Study group discussion: Hemolytic disease of new born

What is immunogenic hemolytic disease of new born?

Answer: In immunogenic type, the immune system plays a role in the pathogenesis of the disease. Rh incompatibility is an example.

What are the causes of non-immunogenic erythroblastosis fetalis?

Answer: Examples of non immunogenic erythroblastosis fetalis are iron deficiency anemia, CMV infection in mother, etc.

Can congenital hemolytic anemia be a cause of non-immunogenic erythroblastosis fetalis?

Answer: Yes.
Though usually, hemolytic anemias don't present till later in life (Mostly because of HbF).
Exceptions would be severe alpha thalassemia in which all 4 alpha chain synthesis is deleted. 4 gamma chains combine, leading to the formation of HbH (Bart's hemoglobin!) They die in utero due to severe hypoxia and hydrops.

Study group discussion: Drugs used in the treatment of Alzheimers disease

Can anyone help me with pharmacological classification of anti Alzheimer's agents?

For Alzheimers, cholinesterase inhibitors.. And a drug called memantine.

NMDA receptor antagonists.

Drugs: Tacrine (tetrahydroaminoacridine), donepezil, rivastigmine and galantamine.
Mechanism: Inhibition of cholinesterase, with a resulting increase in cerebral levels of acetylcholine.

Antioxidants, selegiline, tocopherol (vitamin E), estrogen replacement in females, Ginkgo Biloba extracts are other drugs which may benefit in Alzheimers disease.

Study group discussion: Eponymous terms in hernia and mnemonics

Here's a list of eponymous hernia terms I was sent. I added a few mnemonics to where I could. Others you'll have to memorize!

Gibbon's hernia- Hernia with hydrocoele

Berger's hernia - Hernia in Pouch of Douglas
Mnemonic: Burgers are made of dough.

Grynfelt's hernia - Upper lumbar triangle hernia.

Petit's hernia - Lower lumbar triangle hernia

Cloquet's hernia- Hernia through pectineal fascia
Mnemonic: The hernia is cloaked, peccantly.

Narath's hernia - Behind femoral artery

Hesselbach's hernia - Lateral to femoral artery
Mnemonic: hesseLBAch - Lateral to big artery.

Serofini's hernia - Behind femoral vessels
Mnemonic: SeroFini - Supported by femoral vessels.

Laugier's hernia - Through lacunar ligament
L for Laugier's, L for Lacunar

Tealse's hernia - In front of femoral vessels

Richter's hernia - Part of circumference of bowel wall is gangrenous
Mnemonic: Richie rich has a large circumference pocket of money.
Alternatively, riChter Circumference.

Littre's hernia - Hernia with Meckels's Diverticulum
Mnemonic: Meckels is a congenital defect, found in Little babies.

Sliding hernia - Posterior wall of sac is formed by colon or bladder

Maydl's hernia - 'w' hernia
Mnemonic: M upside down is W.
Phantom hernia - Localised muscle buldge following muscular paralysis
Mnemonic: Phantom for Phantom, P for Paralysis

Spigelian hernia - Through spegelian fascia

Obturator hernia - Through obturator foramen

Femoral hernia - Hernia medial to femoral vein

Beclard's hernia - Femoral hernia through saphenous opening

Study group discussion: Biliverdin

Why biliverdin is reduced to bilirubin? It isn't toxic, it is water soluble.. Then why convert it to bilirubin?

According to some, biliverdin works just fine. Mammals have evolved the energetically expensive, potentially harmful and apparently unnecessary capacity to reduce biliverdin.

According to others, the conversion is not a wasteful process. Bilirubin is a cytoprotectant and that's why biliverdin is converted into bilirubin. It's also a physiological anti oxidant!

Source: http://m.pnas.org/content/99/25/16093.full

About me!

Hello there awesomites! Feels great to write this for Medicowesome :-)

Where to start? Well, I am a total  astrophysics geek. Anything -spacetime,dark energy, black holes, wormholes catches my fancy.That type of guy who loves staring at the starry sky. Just finds amazing how the tiny word 'universe' encompasses the massive expanse lying out there. Loves going to the point where physics meets philosophy.

Likes looking into nothing, thinking and imagining.

House MD fan. Sherlocked.
Christopher Nolan worshipper. Interstellar fanatic.

I have a thing for rare, fancy medical syndromes! Dreams include running a diagnostics department like House. :-p

Talking of music,a Linkin Park fan, like the regular Bollywood music too.

Proud of India and its rich heritage.

Hobbies include driving cars, riding bikes and even bicycling. Gaming included.

Finally, an animal lover,dreamer and a bit of foodie..

-Sushrut



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Heme synthesis mnemonic

Hey everyone! Long time no see!

Today we'll be learning about heme synthesis.

The biosynthesis of heme mnemonic 

Study group discussion: Temporal arteritis

A 60 year old male presents with headache, scalp tenderness, painful temples, pain on chewing & visual disturbances.. Diagnosis?

Answer: Temporal arteritis

What tests you would do to confirm the diagnosis?

Answer: Raised ESR, temporal artery biopsy

Treatment?

Answer: High dose steroids like prednisolone!

Temporal artery branch of?

Answer: ECA, the external carotid artery!

Study group discussion: Causes of edema

Today, we'll be talking about causes of edema.

Causes of Edema can be inflammatory and noninflammatory!

Noninflammatory causes:
1) Increased hydrostatic pressure
2) Hypoproteinaema
3) Lymphatic obstruction
4) Sodium retention

Inflammatory causes:
1) Acute inflammation
2) Chronic inflammation
3) Angiogenesis

Here is a mnemonic shared by an awesomite: HILARI IS SAVE (Hilary)
Heart failure
Iatrogenic
Liver causes
Aldosterone increased/ ADH increased
Renal cause
Inadequate protein in blood (hypoalbuminaemia)

Causes for the inadequate protein in blood are:
Intake Inadequate (Kwashiorkor)
Secretion fro pancreas decreased (pancreatitis)
Synthesis decreased (liver failure)
Absorption decreased (Crohn's disease)
Vomit (pyloric stenosis)
Excretion increased (nephrotic)

I remember this in Conrad Fischer's tone, "Cirrhotic, Nephrotic and CHF. Cirrhotic, Nephrotic and CHF!" though.

That's all!

-IkaN

Study group discussion: Drugs contraindicated in myasthenia gravis

Hey everyone!

Today's topic is about drugs that are contraindicated in myasthenia.

Can you guess them all?

Drug a. Myasthenic woman with eclampsia develops ptosis

Drug b. Patient with hepatitis C develops respiratory depression

Drug c. Filmstar drug

Drug d. Wilson's disease

Answers:
a. MgSO4
b. Interferon
c. Botox
d. Penicillamine

Random fact:
The actor, Amitabh Bachchan has interferon induced myasthenia gravis which was used to cure his hepatitis C infection. And because of that he can't use botox.. Hence, his skin looks so wrinkled compared to other film stars of his age. Hence, two important drugs causing myasthenia and who worsen it are interferon and botox.

More information on study group

Here is some more information, since people have been asking!

How do I join?

Click here!

Can I view the group discussions without being on the group?

Yes! View the Study group index. All topics discussed may or may not be posted on the blog, do to time limitation, of course.

Study group discussion: Evening rise of temperature in tuberculosis and malaria

Why is there an evening rise of body temperature in tuberculosis?

Answer: Because endogenous corticosteroid have their levels low in the evening. Cortisol bursts are least frequent in the evening. And steroids are anti-inflammatory!

Why not in all infections? What's special about tuberculosis?
We don't know the answer to this question. If you do, please tell us!

This answer was submitted to us by an awesomite: Increased Cortisol Cortisone Ratio in Acute Pulmonary Tuberculosis: Recent research works regarding TB has revealed that there is increased cortisol level in TB.
Cortisol & IL-1 interaction: At high level cortisol has negative feedback effect on IL-1.
Conclusion: In TB, cytokines, specifically, IL-1 level is markedly increase that leads to fever, but as cortisol level is also high than normal it counteract the action of IL-1 & as a result fever remains low grade.
Due to exaggerated diurnal variation,cortisol effect is very high in late night while very less in evening onwards that leads to evening rise of temperature & night sweating. Normal diurnal variation of body temperature also play a role to make this change more prominent.
Source: http://www.doctorshangout.com/m/blogpost?id=2002836%3ABlogPost%3A423964

Even malarial paroxysms occur in the evening, don't they?

Answer: Yep. Malarial paroxysms have a different reasons. Steroids ain't responsible.

What's the reason for malarial paroxysms then?

Answer: It depends when the entire cycle of trophozoites burst from RBC's.

Here's from one of the members personal experience:
I have had malaria.. I had paroxysms at late night.

Study group discussion: Smoking and hernia

I have a doubt .. Today in surgery ward, my professor asked me how does smoking directly cause hernia! :/

I know the indirect cause! Coughing!

By weakening collagen?

Does smoking affect collagen synthesis or metabolism? At which step does smoking affect collagen?

It causes less production!
The synthesis of subcutaneous collagen in smokers is specifically impeded, indicating an impaired wound-healing process. Because mature collagen is the main determinator of strength of an operative wound, the results support the view that patients should be advised to stop smoking before an operation.
Source: http://www.ncbi.nlm.nih.gov/pubmed/9551072

In conclusion, smoking is an important risk factor for recurrence of groin hernia, presumably due to an abnormal connective tissue metabolism in smokers.
Source: http://www.ncbi.nlm.nih.gov/pubmed/11910469

Oh....ok. Thanks!

Autonomic system drugs mnemonic

Please give some tips on remembering cholinergic and adrenergic drugs.

- ine are beta agonists
(Terbutaline, ritrodine)

Drugs ending in

-sin are alpha antagonists 

(Prazosin, terazosin)

- olol are beta blockers

(Propanolol, metoprolol)

- alol are alpha + beta blockers (Labetalol)

- stigmine are cholinergic drugs
(Neostigmine, physiostigmine)