Showing posts with label Internal medicine. Show all posts
Showing posts with label Internal medicine. Show all posts

Thursday, April 27, 2023

Dysbarism - Emergency Medicine

 Hello all !


refers to illness that is related to pressure changes in the body , that exceeds the body's capacity to adapt to these changes 

Pathophysiology of dysbariam depends on the Boyle's law : in which pressure is inversely related to volume

When you descend e.g deep water : Pressure increases and volume decreases

When you ascend : Volume increases and pressure decreases 

I will explain the main disorders of Descent and Ascent

Disorders of descent

1. Nitrogen Narcosis 

Gas we breath contains all gases : including nitrogen.

When you descend the nitrogen gas dissolves in blood and causes the symptoms of nitrogen intoxication.

Management : Ascent

2. Barotitis

Pressure damage to the ear due to squeezing secondary to the elevated pressures

Management: Ascent , supportive treatment

Disorders of Ascent

1. Arterial Gas Embolism 

Volume expansion in every air filled areas of the body e.g GIT, Alveoli 

When it occurs in the alveoli it cause the formation of an air embolus into the pulmonary vein : which can travel to the brain - causing stroke, in the heart - causing Myocardial Ischaemia

Usually acute onset : usually within minutes of ascent (e.g from diving)

Management: involves hyperbarric treatment

2. Decompression Sickness

This is caused by formation of nitrogen gas bubbles (opposite to when you descend where it dissolves)

There are two main types of decompression sickness

i. Type 1

- Usually involving the skin and joints : painful skin and joints

ii. Type 2

- Usually involving the CNS : paraesthesia, paralysis 

Management involves : Hyperbarric treatment , Oxygen, Aspirin 

NB : patient with type 1 DS : have to avoid air travel for upto one week ,those with type 2 DS : have to avoid air travel for upto 1 month 

I hope it was helpful ! For any queries feel free to contact me 

Happy reading !

Author : Mohammad Faruk Omar

Emergency Medicine Resident 

Muhimbili University of Health and Allied Sciences, Tanzania

Wednesday, July 27, 2022

AIDS - Defining conditions


CD < 100  Century

                  Cerebral Toxoplasmosis

                  Cryptococcal meningitis

                  Cryptosporidiosis (watery diarrhea)

                  Candida (oesophagitis)

                  Cowdry A oesophagitis (HSV 1)


CD < 50   MAC and Cheese

                 Mycobacterium Avium Complex

                 CMV (Retinitis ,Colitis)



 By- Shanmukh

Monday, December 27, 2021

Infective endocarditis vegetations - which side do they develop?

Infective endocarditis vegetations tend to develop on the upstream side of the valve (flow side) which is typically tend to be the lower pressure side. These are the ventricular side of the aortic valve and the atrial side of the mitral or tricuspid valve. 

Image shows parasternal long axis view on echocardiography showing vegetations on the mitral and aortic valve (green vegetations because vegetables are green lol!)


Sunday, December 26, 2021


Hello friends!

This post is about omicron variant of COVID.
Why do we have to know about any new variants?
✓ more infectious than previous one?
✓ if it's more virulent?
✓ any diagnostic difficulties?
✓ treatment failure?
✓ does previous vaccine work for it?

Basically this OMICRON has more than 30 different mutations on surface of S1 or S2 spike protein with lineage number B.1.1.529 variant of concern (voc).

Preliminary data shows that it is highly infectious but the data is limited. We need to wait for further studies.

Most of the vaccines are targeting 'S' spike protein so antibodies are produced against 'S' spike. Risk of vaccine failure due to 'S' spike mutation is still a point of concern but data is limited now.

Diagnostics- most of the other targets (including N and RdRp genes) remain unaffected. These RTPCR tests detect atleast 2 different SARS-CoV-2 targets, which serves as a backup in case mutation arises. Current PCR tests can detect this variant. 'S' gene target failure can occur if not detected.

Severity of disease - more in immunocompromised and extremes of age groups.

Effectiveness of vaccines - Antibodies decrease severity and death .

Reinfection is higher with omicron.

Treatment - steroids and IL-6 receptor blockers are still effective.

So, be cautious but don't panic! 

That's all!

Tuesday, December 21, 2021


1-Plasma TSH is the first investigation of choice  in a patient with suspected thyroid diease.
This may be mildly elevated in mild or subclinical hypothyroidism
TSH levels may be suppressed  in hyperthyroidism.
The anterior pituitary is very sensitive to minor changes in thyroid hormone levels which is why TSH is usually considered to be the most reliable investigation of thyroid function. 

2- Plasma free T4- confirms the diagnosis and assesses the severity of hyperthyroidism.  It is also used to diagnose secondary hypothyroidism. 

Both TSH and free T3 and T4 levels should be considered as it may be misleading in patients suffering from any pituitary disease. 

Eg: TSH may be normal or low in secondary hypothyroidism 
Raised T4 and T3 levels may be seen in initial stage of levothyroxine therapy. 

Other investigations may include measurement of antibodies against TSH receptors or other Thyroid antigens 
For instance: Antibodies to TPO, Thyroglobulin, TSH Receptor.

Some drugs may affect TFTs. For example: amiodarone may cause a decrease in free T4 and elevation of TSH. Amiodarone may also cause a decrease in TSH  causing hyperthyroidism in certain patients.


Saturday, December 18, 2021

Mitral valve anatomy and types of mitral regurgitation mnemonic

Prolapse tip points towards LV
Flail tip flips away from LV
Secondary stay away from each other (dilation) 

Friday, December 17, 2021

Job's syndrome

Job's syndrome is also known as hyper- IgE syndrome.
It has autosomal dominant inheritance ( STAT3 gene).

Here is the mnemonic to remember its key features :
A - Abscesses of face and lungs by staphylococcus aureus ( pneumatocele)
B - Bone fragility
C - Coarse facies
D - Dermatological features like eczema.
E - Eosinophilia, increased Ig E.

Trick to remember important points: 
"Steve Jobs is a dominant person, interested in business STATs"

That's all!
Dr. Madhuri.

Tuesday, December 14, 2021

Metoprolol tartrate vs succinate dosing mnemonic

Metoprolol tartrate is short acting. 

Metoprolol succinate is long acting. 

Mnemonic succinate single dose, tartrate two doses.

-IkaN (Nakeya Dewaswala Bhopalwala) 

Wednesday, November 17, 2021

Wednesday, November 10, 2021

Treatment of myocardial infarction associated pericarditis

Hi everyone! There are two types of myocardial infarction associated with pericarditis. Let
s learn more about the management!

Early infarct-associated pericarditis: Occurs 1 to 3 days after transmural myocardial infarction (because of the interaction of the healing necrotic epicardium with the overlying pericardium). 
Late post-myocardial infarction pericarditis (Dressler’s syndrome): Occurs weeks to months after myocardial infarction. 

Initial therapy includes high-dose aspirin (650 to 1,000 mg every 6 to 8 hours).
Proton pump inhibitor (PPI)  - improves the gastric tolerability of the aspirin. 
Acetominophen can be added for pain management.

Dosing of aspirin:
Initial: 650 mg to 1 g every 8 hours until resolution of symptoms for at least 24 hours and normalization of inflammatory biomarkers (eg, C-reactive protein). A treatment period of one to two weeks before tapering is usually sufficient. 
Taper: Decrease each dose by 250 to 500 mg every 1 to 2 weeks. Ensure patient remains asymptomatic and inflammatory biomarkers are normal. 

There is no published experience on the use of colchicine in peri-infarction pericarditis. Colchicine may reduce the need for pericardiocentesis or other pericardial interventions and is usually given at a dose of 0.6 mg twice daily for a month, or longer if the patient has a recurrence of symptoms.

Why are NSAIDs such as ibuprofen avoided in the peri-infarct period?
Interferes with the antiplatelet aggregation effects of aspirin. 
Interferes with myocardial healing.
PS: Acetominophen does not affect the coagulation system and can be used.


-IkaN (Nakeya Dewaswala)