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.



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Please remember to practise caution as the presentations may overlap.

Thank you for reading.



Ashish Singh