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