Treatment of Babesiosis

Short post for the day!

Barbecue city - BBQ City
Babesia, Quinine, Clindamycin

Step 2 CK: GBS prophylaxis mnemonic

Hi!

Drugs used for GBS prophylaxis mnemonic: PACE CV
Penicillin
Ampicillin
Cefazolin
Erythromycin
Clindamycin
Vancomycin

Indications of GBS prophylaxis:
- Previous infant with invasive GBS disease.
- GBS bacteriuria / positive culture during current pregnancy.
- Unknown GBS status with:
- Delivery at < 37 weeks
- Amnionic membrane rupture > 18 hours
- Intrapartum temperature > 100.4 (38.0)

That's all!
-IkaN

Most common sites of bone tumors mnemonic

I made these mnemonics on request by an awesomite, Yashwanth.

Here's the most common sites list he sent, mnemonics follow.

SAAG mnemonic

Hello!

SAAG is serum albumin ascites gradient.

SAAG is >1.1 in portal HTN, CHF, HVT and constrictive pericarditis.

The mnemonic for this is SAAG is High in conditions with an H.

portal Hypertension
congestive Heart failure
Hepatic vein thrombosis
Heart constriction (Constrictive pericarditis)

For completion, SAAG < 1.1 is seen in nephrotic syndrome, cancer and infections (except SBP)

That's all!
Have an amazing day!
-IkaN

Lofgrens syndrome mnemonic

What is Lofgrens syndrome?

The triad of Arthritis, Erythema Nodosum & Hilar adenopathy seen in sarcoidosis.

Why smoking is protective for endometrial cancer?

Smoking is a risk factor for quite a number of cancers. But it can be protective for certain diseases as well..like ulcerative colitis.

It is also protective for endometrial carcinoma and how?
1. It reduces estrogen level
2. Decreases weight
3. Associated with early menopause.

Remember that endometrial cancer is due to excess estrogen..and even being obese or having diabetes mellitus is a well known risk factor

Irrespective smoking is bad for health. Each cigarette reduces your life span by 11 minutes or so they say.

Live happy stay healthy

-sakkan

Types of abortion mnemonic

Hello!

I'll start off the post with a mnemonic and then go on explaining what these terms mean...

Prostaglandins mnemonic for obstetrics

Hey!
Thought this will help.

Dinosaurs are Extinct. Ex-two-inct.
Dinoprostone is PGE2.

Carboprost. Carbofrost.
Carboprost is PGF2 alpha.

MIsoprostol - M flipped is E and I looks like 1.
Misoprostol is PGE1.

That's all!
-IkaN

Step 2 CK: Overflow incontinence mnemonic

Greeting everyone!

In this post, I'll be sharing a mnemonic on overflow incontinence!

McCune Albright syndrome mnemonic

Hello everyone!

McCune–Albright syndrome is suspected when two of the three following features are present:

Endocrine hyperfunction such as precocious puberty
Polyostotic fibrous dysplasia
Unilateral Café-au-lait spots

Here's a mnemonic :)

Precocious puberty mnemonics

Hi! :)

Precocious puberty in females is secondary sexual characteristics, accelerated growth in females greater than 8 years of age.

Normal pubertal landmarks mnemonic:

Biophysical profile mnemonic and step 2 CK notes

Hello!

Here's a mnemonic for biophysical profile: BAT HAM
Breathing
Amniotic fluid volume
Tone
Heart rate Acceleration
Movements

Here's an overview of interpretations from the BPP score.

BPP 10/10
BPP 8/10 (Normal AFV)
No fetal indication for intervention.
Repeat weekly.

BPP 6/10 (Normal AFV)
Equivocal. Repeat test within 24 hours.

BPP 4/10 (Normal AFV)
Fetal lungs mature (>37 weeks), deliver.
Fetal lungs immature, betamethasone, repeat test within 24 hours.

General rule: If oligohydramnios, consider delivery.

BPP 8/10 (Decreased AFV)
BPP 6/10 (Decreased AFV)
Assess clinical scenario, consider delivery depending on gestational age, risk of fetal, maternal death, etc.

BPP 4/10 (Decreased AFV)
If >32 weeks, deliver.
If <32 weeks, observe.

BPP 2/10
BPP 0/10
Deliver regardless of gestational age.

That's all!
I wrote this down from a number of resources, including uptodate
-IkaN

Study group discussion: Rh incompatibility and ABO incompatibility

Here is some food for thought.

Think about which of the following scenario is worse:
1- Mom is O- and baby is O+ first pregnancy
2- Mom is O- and baby is O+ second pregnancy
3- Mom is O+ and baby is O+ second pregnancy
4- Mom is O+ and baby is A+ second pregnancy
5- Mom is O- and baby is A+ second pregnancy
6- Mom is O+ and baby is O- first pregnancy

Answer is 2
Rh incompatibility in second pregnancy. In presence of ABO incompatibility, Rh incompatibility, has lesser effect.

Detailed explanation:

The most common group O has anti A IgM, anti B IgM and anti AB IgG.
Group A has anti B IgM.
Group B has anti A IgM.
Group AB has no antibodies.

So if I was dumb enough to transfuse GroupyA blood to a group B guy there would be hemolysis. But what would be the mechanism for this?

The patient with group B would have anti A IgM. IgM is a very potent complement activator. IgM is very trigger itchy, it first shoots the cell and then asks questions. So this hemolysis is very fast.

Now coming to the Rh question, imagine there was a mom with O- group and baby with O+ group.

In first pregnancy, the mom is not exposed to the Rh antigen until delivery, so the 1st baby is safe. But there would be a mixture of baby and mom's blood.

Now imagine a weird person (Rh+ cell) walking through an airport, he would taken by the TSA (macrophage) for an "interrogation". So the macrophages do this interrogation (phagocytosis) in the dark corners of spleen and pick up info (antigens) about these weirdos. This info is passed to T cells and they issue warrants to B cells (IgG) for identifications of these guys and they are killed on site (IgG mediated destruction)

You can see that this will, obviously, take time time. When she gets pregnant with Rh incompatibile kid again, the IgG have been synthesized and they cross placenta and attack the baby RBC's. Voila - Hydrops fetalis.

Now imagine a mom who is O- and has a baby with A+ group. This time, at delivery, there is mixing of blood again!
But the mom has anti A IgM which is so fast like a ninja, kills of the majority of the cells before they go for their interrogation with macrophages in spleen... So ABO incompatibility actually protects against the Rh sensitization.

What's the clinical significance of Rh incompatibility?

Whenever you take care of a pregnant lady, you will confirm her blood group and if you suspect Rh incompatibility you would give her "Rh IgG" (standard dose) at 28 weeks, even though the fetal blood is not exposed to mom's immune system, this is done just in case - there might be a fall, injury etc and baby's blood may get into mom's circulation.

Why do you give Rh IgG when you want prevent the disease which is itself caused by IgG?

Rh IgG are heat treated and they cannot cross the placental barrier unlike normal IgG.

And finally, you give another dose of Rh IgG after delivery. But this time, you actually estimate the amount of fetal blood which is mixed with mom's blood by doing "Kleihauer betke test" and you give an appropriate dose.

Explained by DJ AweSpear.

Related posts:
Rh incompatibility
Hydrops fetalis
Blood group doubts
Removal of antigens from RBC's
Barts hemoglobin mnemonic