Neurologic findings of intermittent confusion, slurred speech, and ataxia.

Why does it happen in patients with small bowel syndrome?

Glucose and other carbohydrates are normally absorbed by the small bowel. If the small bowel is bypassed, removed, or diseased, then delivery of these substances to the colon increases.

Also, overgrowth of gram-positive anaerobes, such as Lactobacilli seen in small bowel syndrome contributes to lactic acidosis.

How is it metabolized?

D-lactate is not metabolized by L-lactate dehydrogenase, the enzyme that catalyzes the conversion of the physiologically occurring L-lactate into pyruvate. Thus, D-lactate is slowly metabolized in humans, accumulates in body fluids, and generates metabolic acidosis.

Diagnosis:
Laboratory studies show increased anion gap metabolic acidosis with normal plasma lactate levels, because the D-isomer is not measured by conventional laboratory assays for lactate. Diagnosis is confirmed by specifically measuring D-lactate.

Treatment:
Sodium bicarbonate if D-lactic acidosis and acidemia are severe.

Oral antimicrobial agents (such as metronidazole, neomycin, or vancomycin) can be used when D-lactic acidosis that decrease the number of D-lactate-producing organisms.
FYI: Although antimicrobials are sometimes helpful, they can occasionally precipitate D-lactic acidosis in susceptible subjects by causing an overgrowth of lactobacilli.

Low-carbohydrate diet (or the use of starch polymers rather than simple sugars) is also helpful because it diminishes carbohydrate delivery to the colon.

That's all!

-IkaN